The Relationship Between Psychopathology, Self-Esteem, Body Perception and Serum Sex Steroids in Pubertal Gynecomastia
Semiha Comertoglu Arslan 1*, Ibrahim Selcuk Esin 2, Atilla Cayır 3, Zerrin Orbak 4, Onur Burak Dursun 5
1Department of Child and Adolescent Psychiatry, Kahramanmaras Sutcu Imam University, Medical Faculty , 2Department of Child and Adolescent Psychiatry, Ataturk University, Medical Faculty, 3Department of Child Endocrinology, Erzurum Training and Research Hospital , 4Department of Child Endocrinology, Ataturk University, Medical Faculty , 5Department of Child and Adolescent Psychiatry, Trabzon Kanuni Training and Research Hospital
Received: July 7, 2020; Revised: November 16, 2020; Accepted: December 15, 2020; Published online: December 15, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: The current study aimed to investigate the psychopathology behind gynecomastia and potential associated problems regarding self-esteem and body perception, and the relationships of these variables with sex steroid levels in adolescents with pubertal gynecomastia.
Methods: The study included 50 normal weight male adolescents aged between 11 and 18 years with gynecomastia but without any chronic organic pathology, and 50 healthy pubertal male adolescents matched for age. The adolescents underwent psychopathology assessment by Development and Well-Being Assessment interviews; self-esteem was assessed using the Rosenberg Self-Esteem Scale; body perception was evaluated using the Body Image Scale, and the relationship between these variables and sex steroid levels were explored.
Results: The results of the study revealed that the gynecomastia group had significantly greater internalization disorder (X2=12.96, p<0.001), and impairments in self-esteem (z=-1,975, p=0.024) and body perception (z=-2,286, p=0.022), and these variables were correlated with the gynecomastia stage. In the study group, cortisol levels were significantly higher (z=-2,330, p=0.02) in adolescents with internalization disorder compared to those without, and cortisol levels increased in parallel with increased gynecomastia duration (r=.386, p=0.006). No relationship was observed between self-esteem and body perception scores and levels of serum sex steroids.
Conclusion: In our study, we found that gynecomastia, depending on its stage, may lead to internalization disorder and impair self-esteem and body perception. It was found that there was no direct relationship between these parameters and sex steroids in pubertal gynecomastia, except for high cortisol levels in adolescents with internalization disorder.
Keywords: Gynecomastia, Psychopathology, Self-esteem, Body image, Sex steroids

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