The Role of Cannabis in Recurrent Adolescent Gynecomastia.

Ashamalla M.; McDermid K.; Arneja J. · The Journal of craniofacial surgery · 2026

**Background & Methods** This is a case series review examining the association between cannabis use and recurrent gynecomastia in adolescent males. Three adolescent patients who underwent initial surgical excision for gynecomastia, subsequently used cannabis postoperatively, and developed recurrent glandular breast tissue requiring secondary surgery are presented and analyzed. **Key Findings** - All three patients presented with gynecomastia recurrence following initial surgical excision despite having normal baseline endocrine evaluations and stable or decreased body weight, suggesting factors beyond typical metabolic causes. - Recurrence occurred in patients with varied presentations including differences in body mass index, disease severity, and laterality, yet all shared a common history of postoperative cannabis use. - Secondary surgical management was successful in all cases with no further recurrence documented at 1-year follow-up after patients discontinued cannabis use, suggesting a potential temporal relationship between cannabis cessation and disease stabilization. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study represents a low level of evidence with significant limitations. The case series format (Level 4 evidence) lacks control groups, randomization, and cannot establish causality between cannabis use and gynecomastia recurrence. The small sample size (n=3) limits generalizability and statistical power. The authors acknowledge these constraints and explicitly state that "causality cannot be established." Confounding variables are not adequately controlled, and the mechanism by which cannabis might promote glandular proliferation remains speculative. The temporal association between cannabis use and recurrence is suggestive but insufficient to prove a causal relationship. The authors appropriately call for prospective, controlled studies to better characterize any potential mechanism linking cannabinoid exposure to endocrine disruption and male breast tissue proliferation. Clinical counseling recommendations are reasonable given the temporal pattern observed, but they should be considered preliminary pending higher-quality evidence.

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