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Estrogen and testosterone do not rise in perfect balance, so many boys develop gynecomastia around ages 13 to 14

A period of 3 years was chosen a priori based on previous literature as well as the anticipated sample size and follow-up duration [23, 24]

Results from a 2018 cross-sectional survey in Tokyo, Osaka and Sendai to assess tobacco and nicotine product usage after the introduction of heated tobacco products (HTPs) in Japan