Male Breast Enlargement May Be Common

Gynecomastia, the enlargement of breast tissue in men, can
be an embarrassing condition, but it is surprisingly common and usually
benign.

Overall, nearly half of men may experience the condition at some time in
their lives, says Glenn D. Braunstein, MD, chairman of the department of
medicine at Cedars-Sinai Medical Center in Los Angeles and the author of an
article on the topic in the Sept. 20 issue of The New England Journal of
Medicine.

Later in life, in middle age and older adulthood, the condition can also
appear or reappear, says Braunstein, who wrote the article to inform doctors
about how to diagnose and treat the condition.

During puberty, the condition is even more common, he tells WebMD. "Up
to two-thirds of boys will develop gynecomastia during puberty," he says,
although some cases will be so mild they go unnoticed.

The good news: Gynecomastia during puberty generally disappears on its own.
Later in life, the problem can often be traced to medications or treatments for
prostate cancer. Treatment options, including medication and surgery, are very
effective.

What Causes Gynecomastia?

Underlying the condition is an imbalance of estrogen and testosterone. When
estrogen levels get too high, the breasts can begin to grow. Some breast tissue
is more sensitive to estrogen than others, Braunstein tells WebMD.

As the body mass index, a measure of height to weight, increases, so does
the chance of gynecomastia, he says. So the heavier the teen or man, the more
likely he may get the condition.B But "gynecomastia occurs even in
normal-weight kids," he says.

Gynecomastia in Puberty

When gynecomastia occurs during puberty, it usually appears at about age 13
or 14, Braunstein says.

And if the enlarged breasts are noticeable, already self-conscious preteens
can become embarrassed. "The kids are often socially conscious," he
says. "They don't want to take their shirts off. They fear they are
becoming like girls."

Depending on how enlarged the breasts are, there can also be tenderness.
"[The breasts] can hurt when they are physically active," Braunstein
says.

A pediatrician should do a thorough physical exam, Braunstein tells WebMD,
making sure there are no tumors, thyroid problems, or other medical conditions
that might explain the breast growth.

Recently, doctors have found that use of products containing
lavender oil or tea tree oil may trigger breast growth in preteen boys ,
says Braunstein, citing a study published earlier in 2007. The boys who
developed the breast growth had been using a lavender oil skin balm, a hair gel
with lavender and tea tree oils, or lavender-scented soap and skin lotions.
When they stopped using the products, their breasts returned to normal within a
few months.

After ruling out other conditions, a pediatrician typically suggests waiting
to see if the gynecomastia disappears, Braunstein says, typically telling the
patient to return in three months.

"About 95% of the time, this [condition during puberty] will disappear
within three to six months," he says.

Another expert, Yong Bao, MD, assistant professor of pediatric endocrinology
at the University of Miami Leonard M. Miller School of Medicine, agrees that
"tincture of time" often works. The smaller the growth, the more likely
it will go away, Bao says. "After the peak of puberty, it usually goes
away," he says.

"Most teens do not need any therapy," Braunstein says. But if the
breasts are very tender and the patient is bothered by a large degree of
growth, doctors may suggest taking tamoxifen, used in breast cancer treatment,
Braunstein says. It works by interfering with the activity of estrogen on the
breast cells, thus stopping the growth. While tamoxifen is not officially
approved for this purpose, it's used "off-label," which is legal. A
course of three months of the drug is typical, he sas.

About 60% of teens and adults who take tamoxifen have complete regression of
the growth, Braunstein says, citing published studies, and about 80% have at
least partial regression.

If tamoxifen does not work, male breast reduction or liposuction can be
done.

Gynecomastia Later in Life

In older men, an imbalance of hormones is also at the root of gynecomastia,
Braunstein says. "In older men, testosterone is down, estrogen is up. There
is often an increase in body fat [which makes the condition more
likely]."

A doctor should rule out tumors, breast cancer, and other problems, just as
in preteens and teens, he says. Certain drugs used for the treatment of
prostate cancer, as well as other medications, can lead to excess breast growth
in men.

If possible, doctors should switch the medication associated with the breast
growth, Braunstein says.

Other options are tamoxifen or surgery such as breast reduction or
liposuction to remove the excess tissue.

Treatment May Not Be Needed

"Gynecomastia is a very common problem," Braunstein says. "It's
been around a long time." If the teen or man isn't bothered by the problem?
There's no reason to treat it, he says, if other problems have been ruled
out.

Even if a teen is bothered by the condition, immediate treatment isn't
warranted, Bao says. "We always recommend to wait."

Braunstein reports getting consultation fees from companies including Abbott
Diagnostics, Esoterix, M&P Pharma, and Novartis -- and research funds from
Procter & Gamble and BioSante.

By Kathleen Doheny
Reviewed by Louise Chang
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