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Sept. 19, 2007 -- 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.
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.? But "gynecomastia occurs even in normal-weight kids," he says.
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 says.
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.