CosmeticSurgery.com Staff Report
CONSUMER BRIEF: Unfortunate as it may be, two seemingly unrelated words, "male breasts" usually cause either guffaws or blushing. Cases of gynecomastia -- abnormally large breasts on males -- have increased in both England and the United States. Researchers have found that some products mimic female hormones while English researchers note more estrogen is found in their drinking water.
When three otherwise healthy boys aged four, seven and 10 showed unusual growth in their breasts, Clifford Block, M.D., suspected that some female hormones, somewhere, had come into the lads' environments. Dr. Bloch is a pediatric endocrinologist at the University of Colorado at Denver and Health Science Center's School of Medicine.
Experts say it's very unusual for boys under the age of puberty to grow large breasts. But after puberty, the situation is just the opposite: anywhere from 30 to 60 percent of teen boys develop enlarged breasts, some of which go away on their own.
Male Breast Reduction
The case attracted a lot of attention because the rate of male breast reduction procedures has encountered an uptick in both America and the United Kingdom. In the United States., male breast reduction, with 23,670 cases performed, ranked was among the top five surgical procedures for males in 2006, according to the American Society of Aesthetic Plastic Surgery (ASAPS.) Even more startling, the ASAPS reported plastic surgery to correct gynecomastia had increased 112 percent between 1997 and 2005.
The University of Colorado researchers already knew that some over-the-counter soaps, shampoos and lotions containing tea tree oil and lavender had feminizing effects on males. The affect was stronger on young boys because their bodies had very little of the male hormone testosterone to counteract the female hormones. But when the youngsters stopped using the tea tree oil and lavender products, their enlarged breasts returned to normal within a few months.
Large Male Breasts
Then, the Denver researchers took an additional step: they sent samples of both oils to the National Institute of Environmental Health Sciences (NIEHS) in Washington, D.C. for testing.
"Using the lab, we found both oils act like estrogens and inhibit the affects of androgen, another important male hormone," Derek Henley, Ph.D. lead author of the research and a postdoctoral fellow at the NIEHS told CosmeticSurgery.com "There is definitely an association between exposure to lavender or tea tree oil and gynecomastia.
"We're hoping this information may help steer physicians who are facing puzzling cases of gynecomastia in a direction they would not have otherwise considered."
A then 14-year-old patient is pictured on the left before his gynecomastia was corrected through surgery.
(Photo, courtesy of Elliott Jacobs, M.D.)
But it's not only tree oil and lavender that can cause gynecomastia. Inadvertent exposure to estrogen in everyday surroundings can also cause the problem for adults. For instance, one case of enlarged male breasts was traced to a sexual partner who was using a vaginal estrogen cream.
Writing in a 2000 issue of the professional journal Pediatrics, Doctors E.I. Felner and P.C. White in Dallas, Texas, reported three cases of boys who developed unusually large breasts. Following the children for a year, Drs. Felner and White found the lads' blood tests showed elevated levels of the female hormone estrodial. Naturally secreted by the ovaries, estrodial is the most potent of the naturally occurring estrogens. Some detective work found that each boy's mother was using a custom compound estrogen cream on her skin. Again, when the mothers stopped using the cream, the boys' gynecomastia decreased and their blood tests returned to normal after about four months.
Concluded the doctors: "We recommend that women requiring estrogen use an alternate form of estrogen delivery if they are in frequent close contact with children."
Researchers also note the effects of excess estrogen would be equally -- if not more -- active for pre-teen girls who would likely develop precocious breasts and show other signs of early puberty.
Male Breast Reduction
In England, where waste water is thoroughly filtered and cleansed and considered safe to drink, researchers have found that a morning cup of tea or coffee might be swimming with female hormones.
The first clue was a United Kingdom Environmental Agency survey in 2003 reporting that about one third of male fish in rivers and lakes had developed female characteristics.
"Several years ago, I was handling one case of male breast reduction a month," says Alan Kingdon, M.D. a cosmetic surgeon and medical director of the Cosmetic Surgery Clinic in London. "Currently, I'm doing one a week."
The British Association of Aesthetic Plastic Surgeons surveyed their members in 2003 and found its members performed 22 male breast reductions. But in 2004, the same surgeons reported 53 cases.
"The increased incident of gynecomastia in England is a personal impression although it does seem to be supported by other practitioners," Dr. Kingdon says. "I'm sure excess estrogen in the food and water cycle must be a factor."
In the United States, the federal Geological Survey found an alarming amount of antibiotics and other drugs in the nation's waterways in 2001 and 2002. The U.S. Environmental Protection Agency (E.P.A.) has no standards for testing waste or recycled water for antibiotics. Moreover, the E.P.A. has several studies that implicate estrogen hormones for the decrease of sperm counts among Western men and reproductive disorders in wildlife.
To add a little more impact to his claim, Dr. Kingdon collected samples of gynecomastia tissue taken from his patients' chests after operations and discovered thicker mammary gland tissue -- which is different than fat -- that is normally found only in women.
According to psychotherapist Merle Yost who operates the website www.gynecomastia.org, older males can develop gynecomastia when their hormones become imbalanced due to natural aging or as a side effect to some medications. Yost is also the author of "Demystifying Gynecomastia: Men with Breasts" one of the first books on the subject. Researchers have so far fingered steroids, marijuana, some heart medications, hair regrowth medications, chemotherapy drugs, antidepressants as well as treatments for ulcers and and epilepsy as causes of unintentional gynecomastia.
Whatever the cause, at least one surgeon who specializes in gynecomastia surgery, urges parents and other caretakers to allow teen boys to have the breast reduction surgery.
Elliott Jacobs, M.D. a board-certified, plastic surgeon in New York City is also the author of Mantalk, a book about plastic surgery procedures for teens and men. Additionally, Dr. Jacobs is one of two accredited gynecomastia experts living in the United States.
"Gynecomastia has a profound effect on the psychological and social development of a boy," says Dr. Jacobs. "Usually, the young man suffers embarrassment, ridicule and sarcastic remarks to the point of becoming reclusive, forgoing sports and never going shirtless."
Often, pediatricians and other physicians tell the lad to just wait and the breasts will disappear on their own.
"But the teens are precious years," says Dr. Jacobs. "Normally, ego strength and self confidence are being developed."
While traditional teaching has been to put off male breast reduction surgery because the condition might return, Dr. Jacobs says appropriate treatment can literally "lift a weight off a boy's chest."
Dr. Jacobs' considerations for surgery are stability, that the breasts are no longer growing, and the general health and maturity of the young patient. The actual surgery requires about an hour to an hour and one-half, performed under "twilight sleep" anesthesia, administered by a board certified anesthesiologist.
"Most boys can return to an active sports life within four weeks," says Dr. Jacobs. "So far, I have operated on somewhere around 55 adolescents and not one boy has had a recurrence of his gynecomastia."