We find that, for most men we work with—whether we talk online, by phone or in person in our offices in Manhattan—the gynecomastia-steroid connection is well understood.  But there are other drugs, prescription medications, which are also linked to the development of man boobs. Propecia, a drug marketed to help stop and even reverse male pattern baldness, is one of those.

Propecia, also known by the generic name finasteride, has been demonstrated to be effective in increasing hair count for men suffering early hair loss.  Speaking very generally, treatment is most effective in younger men who have not yet experienced advanced balding.

Unfortunately, Propecia has also been shown to trigger gynecomastia in a small percentage of patients.  There are no formal studies yet, but there’s enough anecdotal evidence to suggest a link between Propecia and breast tissue growth for some men.  Equally distressing, there’s no way to predict who might suffer this unwanted side effect.

In working with our Manhattan gynecomastia patients and by studying the available literature, we’ve noted the following apparent patterns that impact surgical decision-making:

1. Men who developed gynecomastia early in life, then took Propecia with no apparent additional breast tissue growth, are usually good candidates for male breast reduction surgery. For this group of patients, we’ve observed no breast tissue regrowth after gynecomastia surgery even when the patient continued to take Propecia.
2. Men who developed gynecomastia after taking the medication can also be candidates for surgery.  In these cases, we recommend the patient discontinue the use of the drug to prevent reoccurrence.

If you’re taking Propecia and you have not noticed this particular side effect, don’t be overly concerned.  At this point it appears that the percentage of men who develop man boobs while taking the medication is small.  On the other hand, if you’ve noticed your breasts swelling, a visit to your primary care physician is probably in order and you may need to make a decision about continuing to take Propecia.

We’ve noted that once unwanted breast tissue develops in Propecia patients, it rarely disappears by itself.  If you would like to consult us about this or any other gynecomastia-related topic, call our offices at 212-570-6080 or fill out our short contact form.

Photo by e-Magine Art, available under a Creative Commons attribution license.

The answer to this question from our perspective is, “It’s not yet clear.”  There is some evidence that lavender and tea tree oil may contribute to gynecomastia, particularly in young males, but the proof is far from conclusive.  Here’s the story.

It all started early in 2007 when the New England Journal of Medicine published a study by a University of Colorado pediatric endocrinologist.  The physician found enlarged breasts in three of his male prepubescent patients and discovered that each had used personal products like lotion containing lavender, tea tree oil or a combination.  In addition, after the boys discontinued the use of such products, the gynecomastia disappeared.

A researcher at the National Institute of Environmental Health Services, or NIEHS, then tested the essential oils.  He found that the substances mimic the action of estrogen, which stimulates breast tissue growth, and/or inhibit androgen, which governs male attributes and limits breast development.  The NIEHS researcher said that the combination of effects made the essential oils “somewhat unique as endocrine disruptors” (see http://www.nih.gov/news/pr/jan2007/niehs-31.htm).

All this may sound convincing, and if you’re concerned about enlarged male breasts in adolescents it is something to consider—to a point.  There are several factors to weigh when deciding how worried to be about lavender and tea tree oils.  First is the small size of the study—just three boys.  Much larger groups would have to be studied, including control groups, for the findings to be notable.

Also, the boys used different personal care products, most not identified in the study, containing unknown concentrations of these essential oils.  In addition, there are many other endocrine disruptors the boys may have also been exposed to, such as ingredients found in pesticides.

Scientists have spoken up since 2007 to point out the shortcomings of the lavender and tea tree oil study.  And even while stating that the case histories of the boys and the tests on the oils showed “an association” between the substances and gynecomastia, the NIEHS itself said the strength of the association remained unknown and called for further research.

To our knowledge no further studies have yet been published.   So here we stay for the time being: there may be a link between the use of lavender and tea tree oil and gynecomastia in boys.  When our New York gynecomastia patients ask what they should do, we point out that when it comes to shampoos and lotions, there are plenty of choices these days.  The best answer we can give now is “better safe than sorry.”

Photo by Audrey, available under a Creative Commons attribution license.

Matthew McConaughey

You read it here first!

Back in June, 2009, your humble blogger reported that British surgeons had crunched the plastic surgery statistics for 2008 to reveal that gynecomastia surgery had increased 44 percent over the previous year.

Well, the beat goes on with male breast reductions in the U.K. surgeries up again.

If you haven’t already read the news, here’s how USA Today presented the growing gynecomastia surgery statistics over there.

For 2009, male breast reduction surgery in the British Isles increased 80 percent, from 328 surgeries in 2008 to 581 in 2009, reports the British Association of Aesthetic Plastic Surgeons (BAAPS. )

The BAAPS represents one in three cosmetic surgeons in the U.K., so the actual number can be closer to 1000.

But only five years ago, British surgeons counted just 22 gynecomastia surgeries.

It’s unusual because a worldwide slowdown seemed to have shrunk the number of almost all invasive plastic surgery procedures.

Moreover, all male U.K. surgeries are up 21 percent from last year. Included are:

• Nose jobs
• Ear pinning  (otoplasty)
• Liposuction
• Eyelid lifts

Some British surgeons reckon that the media is partly responsible by featuring more pictures of very flat-chested celebrities like Matthew McConaughey. And, like their female counterparts, more British men are learning they can do something about their “man boobs.”

(Check out what some American teens, bodybuilders and other dissatisfied guys have done about their own female-like chests in these before and after male breast reduction pictures.)

Some plastic surgeons have suggested that an increase in female hormones in the drinking water may be causing more cases. (Read our previous post about female hormones in the water causing more British gynecomastia surgery.)

In contrast, according to American Society for Aesthetic Plastic Surgery (ASAPS), gynecomastia surgery in the United States actually declined (Surprise! Due to the economy!)  5.7 percent from 2007 to 2008. While 2007 saw 20,280 gynecomastia surgery procedures on U.S. shores, only 19,124 were counted in 2008.

Crunching the same data, the American Society of Plastic Surgeons (ASPS) figures male breast reduction declined from 2007 to 2008 by 16 percent. (From 21,311 procedures down to 20,351 operations.)

According to one men’s health site, the cost of gynecomastia surgery in London appears to be around 4000 British pounds (US$6485) and takes about 90 minutes.

Compression vest

While talking with patients during a first consultation, some often remark they have read about creams, pills, lotions and other elixirs that purport to remove or reduce large male breasts or “man boobs.”

A few have actually tried some and found only their size of their wallet is reduced.

It’s a fact of life that faulty information abounds all over the Internet.

But my eyes really widened when I read an off-the-wall Ezine article about why men with fleshy, female-like breast should eschew gynecomastia surgery in favor of wearing a compression vest – full  time!

A compression garment, an extremely tight fitting vest, is usually employed to promote healing after gynecomastia surgery. The vest can also be used to provide a better shape for a patient before surgery – but only while trying to lose weight in preparation for surgery.

(Read our last post about the proper use of compression garments after gynecomastia surgery.)

At first glance, I thought I was reading satire. But after a closer read, I found the purpose of the article was a link to a website that sells compression garments.

The author, who passes himself off as an “expert” revealed his shocking lack of knowledge while writing about gynecomastia surgery. He observes that patients must be “euthanized for the surgery.”

He’s is probably struggling to serve up the word “anesthetized.”

But if he does not actually know the difference between euthanasia and anesthesia — which is the difference of life and death, after all — he shouldn’t be writing about any medical procedures.

The author goes on presenting bad information and then really goes over the top, trying a hard sell to sway gynecomastia sufferers into giving up any thoughts of surgery in favor of wearing a compression garment all the time.

Nor does he allow logic to stand in the way!

He actually suggests wearing a vest poolside, and I quote: “With the vest, it is possible to do such things as sun bathing, playing basketball, and swimming in public.”

Man boobs getting in the way of your love life? No problem, assures our glib author: just wear a “gynecomastia vest” in the sack and your performance anxiety will disappear as will any problems you may have at work.

Besides the ton of illogical information and bad medical facts, he is probably embarrassing the eight pay-per-click plastic surgeons whose ads appear right next to this laughable article.

Here is the article if you want to read the “Gynecomastia Vest” article for yourself.

One of the things I like about the media is when news writers and broadcasters reach past me and bring interesting — indeed, often heart wrenching — anecdotes and details about how gynecomastia affects the lives of both teens and adults.

One of my all time favorites is a letter written by a troubled mother who tells of watching the anguish, shame and embarrassment her teen son goes through because of an increasingly female-like chest that started when the lad was only 10. But it ends well.

Read her story of teen gynecomastia at a leading website.

When Newsweek Health stopped in for an interview, they briefly outlined the story of an associate, Merle Yost, a psychologist who founded and operates the excellent gynecomastia.org website.

In this segment, Merle tells how he suffered the slings and arrows of a chest with womanly breasts until he was 37.  For instance, in junior high school, he was nick-named “Tits.” (Read more about Merle and his two gynecomastia operations.)

And then the ABC affiliate in New York City told about how more about teen boys and their parents are requesting male breast reduction surgery these days because the condition is so much more difficult for youngsters to handle.

The topic apparently struck a nerve because the online version drew no less than 63 reader comments.

One response was from a man, 38, who did not know a treatment for his so-called “man boobs” existed. But he played golf one day with a plastic surgeon, mentioned his embarrassing chest and then had gynecomastia plastic surgery several days later.

Afterwards, the lab found cancer in the breast tissue taken in the operation. He then had treatment for the cancer and now has a flat, more masculine chest and is cancer-free.

(Read our previous post about gynecomastia and cancer.)

Perhaps because teen boys and men are about 40 percent of my practice, The Plastic Surgery Channel filmed a segment about teen gynecomastia and how a boy and his parents may opt for surgery.