Breast development in men not uncommon

DEAR DR. ROACH: I am a reasonably healthy 62-year-old male. During a recent checkup, my doctor observed that I have "abnormal breast development" and suggested that I see an endocrinologist. Besides being embarrassed to take my shirt off in public, are there other reasons I should be concerned about this? What treatment would an endocrinologist be likely to recommend? — Anon.

ANSWER: The appearance of breast tissue in men (gynecomastia) is common, and can have several causes. In adolescents, some transient gynecomastia is normal and usually resolves by itself. In middle-age and older men, medications (such as spironolactone, a common diuretic), liver disease and abnormal hormone levels (both sex hormones and thyroid) are the most common causes, but much of the time, no cause can be found. Since gynecomastia in rare circumstances can be a symptom of a serious disease, and endocrinologists are commonly expert in this evaluation, I would agree that you should get evaluated.

It is important to be sure you do not have male breast cancer, and a mammogram may be necessary. A careful exam, blood hormone levels and sometimes a testicular ultrasound to look for hormone-producing tumors are part of the evaluation. Treatment is of any underlying cause that may be found. If no cause is found, many men prefer surgery or liposuction to remove the breast tissue.

DEAR DR. ROACH: I have arthritis in both knees, injuries from the past. My knees hurt when going up and down stairs, not level ground. How do I go about finding a good orthopedic doctor to check out my knees? There are so many doctors who do knee surgery. — D.M.P.

ANSWER: Well, I must admit to some bias here as an internist. I would recommend starting with a rheumatologist, an expert in medical treatment of joint problems, or an internist, rather than going first to a surgeon. While orthopedic surgeons certainly have expertise in all kinds of treatment (both medical and surgical), I reserve the expertise of the orthopedic surgeons for the people with knee pain who, after a medical evaluation, I think might benefit from surgery.

Knee pain is such a common problem that any rheumatologist will be an expert in diagnosing your condition. There are many kinds of arthritis, each with different treatments and prognoses. It's a good rule of thumb not to see a surgeon unless you think you need surgery, and you don't know enough yet to make that decision.

DR. ROACH WRITES: In February, I answered a question from a woman who wanted to help her husband cut down on alcohol use. I recommended against ever drinking more than five drinks a day. Five per day (four for women) is the usual definition of binge drinking, and linked with high risk for serious medical and social problems.

In no way did I mean to suggest that this is a healthy amount of drinking. While some studies have shown a reduced risk of heart disease among moderate (one to two drinks per day for men, one-half to one for women) drinkers, this is not proof that drinking is good for you. And for people with a history of problems drinking, any alcohol probably is too much.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475. (c) 2014 North America Synd., Inc. All Rights Reserved