My painful moobs are anything but a joke

Every week Dr Martin Scurr, a top GP, answers your questions

A YEAR ago my left breast became enlarged — I am a 22-year-old man. Hospital scans didn’t find anything and I was told that it was hormones and it would normalise with time. My worry is that sometimes the breast is painful, and it hasn’t changed since last year. Do you know of any medication I should take? Name and address withheld.

You have gynaecomastia, the name given to a benign increase in men’s breast tissue. It’s important to check that any enlargement is not due to breast cancer, but the good news is that your scans came back clear.

Gynaecomastia typically affects three groups of patients — newborn babies, teenagers, and men aged 50 and over.

In babies it occurs as a result of the female sex hormone oestrogen passing from the mother while the baby is still in the womb. It disappears within weeks after the baby is born.

In older men, it’s linked to a drop in testosterone and a tendency to have more body fat, which produces oestrogen; these changes affect the ratio of male to female hormones, with oestrogen becoming more dominant than usual, causing breast tissue to grow.

When gynaecomastia occurs in teenagers and young men, around a quarter of cases will be due to the effects of puberty persisting into adulthood — as with older men, it’s an imbalance of the ratio of female to male hormones that’s the problem.

HOWEVER, unlike with older men, younger men also experience tenderness and pain, as you have. People may joke about ‘moobs’ — male boobs — but this can be distressing and you have my sympathy.

In around 10 to 25 per cent of cases of gynaecomastia in young men, prescription medication is to blame. Certain drugs, such as spironolactone, used to treat high blood pressure, and cimetidine, used to treat stomach ulcers, can trigger the growth of breast tissue (essentially because of the medication’s effect on hormonal balance).

I recently saw a man of your age, an obsessive bodybuilder, who’d developed gynaecomastia after illicitly self-administering injections of an anabolic steroid, which is identical to testosterone — and which has the paradoxical effect of increasing breast tissue.

A small proportion of cases in young men are caused by conditions such as malnutrition, testicu- lar tumours, an overactive thyroid gland and hypogonadism (underproduction of male hormones by the testes).

Your doctor will have considered these and dismissed them, even if he didn’t discuss the details closely in your consultation.

In another 25 per cent of cases in young men, there is no identifiable cause.

The standard approach is to watch and wait, as usually the condition resolves itself. But if the problem persists for more than a year, it can be a sign that the tissue has become more fibrous; essentially there is a build-up of collagen — the protein that helps give skin its structure — causing a hard, knotted swelling.

Surgery — which would be a minor operation — is probably the best option here.

There are drug treatments that can be prescribed for severe breast enlargement causing pain, and embarrassment — the drugs, known as selective oestrogen receptor modulators, include tamoxifen, best known as a breast cancer treatment in women.

They work by blocking the effect of oestrogen on breast tissue.

However, my view is that this is an exceptional treatment and I would suggest instead that you wait longer. If the lump has not resolved by later in this second year, then you may be a candidate for surgery. RECENTLY I became ill with what the paramedic who attended me described as labyrinthus virus or something similar. I was shaking for about three days with some initial sickness and vertigo, causing the room to spin and making it difficult to balance.

I was prescribed paracetamol and anti-sickness tablets and in a week or so, felt better. I have not heard of this before. Is it common, can it be serious? It was certainly unpleasant. And can it be prevented?

A. J. Pope, Alford, Lincs. THE condition you describe is a common one — labyrinthitis, also known as vestibular neuritis, is a benign illness with no subsequent complications or dangers. While thoroughly unpleasant, it does eventually resolve itself.

Labyrinthitis is essentially down to a problem with the nerve that plays a key role in balance, known as the cranial nerve VIII. This nerve transmits sound and balance information to the brain from the labyrinth, the inner ear.

Labyrinthitis — technically, inflammation of the labyrinth — is thought to be due to a virus infec- tion or post-viral inflammation of the nerve; studies have shown that just under half of patients who have labyrinthitis have recently had a viral illness.

The other cases are assumed to be linked to a viral illness that had no obvious symptoms.

Typically, labyrinthitis comes on suddenly, causing acute sensations of vertigo, which can be disabling, along with nausea, vomiting, and unsteadiness of gait.

The symptoms are usually severe for a couple of days and then gradually settle over a week or two, although occasionally patients report dizziness for longer — for several weeks or even months.

If the symptoms remain severe for more than two or three days, the concern is that the problem may in fact be down to a stroke, caused by a blockage or haemorrhage of a blood vessel in the brain.

Indeed in about a quarter of patients over 50 who suffer sudden vertigo that then persists, this is the cause.

THIS doesn’t apply in your case as you rallied so quickly, so it was clearly labyrinthitis. The symptoms during the early, acute stage are mainly treated with medication to reduce the nausea, vomiting and vertigo. This is usually given by injection for the first day or so.

Some doctors also prescribe steroids such as prednisolone as this has been shown to improve the function of the balance mechanism more rapidly (the medication works by easing the inflammation).

Patients who continue to feel unsteady after the acute phase can benefit from vestibular rehabilitation exercises taught by a specialist physiotherapist.

In answer to your question about prevention: this is far from easy, as there are so many viruses that might trigger it (there are more than 200 different cold viruses alone), and only some people will develop labyrinthitis as a subsequent complication.

Put simply, you can’t prevent it but rest assured, if you do get it, then it should pass quickly.