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Dear Dr. Roach: I am an otherwise healthy 81-year-old suffering from gynecomastia. I play tennis twice a week and work out. My weight is 172, and I am 67 inches tall. The diagnosis followed via mammogram and ultrasound. Both breasts are affected, but the right one is worse, with swelling and significant tenderness when touched. My endocrinologist ran a full battery of hormone tests and all show normal for a man my age. There was some suspicion that an allergy med (loratadine) was the cause.

My questions: Since breast cancer and low testosterone have been ruled out, what other test should be taken to determine the cause of this problem? Is it reversible? Other than surgery, are there any suggestions?

R.S.

Dear R.S.: Gynecomastia is a benign enlargement of the male breast. It is not uncommon, and it can happen at any age. Puberty probably is the most common time, but it certainly can happen in middle-age and older men.

Your endocrinologist has done everything right, as far as I can tell. Looking at medication use is important, since in healthy men it is one of the most common causes. Making sure it isn’t breast cancer is critical, and a mammogram may be necessary. I have had three male patients with breast cancer.

If the tests are all normal, as in your case, then no cause is usually ever found. Sometimes, gynecomastia goes away by itself, and if it isn’t bothering you, it doesn’t have to be treated. However, either because of appearance or because of tenderness, many men wish to be treated. There is medication treatment for gynecomastia, and it is most effective if begun within a year or two after it appears. For adults, tamoxifen and dihydrotestosterone have been effective for gynecomastia, but neither is approved by the Food and Drug Administration for this purpose.

Surgery is very effective when performed by an experienced cosmetic surgeon, and often includes both direct surgical removal of the glandular tissue and liposuction.

Dear Dr. Roach: I’d like to get a tattoo. I am 22.

The only thing holding me back is a fear of AIDS. Has AIDS transmission ever been traced to tattooing, and what exactly is the danger to me?

L.H.

Dear L.H.: A very, very few cases of AIDS have been linked to tattooing.

If you’re determined to decorate yourself with one, first look carefully around the tattoo parlor you have chosen, and make sure it’s clean. Have the owner explain how the instruments and equipment are sterilized. If he or she sounds reasonable and has sterilization procedures, your chances for getting AIDS through tattooing are all but nonexistent.

Email questions to ToYourGoodHealth@med.cornell.edu.

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