Dear Dr. Roach: I am a 70-year-old man who has been experiencing an increase in breast size (slightly more on the left than the right) over the past year. I am healthy and have taken no medications for the past six months except sildenafil, on an as-needed basis. I am approximately 10-15 pounds overweight, but exercise regularly. Because of male breast cancer of my uncle on my mother’s side, I had a mammogram and ultrasound recently, which was negative. What could be the cause of this condition?
Gynecomastia, the development of breast tissue in men, is common among newborns, at puberty and again in adulthood, but all for different reasons.
For older men, breast cancer is indeed a concern. I am glad your doctor sent you for the appropriate diagnostic tests, even though breast cancer in men is uncommon. It’s wise to make sure.
The most likely cause in older men is the lowering of testosterone levels that is normal in a man’s 60s and 70s. This can be tested via a simple blood test. Ideally, the testosterone level should be drawn at 8 a.m. and then repeated if low. A trial of replacement testosterone is appropriate only if the blood level is low. The sildenafil you are taking (usually prescribed for erectile dysfunction) might be a clue that your testosterone is low.
Your thyroid level ought to be checked, as uncontrolled hyperthyroidism is another cause of gynecomastia.
Dear Dr. Roach: Everyone has been told to reduce their sodium intake for many years. My mother was told this in the 1970s. Because of high blood pressure, she didn’t add salt to anything she cooked, and I mostly continued that practice throughout adulthood. Many people no longer add iodized table salt to food. Over the past 15 years, my husband, adult daughter and I all have been diagnosed with hypothyroidism. Several members of my husband’s immediate family also have thyroid issues. Our adult son does not, so far.
Several years ago, I called a well-known soup company and asked if the salt in their foods contained iodine. I was told it didn’t. I don’t know if that is accurate or whether most processed foods don’t use iodized salt. We know a lot of people with thyroid issues, and I wonder if lack of iodine could be the problem. Even though we are getting lots of salt/sodium in our diets, maybe we aren’t getting enough iodine?
Iodine deficiency in the United States and Canada is rare, with almost no severe deficiency, and moderate deficiency found in 1% of all people in the U.S. and about 6% of Canadians. In both countries, iodine deficiency is more likely in young adults than in children or older adults. Also, in both countries, iodine intake has reduced over the past decades, probably because of food companies (such as the soup company you called) using non-iodized salt and because of lower salt intake overall. Dairy producers and commercial bakers also use less iodine than they used to. Still, there are many sources of iodine in the North American diet.
Severely low iodine intake is indeed a rare cause for low thyroid levels, although it is more likely to cause an enlargement of the thyroid (called a goiter). In areas of the world where there is adequate iodine, such as all North America, the most common cause of low thyroid levels is the autoimmune disease Hashimoto’s thyroiditis. This may run in families. You should ask your doctor the cause for your family’s low thyroid level. It’s unlikely to be low iodine.
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 ToYourGoodHealth@med.cornell.edu