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 commonly found 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 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 am looking to have surgery on my cervical vertebrae at a prestigious hospital in St. Louis. Before I had even made up my mind, the hospital sent a form regarding arbitration. If anything should go wrong, they want me to agree to arbitration instead of going the usual route of the court system. They say the choice is mine. Is this normal preoperative paperwork? — T.B.
ANSWER: This is increasingly common, and a brief survey of surgeons gave me a mixed response — some felt it wasn’t a red flag at all, and others recommending double-checking the surgeon’s record, perhaps through the state medical board. Any disciplinary action must be publicly available, and in Missouri it is freely available on the website at pr.mo.gov/healingarts.asp.
While I understand you might be taken aback by the question, many hospitals are moving toward arbitration as a means of reducing malpractice coverage costs. I personally don’t see it as a reason to be concerned about the surgeon. However, I spoke with an attorney, who advised not agreeing to arbitration, as it isn’t germane to your medical condition and may limit your options later.
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 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.