DEAR DR. DONOHUE: This is about my grandson, who is 21. He always had overdeveloped breasts for a boy, but lately his nipples have been bleeding. What is the cause, and what can be done? He is too embarrassed to see a doctor. – I.L.

ANSWER: Your grandson must get over his embarrassment and see a doctor if he wants to solve both problems – breast enlargement and nipple bleeding.

During puberty, close to 70 percent of boys’ breasts noticeably enlarge. There is an imbalance between male and female hormones then, and the female hormone, even in minute quantities, promotes breast tissue growth. As boys mature, the breast enlargement usually recedes. However, careful breast examination in men between the ages of 21 and 40 will uncover a small amount of breast tissue still remaining in one-third of them.

Sometimes male breast enlargement indicates more serious trouble. Adrenal gland tumors, testicular tumors and an overactive thyroid gland cause male breast growth. So do some medicines. Marijuana stimulates breast growth in men, as do the male hormones that bodybuilders take to increase muscle size. For most, however, serious causes are never found.

Your grandson suffers psychological stress from his larger-than-normal breasts. A surgeon can remove that tissue, and I hope the young man consults one.

Bleeding nipples in men have the same significance that they do in women. One quite common reason for bleeding nipples is a condition called duct ectasia. The ducts of breast tissue become inflamed and clogged, and secrete a reddish-brown fluid that looks like blood. Another cause is a noncancerous tumor – intraductal papilloma – but it usually leads to bleeding only on one side. In exceedingly rare instances, true breast cancer can cause male nipple bleeding. Your grandson must see a doctor. His life will be so much better when he does.

DEAR DR. DONOHUE: I have a vaginal discharge that my physician’s assistant says is vaginosis. I have tried to find more information on this, but I cannot. Will you tell me more about it? – C.P.

ANSWER: In women, the vagina is populated with many bacteria that are innocent organisms and do not cause any trouble. When, however, rogue bacteria find their way into the vagina, they upset its normal balance and produce symptoms such as a discharge and itching. One of those bacteria is gardnerella, a germ found in women with vaginosis. It is not the sole cause, however.

The foremost symptom of vaginosis is a gray, foul-smelling discharge.

Treatment with metronidazole gel or clindamycin cream usually clears up the problem. If neither does, oral medicines will.

The newly written pamphlet on vaginal infections deals with this condition and the many others similar to it. Readers can obtain a copy by writing: Dr. Donohue – No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My 3-year-old granddaughter is pigeon-toed. Her doctor told my daughter that they won’t do anything about it until she is about 5 years old. My daughter agrees with the doctor.

I would like your opinion on waiting that long. – W.F.

ANSWER: Pediatricians and family doctors get daily questions about a youngster’s intoeing (pigeon toes). It’s something that bothers parents and grandparents. Most children grow out of it between the ages of 4 and 7.

The most common reason why children are pigeon-toed has to do with the way they were curled up within the uterus during fetal life. The curled position rotates a leg bone, and that results in pigeon toes.

A doctor can distinguish between this innocent and self-correcting cause and the seldom-seen causes that do require intervention at an early age.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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