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Licensed Unlicensed Requires Authentication Published by De Gruyter September 3, 2015

Prepubertal gynecomastia and chronic lavender exposure: report of three cases

  • Alejandro Diaz EMAIL logo , Laura Luque , Zain Badar , Steve Kornic and Marco Danon


Introduction: Prepubertal gynecomastia is a rare condition characterized by the growth of breast tissue in males as a consequence of early exposure to sexual hormones. When this condition is present, pathological sources of testosterone/estrogen production, such as adrenal or gonadal tumors must be searched for. A few reports have described an association between gynecomastia and substances that produce stimulation of the estrogen receptor, such as lavender and tea tree oil.

Methods: Here we describe the cases of three boys who presented with prepubertal gynecomastia and were chronically exposed to lavender. Two of these boys were exposed to a cologne, named agua de violetas, used by Hispanic communities in the US, and in their countries of origin.

Results: We studied a sample of the cologne used by one of the patients. Analysis of the chemical composition of the agua de violetas cologne was performed using high-performance liquid chromatography as well as off-line mass spectrometric detection. All these, combined with the physical appearance and the smell, determined that the cologne had lavender as an ingredient.

Conclusion: Exposure to estrogenic substances, such as lavender, should be explored in children presenting with prepubertal gynecomastia/thelarche.

Corresponding author: Alejandro Diaz, MD, Division of Pediatric Endocrinology, Nicklaus Children’s Hospital, 3100 S.W., 62nd Avenue, Miami, FL 33155, USA, Phone: +(305) 6628368, E-mail:


We thank Dr. Elizabeth G. Lipman Diaz, Ph.D., for helping in the critical review and drafting of the manuscript.

Funding source: No funding was secured for this study.

Financial disclosure: The authors have no financial relationships relevant to this article to disclose.

Conflict of interest: The authors have no conflicts of interest to disclose.

Contributor’s statement

Alejandro Diaz: Evaluated the patients, ordered laboratory tests, conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted.

Laura Luque: Co-writer, Coordinated literature review, revised and critically reviewed the manuscript.

Zain Badar: Coordinated the chemical evaluation of the lavender sample, and revised the manuscript for submission.

Steve Kornic: Literature review, performed the chemical analysis of the lavender sample.

Marco Danon:Contributed with one of his patients and revised the manuscript.


1. Cakan N, Kamat D. Gynecomastia: evaluation and treatment recommendations for primary care providers. Clin Pediatr (Phila) 2007;46:487–90.10.1177/0009922806294800Search in Google Scholar PubMed

2. Rivarola MA, Belgorosky A. Prepubertal and pubertal gynecomastia. Accessed on April 10, 2014.Search in Google Scholar

3. Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleve Clin J Med 2004;71:511–7.10.3949/ccjm.71.6.511Search in Google Scholar PubMed

4. Wasniewska M, Raiola G, Galati MC, Salzano G, Rulli I, Non-classical 21-hydroxylase deficiency in boys with prepubertal or pubertal gynecomastia. Eur J Pediatr 2008;167:1083–4.10.1007/s00431-007-0625-6Search in Google Scholar PubMed

5. Einav-Bachar R, Philip M, Auerbach-Klipper, Lazar L. Prepubertal gynaecomastia: aetilogy, course and outcome. Clin Endocrinol 2004;61:55–60.10.1111/j.1365-2265.2004.02059.xSearch in Google Scholar PubMed

6. Henley DV, Lipson N, Korach KS, Bloch C. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med 2007;356:479–85.10.1056/NEJMoa064725Search in Google Scholar PubMed

7. Turek C, Stintzing FC. Application of high-performance liquid chromatography diode array detection and mass spectrometry to the analysis of characteristic compounds in various essential oils. Anal Bioanal Chem 2011;400:3109–23.10.1007/s00216-011-4976-5Search in Google Scholar PubMed

8. Cavanagh HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res 2002;16:301–8.10.1002/ptr.1103Search in Google Scholar PubMed

9. Stoltz S. Lavandula angustifolia Miller. English lavender. Holist Nurs Pract 2009;23:57–64.10.1097/01.HNP.0000343210.56710.fcSearch in Google Scholar PubMed

10. Braunstein GD. Gynecomastia. N Engl J Med 1993;328:490–5.10.1056/NEJM199302183280708Search in Google Scholar PubMed

11. Goldman R. Drug-induced gynecomastia in children and adolescents. Can Fam Physician 2010;56:344–5.Search in Google Scholar

12. Brody SA, Loriaux DL. Epidemic of gynecomastia among Haitians refugees: exposure to an environmental antiandrogen. Endocr Pract 2003;9:370–5.10.4158/EP.9.5.370Search in Google Scholar PubMed

13. Sherings RJ, Olweny CL, Ziegler JL. Gynecomastia and gonadal dysfunction in adolescent boys treated with a combination chemotherapy for Hodgkin’s disease. N Engl J Med 1978;299:12–6.10.1056/NEJM197807062990103Search in Google Scholar PubMed

14. Robert Tisserand. Tea tree and lavender not linked to gynecomastia. 2008. Accessed on April 13, 2014.Search in Google Scholar

15. Block SL. The possible link between gynecomastia, topical lavender, and tea tree oil. Pediatr Ann 2012;41:56–8.10.3928/00904481-20120110-05Search in Google Scholar PubMed

Received: 2015-6-18
Accepted: 2015-8-3
Published Online: 2015-9-3
Published in Print: 2016-1-1

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