Prepubertal gynecomastia and chronic lavender exposure: report of three cases

Alejandro Diaz 1 , Laura Luque 1 , Zain Badar 2 , Steve Kornic 3 ,  and Marco Danon 1
  • 1 Division of Pediatric Endocrinology, Nicklaus Children’s Hospital, Miami, FL, USA
  • 2 Division of Radiology, SUNY Upstate Medical Center, Syracuse, NY, USA
  • 3 Department of Chemistry, McMaster University, Hamilton, ON, USA
Alejandro Diaz, 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.

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The Journal of Pediatric Endocrinology and Metabolism (JPEM) is the only international journal dedicated exclusively to endocrinology in the neonatal, pediatric and adolescent age groups, and publishes the results of clinical investigations in pediatric endocrinology and basic research. JPEM publishes Review Articles, Original Research, Case Reports, Short Communications and Letters to the Editor.