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24 years old male, a student reported on 22/6/2016 at our hospital with complaints of Gynecomastia that is progressively increasing in size since 2 years.

Physical Generals – Chilly, appetite normal but disagreed strongly with hot drinks / food. Thirst, sweat, urine and sleep were normal. He was generally constipated and occasionally consumed Herbal medicines. Stool was normal in consistency. No mucus or blood.

Sexual History – Heterosexual. Has had frequent contacts with his girlfriend since past 2 years but since 2 months before reporting to us, has stopped to avoid embarrassment due to his enlarged breasts. History of delayed or no ejaculation during contact was present which was a great source of frustration.

Temperament – A happy go lucky male who can socialize but prefers selected company. He has an average intellect. He can take decisions quickly and stick to those decisions. He can manage his emotions well, except since 2 months he has a fear about his enlarging breasts and possible surgery.

Personal history – Consumes Scotch 1-2/ month and is an occasional cigarette smoker. 

Past & Family History – Uneventful

On Examination

Weight 62 kg. Stout with a wheatish to dark complexion with fidgety feet.

Vitals stable. BP - 140/90mm Hg (Right upper arm sitting)

Chest – bilateral gynecomastia. Breasts soft lumpy left more prominent than right. Nipples well developed. No discharge. Circumference 42 inches.

Heart sounds normal. Respiratory system normal.

Per Abdomen – soft, non tender, no organo-megaly. External Genitals developed as per age and normal.

CNS – NAD

 

Investigations –

Serum Estradiol 50.78 pg/ml (N: 7.6 – 42pg/ml)

Serum Prolactin 18.30 ng/ml (N: 1.8 – 17ng/ml)

Serum Testosterone 68.40 ng/ml (N: 265 – 800 ng/ml)

Semen analysis (done later on 6/10/14): Total sperm count = 12 million/ml; motility 1st hour 30%, Active 30%, Dead sperms 60%--- Oligospermia

CAT Scan of Head and Chest – Normal

Sonography of Abdomen – normal.

 

Following symptoms were taken

Chest, Breast hypertrophy

Generalities, Chilly

Rectum, Constipation

Stomach, Hot things disagree

Seminal discharge, failing during coition

 

Following remedies emerged – Graphitis, Puls, Lycopodium

 

22/06/16: Graphitis 200 1 dose

18/07/16: No major change in symptoms. But investigations wise there was      improvement: Serum Estradiol 57.1 pg/ml; Serum Prolactin 11.48ng/ml; Serum Testosterone 635.20 ng/ml. Rx: Graphitis 1M 1 dose

15/10/16: History of fever with watery nasal discharge < cold air. Lasted for 3 days. Recovered without any treatment. Constipation >>. Chest Circumference = 40.5inches. Semen analysis (4/09/16): Total sperm count = 36 million/ml; motility 1st hour 48%, Dead sperms 44%. Rx: Graphitis 10M 1 dose

14/11/16: Patient was a very happy boy this time. History of successful contact with girlfriend (30/10/16). No         complaints of delayed ejaculation. BP 130/78 mm Hg. Chest Circumference = 39inches. Semen analysis (07/11/16): Total sperm count = 122 million/ml; motility 1st hour   69%, Active 62%, Normal semen

Discussion – Gynecomastia is a common endocrine disorder presenting as a benign enlargement of breasts in males. About 70% boys in the ages of 13-16 years have full breast development. Newborn and adolescent males frequently experience temporary gynecomastia due to the influence of maternal hormones and hormonal changes during puberty, respectively. The development of gynecomastia is usually associated with benign pubertal changes. The psoro-sycotic miasm activation leads to disturbances in the endocrine system leading to an increase in the levels of estrogens / androgens or even if the levels of estrogens and androgens are both appropriate but if the ratio is altered then the resultant presentation can be gynecomastia. In our case Graphitis not only helped in significant reduction of the sizes of breast tissue (as measured by comparing the chest circumference) but also normalized the abnormal semen report which was done as a routine for work-up of gynecomastia.

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