Lavender Products Associated With Premature Thelarche and Prepubertal Gynecomastia: Case Reports and Endocrine-Disrupting Chemical Activities

Abstract

Context Previous case reports associated prepubertal gynecomastia with lavender-containing fragrances, but there appear to be no reports of premature thelarche. Objective To add to a case series about lavender-fragranced product use and breast growth in children and to measure endocrine-disrupting chemical activity of essential oil components. Design, Setting, and Patients Patients experiencing premature thelarche or prepubertal gynecomastia with continuous exposure to lavender-fragranced products were evaluated in the pediatric endocrinology departments of two institutions. Mechanistic in vitro experiments using eight components of lavender and other essential oils were performed at National Institute of Environmental Health Sciences. Main Outcome Measures Case reports and in vitro estrogen and androgen receptor gene expression activities in human cell lines with essential oils. Results Three prepubertal girls and one boy with clinical evidence of estrogenic action and a history of continuous exposure to lavender-containing fragrances were studied. Breast growth dissipated in all patients with discontinuation of the fragranced products. Some of the components tested elicited estrogenic and antiandrogenic properties of varying degrees. Conclusion We report cases of premature thelarche that resolved upon cessation of lavender-containing fragrance exposure commonly used in Hispanic communities. The precise developmental basis for such conditions could be multifactorial. In vitro demonstration of estrogenic and antiandrogenic properties of essential oil components suggests essential oils in these cases could be considered a possible source and supports a possible link with idiopathic prepubertal breast development. Whether the level of lavender oil estrogenic potency is sufficient to cause these effects is unknown.

Safety Profile of Essential Oils

“…Recently, another study published in 2019, confirmed the mentioned data, showing that a continuous exposure to lavender-fragranced products induced a Safety Profile of Essential Oils DOI: http://dx.doi.org /10.5772/intechopen.91363 premature thelarche in four patients [37]. The chemical constituents from the essential oils were individually tested concerning their capacity of stimulating ERα estrogen response element (ERE)-mediated activity.…”

“…The most active compounds with estrogenic activity were α-terpineol, 4-terpineol and linalool. Further research on a more statistically significant population is needed to confirm the relevance of these findings [37].…”

DIAGNOSIS OF ENDOCRINE DISEASE: Sex steroid action in adolescence: too much, too little; too early, too late

“…Persistent pubertal gynecomastia can be a sign of decreased levels of androgens as seen in Klinefelter syndrome, or due to defective androgen receptor signaling as seen in boys with PAIS (41). If the patient is otherwise healthy, the clinician might want to ask the patient about the use of lavender oil, which is linked to prepubertal gynecomastia (57).…”

Perturbation of Nuclear Hormone Receptors by Endocrine Disrupting Chemicals: Mechanisms and Pathological Consequences of Exposure

“…Peripheral precocious puberty refers to early pubertal development as a consequence of inappropriate exposure to estradiol, testosterone, or chemicals with estrogenic/androgenic activities. Clinical studies have described peripheral precocious puberty in preadolescent males who developed gynecomastia and premature thelarche in females following topical administration of products containing lavender or tea tree oils [65,69]. Mechanistic analysis revealed that the oils and their constituents activated ERs in human breast epithelial cells and increased ER-alpha-dependent gene transcription and cell proliferation.…”

“…Lavender and tea tree oil were also designated as EDCs via their ability to antagonize AR function. It was concluded that the repeated exposure to the estrogenic and anti-androgenic components of the oils was likely responsible for the prepubertal gynecomastia in the boys [65,69].…”