Dr Thomas Stuttaford, the Times medical expert, is online every Wednesday. Email here about his latest topic: Caesarean section. If your question is published we like to include name and town/country. Please indicate if you would like to remain anonymous

Please note that Dr Tom isn't familiar with all the circumstances in individual cases and can only deal with the points raised in general terms. Patients should always discuss any specific problems they have with their own doctors.

Readers' questions are answered as examples of general problems commonly met in practice. It is a good rule in medicine that only their own doctors know the patient well enough to pontificate on the case as there are often other factors unknown to strangers.

I am 36 years old and have breasts nearly as big as my girflfriend. Definitely a size AA. Is there anything I can do to reduce their size? I work out and diet, but still I have these damnable breasts. I never want to have to pretend to smile again about any jokes concerning male boobies, if for no other reason than that I have heard them all before. What should I do? Name and address withheld.

Gynaecomastia, enlargement of the male breast, is becoming more common. Its cause may be a genetic trait, it is often no more than a localised .ccumulation of fat in an overweight person. It is sometimes the result of disruption of the normal testosterone/oestrogen ratio, the male and female sex hormonal balance, because a man's liver for whatever reason - but often too much alcohol - is lacking this. Anything that leaves the liver no longer fit for purpose, as our home secretary would say, can render it incapable of metabolising the oestrogen that circulates through even the most macho of men's veins and arteries.

An increasingly common cause of enlarged male breasts is hormone therapy for cancer of the prostate. There are over 20,000 new cases of this disease a year and at some time or another in a man's treatment of it they are likely to have hormone therapy. This will either be designed to prevent their testes from manufacturing testosterone, or will block the testosterone receptors in the body so that the tissues are unable to use the testosterone a man is producing. Either way the breasts enlarge, even in the comparatively thin, to the size of a 17 year old girl's.

Unlike most adult cases of gynaecomastia those from hormonal treatment can be acutely tender. I understand the reader's problem well because like many of the other 20,000 a year with prostate cancer I have breasts of his size. Unlike him I don't care about the appearance but the tenderness is a nuisance.

The reader doesn't suffer from dysmorphophobia as he truly has a visible abnormality and there is nothing delusionary about his concerns or even his preoccupation with them. Although I may not worry about my appearance I am rather older than he is but any pre-occupation he has about his breasts is understandable. The best advice for the reader is to read Mr Steve Beale's account in T2 on Tuesday February 6 in which he describes his experiences of having gynaecomastia treated by male breast surgery. This very effective treatment is now available.

I am an unemployed 19 year old man and sometimes spend three hours in front of the bathroom mirror staring at my nose. My embarrassment about my nose so destroyed my concentration at school that I think that it has been the underlying cause of many of my problems in life. Is this behaviour normal, or am I suffering from psychiatric disorder? T.L., Stowmarket.

Only if we had a more detailed history of this reader's anxieties over his nose, and what detached friends and relatives think about his nose, would we be able to say whether he was suffering from body dysmorphic disorder (dysmorphophobia).

The condition is defined as an abnormal preoccupation with an imagined or slight defect in appearance that is time consuming and worrying enough to interfere with the person's social, occupational or other activities. The first reader has an obvious problem that his colleagues at work, other holiday makers on the beach as well as any potential lovers would spot immediately.

Unfortunately we have no knowledge about the reader's nose, perhaps it is of enormous size, bent to one side so that the airways are blocked, or red and bulbous as the result of rosacea. If he has a diagnosable problem with his nose that is apparent to contemporaries and to his medical advisors he would be right to press for treatment. Cosmetic surgeons can do wonderful rhinoplasty (nose jobs) that would give a patient a nose fit to grace any classical statue. Some people's rosacea is so severe that they develop rhinophyma, a large bulbous red nose. Mild cases respond to topical metronidazole (Flagyl) applied to the skin mouth but any gross rhinophyma needs cosmetic surgery.