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On completion of this article, you should be able to: (1) recognize the different mechanisms and causative medications and conditions associated with gynecomastia, (2) demonstrate the ability to conduct a stepwise diagnostic approach to evaluate and diagnose most cases of gynecomastia, and (3) identify the available treatments for gynecomastia and assist patients in the process of decision making about treatment.
Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety. The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed. The evidence in this area is mainly of observational nature and lower quality.
Mayo Clin Proc. 2009;84(11):1010-1015
Gynecomastia is defined as benign proliferation of male breast glandular tissue.1 Asymptomatic gynecomastia is very common and has a trimodal age distribution, occurring in neonatal, pubertal, and elderly males. The prevalence of asymptomatic gynecomastia is 60% to 90% in neonates, 50% to 60% in adolescents, and up to 70% in men aged 50 to 69 years.25 Prevalence of symptomatic gynecomastia is markedly lower. A screening for gynecomastia in 214 hospitalized adult men aged 27 to 92 years revealed that 65% had gynecomastia, defined in this study as nodule size greater than 2 cm; however, none of them were symptomatic.3 Variation in reported prevalence across studies is attributed to variations in the size of the palpable breast tissue used to define gynecomastia and to population characteristics such as age and setting of treatment (primary care vs referral clinics). The evaluation and management perspectives presented in this article do not pertain to physiologic neonatal and adolescent cases but rather to symptomatic adults who are concerned and seek evaluation and treatment.
Although breast cancer is rare in men, those with gynecomastia often become anxious and seek medical attention, making this presentation fairly common in primary care settings. Diagnostic evaluation of these cases can be costly and involves laboratory and...