From the Guidelines
The patient's estradiol level of 29 pg/mL is slightly elevated, and given the symptoms of male breast tissue, it is essential to rule out breast cancer and other underlying conditions, as recommended by the American College of Radiology 1. The normal male estradiol levels typically range from 10-40 pg/mL, and this elevation could be contributing to the development of gynecomastia. I recommend consulting with an endocrinologist for a complete hormonal evaluation, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels. Some key points to consider in the evaluation and management of this patient include:
- Identifying and addressing potential causes of the elevated estradiol, such as obesity, liver disease, certain medications (antipsychotics, antiandrogens, some antibiotics), marijuana use, or pituitary disorders 1
- Considering treatment options, including selective estrogen receptor modulators like tamoxifen (10-20 mg daily for 3-6 months) or aromatase inhibitors such as anastrozole (1 mg daily) 1
- Weight loss may help if obesity is a factor, and surgical options like liposuction or mastectomy could be considered if medical management is unsuccessful after 6-12 months
- The elevated estradiol is significant because the imbalance between estrogen and testosterone can stimulate breast tissue growth in males, leading to gynecomastia, and it is crucial to investigate and manage this condition to improve the patient's quality of life and reduce the risk of morbidity and mortality.
From the Research
Evaluation of Male Breast Tissue
The patient's concern for male breast tissue, also known as gynecomastia, is a common condition that can be caused by an imbalance of hormones, particularly an increase in estrogen and a decrease in testosterone 2, 3, 4.
Laboratory Investigations
The patient's laboratory results show an estradiol level of 29 pg/mL, which is within the normal range for adult males, but the reference range provided is for adult females 2. According to the study by 2, a set of laboratory investigations may include testosterone, estradiol, sex hormone-binding globulin, luteinizing hormone, follicular stimulating hormone, thyroid stimulating hormone, prolactin, human chorionic gonadotropin, alpha-fetal protein, liver, and renal function tests.
Diagnosis and Management
The diagnosis of gynecomastia should be based on a thorough medical history, physical examination, and laboratory investigations 2, 3, 4. The management of gynecomastia depends on the underlying cause and may include treatment of underlying conditions, discontinuation of medications that may be causing the condition, and in some cases, surgical treatment 2, 3, 4.
Key Points
- Gynecomastia is a common condition that can be caused by an imbalance of hormones 2, 3, 4
- Laboratory investigations may include testosterone, estradiol, and other hormone levels 2
- Diagnosis and management depend on the underlying cause and may include treatment of underlying conditions, discontinuation of medications, and surgical treatment 2, 3, 4
- Estradiol levels should be interpreted with caution, as the reference range provided may not be applicable to adult males 2
- Monitoring of estrogen levels in men on testosterone therapy is important, and symptoms play a role in prescribing patterns 5