From the Guidelines
The recommended treatment for unilateral gynecomastia is to first rule out underlying causes such as medications, hormonal disorders, liver disease, or malignancy through appropriate laboratory testing and imaging, and then consider watchful waiting, medical treatment with tamoxifen or anastrozole, or surgical intervention. For recent-onset gynecomastia (less than 12 months), watchful waiting is often appropriate as up to 80% of cases may resolve spontaneously 1. If medication is needed, tamoxifen (10-20 mg twice daily for 3-6 months) is typically the first-line pharmacological treatment, as it blocks estrogen receptors in breast tissue 1. Alternatively, anastrozole (1 mg daily) may be used, particularly in cases with elevated estrogen levels. Some key points to consider in the management of unilateral gynecomastia include:
- Breast cancer must be excluded, particularly in older men or those with suspicious clinical features such as hard masses, skin changes, or nipple discharge 1.
- Imaging studies such as mammography or ultrasound may be necessary to evaluate the breast tissue and rule out malignancy 1.
- Surgical intervention may be recommended for persistent gynecomastia causing significant physical discomfort or psychological distress, with options including liposuction, subcutaneous mastectomy, or a combination approach.
- It's essential to address the underlying cause of gynecomastia, whether it's related to medications, hormonal imbalances, or other factors, to prevent recurrence and improve treatment outcomes. Some medications that may contribute to gynecomastia include spironolactone, antipsychotics, and antiandrogens, and these should be reviewed and adjusted as necessary 1. Hormonal disorders, liver disease, and other underlying conditions should also be evaluated and managed appropriately to prevent gynecomastia and related complications. Overall, a comprehensive approach to diagnosis and treatment is necessary to ensure the best possible outcomes for patients with unilateral gynecomastia.
From the Research
Unilateral Gynecomastia in Males
- Unilateral gynecomastia is a benign proliferation of glandular tissue in the male breast, which can occur on one side of the chest 2.
- The causes of unilateral gynecomastia are diverse and can be triggered by an imbalance of female to male hormones, endogenous diseases, medication, or drug abuse 3.
Diagnosis and Evaluation
- A thorough medical history and physical examination of the breast and genitalia are essential for the diagnosis and evaluation of unilateral gynecomastia 2.
- Laboratory investigations, such as testosterone, estradiol, and sex hormone-binding globulin, may be necessary to integrate the evaluation 2.
- Breast imaging, including mammography and ultrasound, may be helpful in certain cases when physical examination is inconclusive [(2,4)].
Treatment Options
- Watchful waiting is recommended after treatment of underlying pathology or discontinuation of substances associated with unilateral gynecomastia 2.
- Testosterone treatment should be offered only to men with proven testosterone deficiency 2.
- Surgical treatment is the therapy of choice for patients with long-lasting unilateral gynecomastia that does not regress spontaneously or following medical therapy [(2,3)].
- The use of selective estrogen receptor modulators, aromatase inhibitors, or non-aromatizable androgens is not justified in general 2.
Management and Recommendations
- A thoughtful approach to managing unilateral gynecomastia can lead to high patient satisfaction 3.
- Inquiring about the patient's lifestyle and medication history is essential for proper therapy planning 3.
- Drug therapy with tamoxifen may be considered at an early stage 3.
- Surgical excision is the treatment of choice for unilateral gynecomastia persisting over 12 months 3.