Is beta human chorionic gonadotropin (beta hCG) checked in males requiring a gynecomastia workup?

From the Guidelines

Beta hCG is not routinely checked for males requiring a gynecomastia workup, but it may be considered if there's suspicion of a testicular tumor, as some of these tumors can produce hCG and cause gynecomastia. The standard workup typically includes tests for testosterone, estradiol, prolactin, and sometimes thyroid function, as these hormones are more commonly associated with gynecomastia development in males 1. However, according to the most recent and highest quality study, serum tumor markers, including beta hCG, are critical in the diagnosis and staging of testicular cancer, and should be measured before orchiectomy and repeated after orchiectomy if elevated 1.

Key Points to Consider

• Gynecomastia in males is often related to an imbalance between estrogen and testosterone levels, which is why these hormones are the primary focus of the initial workup.
• Beta hCG may be considered if there's suspicion of a testicular tumor, as some of these tumors can produce hCG and cause gynecomastia.
• Testicular ultrasound is a sensitive and important tool in determining whether a mass is intra- or extratesticular, and can help identify impalpable testicular lesions 1.
• Serum tumor markers, including beta hCG, have a low sensitivity and specificity, but are still important in the diagnosis and staging of testicular cancer 1.

Recommendations

• Beta hCG testing should be included in the evaluation of males with gynecomastia if there are other symptoms suggestive of a testicular tumor, such as testicular pain, swelling, or a palpable mass.
• The standard workup for gynecomastia should include tests for testosterone, estradiol, prolactin, and sometimes thyroid function.
• Testicular ultrasound should be performed to confirm the presence of a testicular mass and to explore the contralateral testis.

From the Research

Gynecomastia Workup and Beta hCG

• Beta human chorionic gonadotropin (beta hCG) is a hormone that can be associated with gynecomastia in males, particularly in cases of ectopic production due to malignant tumors 2, 3.
• The evaluation of gynecomastia should include a detailed medical history, clinical examination, and specific blood tests, including hormone levels such as testosterone, estradiol, and hCG 4, 5.
• The European Academy of Andrology (EAA) clinical practice guidelines for gynecomastia evaluation and management recommend that a set of laboratory investigations may include hCG, among other hormones, to detect underlying pathological conditions 4.
• In cases of rapidly progressing or recent onset of painful gynecomastia, hormonal work-up including hCG beta subunit should be considered to rule out ectopic production of hCG beta subunit due to lung cancer or other malignant tumors 3.
• The incidence of gynecomastia is common during three phases in the age distribution curve: the neonatal period, puberty, and senescence, and an imbalance between estrogen and androgen action at the level of breast tissue is believed to be the underlying pathophysiology 6.

Laboratory Investigations

• Laboratory investigations for gynecomastia may include:
  • Testosterone (T)
  • Estradiol (E2)
  • Sex hormone-binding globulin (SHBG)
  • Luteinizing hormone (LH)
  • Follicular stimulating hormone (FSH)
  • Thyroid stimulating hormone (TSH)
  • Prolactin
  • Human chorionic gonadotropin (hCG)
  • Alpha-fetal protein (AFP)
  • Liver and renal function tests 4
• These investigations can help identify underlying pathological conditions, reversible causes, and discriminate gynecomastia from other breast lumps, particularly breast cancer 4.