From the Research
Management of gynecomastia in this 39-year-old male with a history of treated testicular seminoma should begin with a thorough evaluation to determine the cause, including laboratory testing to evaluate hormone levels, and consideration of his cancer history, chemotherapy effects, and current medications. Given his history of orchiectomy, he may have hormonal imbalances contributing to breast tissue growth.
- Initial steps should include:
- Laboratory testing to evaluate hormone levels, including testosterone, estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin 1.
- Assessment of his current medications, although neither sildenafil nor famotidine typically cause significant gynecomastia.
- If laboratory findings are abnormal, endocrinology consultation is recommended to address potential hormonal imbalances.
- For symptomatic relief, a compression garment may help conceal the appearance.
- If gynecomastia is persistent (present for over 12 months) and causing significant physical or psychological distress, medical therapy with tamoxifen 10-20 mg daily for 3-9 months could be considered.
- For severe, long-standing cases unresponsive to medical management, surgical options including liposuction or mastectomy might be appropriate. Throughout treatment, regular monitoring of his cancer status is essential, as gynecomastia could potentially signal disease recurrence or a secondary malignancy, as suggested by recent molecular analyses of testicular germ cell tumors 1.