From the Research
The initial approach to treating gynecomastia involves a thorough medical history, physical examination, and identification of underlying causes, with watchful waiting recommended after treatment of underlying pathology or discontinuation of substances associated with gynecomastia 1. The diagnosis and management of gynecomastia should prioritize the detection of underlying pathological conditions, reversible causes, and discrimination from other breast lumps, particularly breast cancer.
- A thorough medical history should include information on the onset and duration of gynecomastia, sexual development and function, and administration or abuse of substances associated with gynecomastia 1.
- Physical examination should detect signs of under-virilization or systemic disease and confirm the presence of palpable glandular tissue to discriminate gynecomastia from lipomastia and rule out suspicion of malignant breast tumor 1.
- 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, and liver and renal function tests 1.
- Breast imaging may be used when the clinical examination is equivocal, and core needle biopsy should be performed if the clinical picture is suspicious for a malignant lesion 1.
- Testosterone treatment should be offered only to men with proven testosterone deficiency, and surgical treatment is the therapy of choice for patients with long-lasting gynecomastia 1. Key considerations in the management of gynecomastia include:
- Discontinuation of medications potentially causing gynecomastia
- Watchful waiting for mild cases, especially in adolescents
- Medical therapy for persistent cases, including selective estrogen receptor modulators or aromatase inhibitors, although their use is not justified in general 1
- Surgical options, including liposuction or mastectomy, for gynecomastia causing significant psychological distress or persisting beyond two years
- Addressing psychological impact through counseling and support, as gynecomastia can significantly affect body image and self-esteem, particularly in adolescents and young men.