From the Guidelines
The initial approach to treating gynecomastia should focus on clinical diagnosis and reassurance, as most cases can be diagnosed without imaging, according to the American College of Radiology criteria 1. When evaluating a patient with symptoms of gynecomastia, a thorough physical examination is crucial to differentiate gynecomastia from other conditions, such as pseudogynecomastia or breast cancer.
- Gynecomastia often presents as a soft, rubbery, or firm mobile mass directly under the nipple, and it is more likely to be painful than cancer, especially if it has been present for less than 6 months 1.
- The approach to breast imaging in symptomatic men, as recommended by the American College of Radiology, suggests that no imaging is routinely recommended for men with clinical findings consistent with gynecomastia or pseudogynecomastia 1. Key considerations in the management of gynecomastia include:
- Identifying and addressing any underlying causes, such as medication use or hormonal imbalances
- Providing reassurance and observation, particularly for pubertal cases which often resolve spontaneously within 1-2 years
- Considering medical therapy, such as tamoxifen or anastrozole, for persistent cases causing significant psychological distress or physical discomfort
- Encouraging weight loss for overweight patients, as adipose tissue can contribute to the development of gynecomastia
- Reserving surgery for cases resistant to medical management or those with long-standing fibrotic changes that won't respond to medication.
From the Research
Initial Approach to Treating Gynecomastia
The initial approach to treating gynecomastia involves several key steps:
- Differentiating gynecomastia from pseudogynecomastia and ruling out male breast carcinoma 2
- Conducting a selective laboratory and radiological work-up to identify the underlying cause 2
- Providing reassurance and observation for pubertal gynecomastia, as it often resolves spontaneously 2, 3
- Considering a short-term trial of medical therapy for adults with persistent painful gynecomastia 2
- Evaluating the need for surgery in cases of chronic, bothersome gynecomastia 2, 3
Considerations for Treatment
When considering treatment for gynecomastia:
- Medical therapy may include antiestrogens, androgens, or aromatase inhibitors 3
- Surgery is useful in the management of patients with long-standing symptomatic gynecomastia or when medical therapy is not successful 3
- The use of selective aromatase inhibitors, such as anastrozole, may be beneficial in reducing breast tenderness and size, but further studies are needed to confirm its effectiveness 4
- Treatment should be highly individualized and patient-centered, taking into account the patient's presentation, concerns, and treatment goals 5
Importance of Early Management
Early management of gynecomastia is crucial, as: