Gynecomastia is benign growth of glandular breast tissue in males caused by an imbalance between estrogen and testosterone. It is normal in newborns, at puberty and in older age, but it can also come from drugs, liver or kidney disease and hormone-producing tumors.
Key symptoms
- Rubbery swelling under one or both nipples
- Breast tenderness, mostly at onset
- Embarrassment or distress about appearance
- Possible clues: low libido, alcohol or drug use, anabolic steroids
What you find on exam
- Firm disk of tissue centered under the areola
- Tell it apart from fat (pseudogynecomastia) by pinching
- Testicular exam for a mass or small testes
- Signs of liver disease, hyperthyroidism or hypogonadism
Tests
- Medication review: spironolactone, finasteride, antiandrogens, marijuana
- Testosterone, LH, estradiol and hCG if not pubertal
- Liver, kidney and thyroid tests
- Testicular ultrasound if a mass or high hCG; mammogram if cancer is suspected
Treatment basics
- Reassurance and observation for pubertal gynecomastia
- Stop the causing drug or treat the underlying disease
- Tamoxifen for painful or recent cases
- Surgery for long-standing or severe cases
Red flags
- Hard, fixed, one-sided mass or nipple changes (male breast cancer)
- Testicular mass
- Rapid growth with signs of a hormone-producing tumor
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.