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Gynecomastia

Key sources
The following summarized guidelines for the evaluation and management of gynecomastia are prepared by our editorial team based on guidelines from the European Academy of Andrology (EAA 2019).
1

Guidelines

1.Diagnostic investigations

General principles: consider presence of an underlying pathology in patients with gynecomastia of adulthood. Obtain a detailed investigation even if an apparent reason for gynecomastia of adulthood is identified, including the use of medication known to be associated with gynecomastia.
B
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  • History taking

  • Physical examination

  • Diagnostic imaging

  • Laboratory testing

2.Diagnostic procedures

Core needle biopsy: perform core needle biopsy if the clinical picture is suspicious for a malignant lesion.
B

3.Medical management

Medical therapy
Offer testosterone only to male patients with proven testosterone deficiency.
B
Do not use selective estrogen receptor modulators, aromatase inhibitors, or non-aromatizable androgens in the treatment of gynecomastia in general.
D

4.Surgical interventions

Surgery: offer surgical treatment only for patients with long-lasting gynecomastia, which does not regress spontaneously or following medical therapy. The extent and type of surgery depend on the size of breast enlargement, and the amount of adipose tissue.
B

5.Follow-up and surveillance

Follow-up: offer watchful waiting after treatment of underlying pathology or discontinue the administration/abuse of substances associated with gynecomastia.
B