Management of gynecomastia
- Glenn D Braunstein, MD
Glenn D Braunstein, MD
- Professor of Medicine Emeritus, David Geffen School of Medicine at UCLA
Gynecomastia, a benign proliferation of the glandular tissue of the male breast, is caused by an increase in the ratio of estrogen to androgen activity. It is categorized as physiologic (occurring normally during infancy, puberty, and older age) or pathologic (due to drugs or disorders such as androgen deficiency, testicular tumors, hyperthyroidism, and chronic kidney disease). In adult men seeking consultation for gynecomastia, about 40 percent of cases of gynecomastia are due to persistent pubertal gynecomastia or medications and 25 percent are idiopathic (table 1) .
True gynecomastia should be differentiated from pseudogynecomastia, which refers to fat deposition without glandular proliferation. Gynecomastia must also be differentiated from breast carcinoma, which is far less common.
The management of gynecomastia will be reviewed here. An overview of gynecomastia in children and adolescents and the epidemiology, causes, and evaluation of gynecomastia in adults are discussed separately. (See "Gynecomastia in children and adolescents" and "Epidemiology, pathophysiology, and causes of gynecomastia" and "Clinical features, diagnosis, and evaluation of gynecomastia".)
The management of gynecomastia depends upon its etiology, duration, severity, and the presence or absence of tenderness.
●A careful breast examination is the first step to distinguishing true gynecomastia (enlargement of the glandular tissue) from pseudogynecomastia (excessive adipose tissue) (figure 1). Additional details on the breast examination and evaluation of the patient with gynecomastia are reviewed separately. (See "Clinical features, diagnosis, and evaluation of gynecomastia", section on 'Evaluation'.)
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- GENERAL PRINCIPLES
- APPROACH TO MANAGEMENT
- Stop offending drugs
- Observation only
- Treat underlying condition
- Pharmacologic therapy
- - Androgens
- - Selective estrogen receptor modulators
- - Aromatase inhibitors
- - Procedure
- - Outcome
- - Pathology
- Men with prostate cancer
- - Tamoxifen
- - Anastrozole
- - Radiotherapy
- - Tamoxifen versus radiotherapy
- - Surgical intervention
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS