- Referral Guidelines
June 23, 2021
Kathryn Obrynba, MD
Differential diagnosis of gynecomastia:
- Pubertal gynecomastia
- Pseudogynecomastia due to obesity/lipomastia
- Exogenous exposures to lavender, tea-tree oil
- Medication Induced: Antipsychotics, Anabolic steroids, Alcohol or drugs of abuse including: marijuana, heroin, amphetamines
- Pathologic causes: hCG secreting tumors, testosterone or estrogen secreting tumors (Leydig cell tumor, adrenal tumor), liver disease (chronic)
- Breast masses: benign tumors (lipomas, neurofibromas, dermoid cysts), rarely carcinomas
- Benign, pubertal gynecomastia is the most common cause of gynecomastia and occurs in up to 2/3 of normal pubertal boys, with the majority of pubertal gynecomastia self-resolving by completion of puberty.
- Laboratory/radiologic evaluation is generally not needed in boys with suspected pubertal gynecomastia unless there is significant or rapidly changing breast development.
- Boys with suspected pubertal gynecomastia should be monitored for rapid progression of breast development.
- Gynecomastia results due to relative imbalance between testosterone and estradiol levels, transient estradiol excess or increased sensitivity of breast tissue to estrogen.
- Gynecomastia can be commonly associated with Klinefelter syndrome.
- No good treatment options exist, regardless of cause. Once growth and puberty is complete, referral for cosmetic surgery may be considered.
Suggested References and Additional Reading:
- Question From the Clinician: Adolescent Gynecomastia. Peds in Review. 2003 Sep; 24(9): 317-319. doi: 10.1542/pir.24-9-317
- Nordt CA, DiVasta AD. Gynecomastia in adolescents. Curr Opin Pediatr.2008 Aug;20(4):375-82. doi:10.1097/MOP.0b013e328306a07c.