Gynecomastia: evaluation and treatment recommendations for primary care providers

Gynecomastia is defined as excessive development of the breast in boys. It is common in neonates and adolescents. Although in most cases this is a transient phenomenon, it might lead to significant social impediments such as decreased participation in physical education because of embarrassment. A primary care provider should be able to diagnose a false gynecomastia, a physiologic gynecomastia, and a gynecomastia with underlying pathology by taking good history, performing a thorough physical examination, and checking few screening laboratory tests. In most cases with physiologic gynecomastia, just reassurance and close follow-up is sufficient; however, psychologic counseling and surgical intervention may be required in few selected cases of physiologic gynecomastia. Suspected cases with underlying pathologic causes should be referred to a pediatric endocrinologist for further evaluation and management. Treatment of underlying causes should resolve the gynecomastia in those patients.