[Evaluation and management of gynecomastia]

Gynecomastia is a benign proliferation of the glandular tissue of the male breast and results from an imbalance between androgen and estrogen action. It must be differentiated from lipomastia and breast carcinoma. Gynecomastia is physiologic in infancy, adolescence and in middle-aged to elderly men and is associated with various conditions such as side effects of medications and disorders with low androgens or high estrogens levels. In the absence of a clearly apparent cause, biochemical testing should include evaluation of kidney, liver and thyroid function and measurement of LH, hCG, estradiol and total testosterone. However this evaluation is commonly normal and gynecomastia classified as idiopathic. During the acute stage of gynecomastia, a trial of tamoxifen for up to 3 months may be attempted.