Management of senescent gynecomastia in the Veterans Health Administration

Senescent gynecomastia is common in Veterans Health Administration patients because of clinical characteristics in the population, mainly obesity and the use of numerous etiologic drugs. To assess management of the disease, we studied patients treated between January 1, 2003 and December 31, 2007, in the Veterans Affairs-Tennessee Valley Healthcare System. Four hundred and fifty-four cases of senescent gynecomastia were retrieved from 670 charts addressing breast complaints (positive predictive value = 68%). Average patient age was 68.5 years. Mean body mass index was 29.7. Ninety-two percent of patients were using multiple medications associated with gynecomastia. Medications were considered at least partially etiologic in 79.3% of cases. Medical conditions caused gynecomastia in 13.7%. Over 50% of patients underwent diagnostic imaging studies. One-fifth of patients were tested for etiologic endocrine tumors. Yield on this testing was 1.1% (1/93). Ninety-four percent of patients were managed nonoperatively. Case management in the Tennessee Valley Healthcare System was generally correct, though there was excessive use of imaging, invasive diagnostic procedures, and endocrine assessment. Senescent gynecomastia, a benign disease, can usually be diagnosed by history and physical examination, requires little diagnostic testing, and should be treated nonoperatively.