[The significance of gynecomastia in general practice]

Gynecomastia in the male is usually due to a change of the estradiol/testosterone ratio in favor of the estrogens. There is usually no need for therapy of the gynecomastia which frequently occurs during puberty and old age. However, it is important not to overlook hormone-secreting tumors, often testicular malignancies, as the underlying cause of gynecomastia. A careful history and clinical investigations including thorough palpation of the testes (sonography) are complemented by a laboratory workup including blood chemistry (liver function) and hormone determinations (estradiol, beta-HCG, FSH, LH, prolactin, testosterone, thyroid hormones). Treatment of gynecomastia includes elimination of the cause of the condition. In cases with fibrous and voluminous gynecomastia breast tissue must be removed surgically. Antiestrogenic treatment with tamoxifen is indicated only in patients with recently developed, tender gynecomastia.