Gynecomastia: incidence, causes and treatment

Gynecomastia is a benign proliferation of glandular tissue of the breast in males. It is common during three phases in the age distribution curve: the neonatal period, puberty and senescence. An imbalance between estrogen and androgen action at the level of breast tissue is believed to be the underlying pathophysiology. Initial steps in the clinical evaluation involve differentiating it from pseudogynecomastia and ruling out male breast carcinoma. A selective laboratory and radiological work-up should follow to identify the underlying cause. Pubertal gynecomastia resolves spontaneously in the majority of adolescents, and hence reassurance and observation is regarded as the best approach. In adults with persistent painful gynecomastia, a short-term trial of medical therapy is an option that has shown good results. For chronic, bothersome gynecomastia, removal by plastic surgery is the treatment of choice.