Gynecomastia is a relatively common disorder. The causes of its development range vastly from benign physiologic processes to rare neoplasms. Thus, in order to properly diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, along with GH and IGF-1, is required for breast growth in males. Since a balance exists between estrogen and androgens in males, any disease state or medication that can increase circulating estrogen or decrease circulating androgen, causing an elevation in the estrogen to androgen ratio, can induce gynecomastia. Due to the diversity of possibly etiologies, including neoplasm, performing a careful history and physical is imperative. Once gynecomastia has been diagnosed, treatment of the underlying cause is warranted. If no underlying cause is discovered, then close observation is appropriate. If the gynecomastia is severe, however, medical therapy can be attempted and if ineffective, glandular tissue can be removed surgically.
Sections ABSTRACT INTRODUCTION BREAST DEVELOPMENT HORMONAL REGULATION OF BREAST DEVELOPMENT ESTROGEN, GH AND IGF-1, PROGESTERONE, & PROLACTIN ANDROGEN AND AROMATASE PHYSIOLOGIC GYNECOMASTIA PATHOLOGIC GYNECOMASTIA Table 1. Examples of hormone-producing tumors
Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. Endotext [Internet] 2015 August