Gynecomastia
Description
Bilaterally symmetric, mildly enlarged breasts in a male patient.
Minimal excess skin.
Normal body habitus, without evidence of obesity.
Work-up
History
Time course of breast development and changes.
New onset of breast pain, lactation, or enlargement.
Presence of testicular masses.
Current and prior medication or drug use (i.e., marijuana)
Anti-androgens (spironolactone), anabolic steroids, HIV medications, diazepam, tricyclic antidepressants, antibiotics, digoxin, calcium channel blockers, furosemide, risperidone.
Alcohol, amphetamines, marijuana, heroin, methadone.
Physical examination
Breast examination
Findings concerning for malignancy: Eccentricity, chest wall fixation, nipple discharge.
Tenderness: > 70% of cases of benign gynecomastia will have tenderness.
Presence of dense fibrous tissue.
Degree of skin excess
Differentiate from pseudogynecomastia.
Other feminizing characteristics.
Testicular examination.
Thyroid examination.
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