Gynecomastia workup
Posted by dkwinter

Etiology

  • Persistent pubertal gynecomastia (25%)
  • Drugs (10-25%)
  • No detectable abnormality (25%)
  • Cirrhosis or malnutrition (8%)
  • Male hypogonadism (primary: 8%, secondary: 2%)
  • Testicular tumors (3%)
  • Hyperthyroidism (1.5%)
  • Chronic renal insufficiency (1%)

 

Exam

  • resistance should not be met until at nipple, any discrete mass should be investigated with ultrasound

 

Imaging

  • ultrasound if unilateral or concerning clinical features

 

Labs​

  • TSH
  • Morning total testosterone -> if low then repeat to confirm and check
    • bioavailable or free testosterone
    • LH (especially in obese men who may have low SHBG)
  • If recent onset, painful or tender then check
    • testosterone
    • hCG (would suggest testicular or extragonadal germ cell tumor)
    • LH
    • estradiol (if elevated with low LH suggests testicular tumor (Leydig or Sertoli cell) or adrenal tumor)

 

Source: UpToDate