Gynecomastia: modern ideas and approaches to treatment

Main Article Content

M.A. Zaitsev


A literature review is devoted to the benign growth of glandular tissue of the breast in men. The prevalence of gynecomastia reaches 32–65 % depending on age and the criteria used to determine. Gynecomastia in childhood and during puberty is considered a benign condition, which in most cases passes spontaneously. Gynecomastia in adulthood is more common in the elderly, and targeted examination can reveal the underlying pathology in 45–50 % of cases. Today, most causes of gynecomastia remain unclear and are discussed at the hypothesis level. The tissue of the mammary glands is laid equally regardless of the sex of a child. The development of the mammary glands depends on the androgen-estrogen ratio (AER). With the predominance of estrogens during puberty and low androgen activity, the breast tissue develops and differentiates by the female type. At the return AER, breast tissue does not develop. The possibility of endocrine or systemic disease should be considered. It is usually sufficient to determine basal levels of testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone. With simple adolescent gynecomastia, there are no permanent hormonal changes. It is important to assess the degree of overall androgenization of the patient. Laboratory tests (clinical, biochemical, hormonal) should correspond to the specific clinical condition of each patient. The effectiveness of therapeutic treatment of gynecomastia in patients without obvious endocrine disorders with the use of hormonal drugs (testosterone, dihydrotestosterone) as well as tamoxifen, danazol, clomiphene should be considered unproven. Surgical treatment is recommended only for patients with prolonged gynecomastia, which does not regress spontaneously or after drug therapy. The extent and type of surgery depend on the size of the breast augmentation and the amount of adipose tissue.

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How to Cite
Zaitsev, M. “Gynecomastia: Modern Ideas and Approaches to Treatment”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 17, no. 1, Apr. 2021, pp. 70-75, doi:10.22141/2224-0721.17.1.2021.226434.
Literature Review


Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology. 2019 Nov;7(6):778-793. doi:10.1111/andr.12636.

Akgül S, Kanbur N, Derman O. Pubertal gynecomastia: what about the remaining 10%? J Pediatr Endocrinol Metab. 2014 Sep;27(9-10):1027-1028. doi:10.1515/jpem-2014-0017.

Alesini D, Iacovelli R, Palazzo A, et al. Multimodality treatment of gynecomastia in patients receiving antiandrogen therapy for prostate cancer in the era of abiraterone acetate and new antiandrogen molecules. Oncology. 2013;84(2) :92-99. doi:10.1159/000343821.

Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-2559. doi:10.1210/jc.2009-2354.

Bel’tsevich DG, Kuznetsov NS, Vanushko VE, Kalinchenko SYu. Gynecomastiya. Endocrine Surgery. 2008;2(1):25-27. doi:10.14341/2306-3513-2008-1-25-28. (in Russian).

Fagerlund A, Lewin R, Rufolo G, Elander A, Santanelli di Pompeo F, Selvaggi G. Gynecomastia: A systematic review. J Plast Surg Hand Surg. 2015;49(6):311-318. doi:10.3109/2000656X.2015.1053398.

Narula HS, Carlson HE. Gynaecomastia – pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014 Nov;10(11):684-698. doi:10.1038/nrendo.2014.139.

Chau A, Jafarian N, Rosa M. Male Breast: Clinical and Imaging Evaluations of Benign and Malignant Entities with Histologic Correlation. Am J Med. 2016 Aug;129(8):776-791. doi:10.1016/j.amjmed.2016.01.009.

Barros AC, Sampaio Mde C. Gynecomastia: physiopathology, evaluation and treatment. Sao Paulo Med J. 2012;130(3):187-197. doi:10.1590/s1516-31802012000300009.

Gottlieb B, Beitel LK, Nadarajah A, Paliouras M, Trifiro M. The androgen receptor gene mutations database: 2012 update. Hum Mutat. 2012 May;33(5):887-894. doi:10.1002/humu.22046.

Grigg J, Worsley R, Thew C, Gurvich C, Thomas N, Kulkarni J. Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research. Psychopharmacology (Berl). 2017 Nov;234(22):3279-3297. doi:10.1007/s00213-017-4730-6.

Gudin JA, Laitman A, Nalamachu S. Opioid Related Endocrinopathy. Pain Med. 2015 Oct;16 Suppl 1:S9-15. doi:10.1111/pme.12926.

Handelsman DJ, Newman JD, Jimenez M, McLachlan R, Sartorius G, Jones GR. Performance of direct estradiol immunoassays with human male serum samples. Clin Chem. 2014 Mar;60(3):510-517. doi:10.1373/clinchem.2013.213363.

Hellmann P, Christiansen P, Johannsen TH, Main KM, Duno M, Juul A. Male patients with partial androgen insensitivity syndrome: a longitudinal follow-up of growth, reproductive hormones and the development of gynaecomastia. Arch Dis Child. 2012 May;97(5):403-409. doi:10.1136/archdischild-2011-300584.

Huhtaniemi IT, Tajar A, Lee DM, et al. Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men. Eur J Endocrinol. 2012 Jun;166(6):983-991. doi:10.1530/EJE-11-1051.

Iglesias P, Carrero JJ, Díez JJ. Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options. J Nephrol. 2012 Jan-Feb;25(1):31-42. doi:10.5301/JN.2011.8481.

James R, Ahmed F, Cunnick G. The efficacy of tamoxifen in the treatment of primary gynecomastia: an observational study of tamoxifen versus observation alone. Breast J. 2012 Nov-Dec;18(6):620-621. doi:10.1111/tbj.12033.

Jayasinghe Y, Cha R, Horn-Ommen J, O'Brien P, Simmons PS. Establishment of normative data for the amount of breast tissue present in healthy children up to two years of age. J Pediatr Adolesc Gynecol. 2010 Oct;23(5):305-311. doi:10.1016/j.jpag.2010.03.002.

Kasielska A, Antoszewski B. Effect of operative treatment on psychosocial problems of men with gynaecomastia. Pol Przegl Chir. 2011 Nov;83(11):614-621. doi:10.2478/v10035-011-0097-2.

Kilic M, Kanbur N, Derman O, Akgül S, Kutluk T. The relationship between pubertal gynecomastia, prostate specific antigen, free androgen index, SHBG and sex steroids. J Pediatr Endocrinol Metab. 2011;24(1-2):61-67. doi:10.1515/jpem.2011.112.

Kinsella C Jr, Landfair A, Rottgers SA, et al. The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg. 2012 Jan;129(1):1-7. doi:10.1097/PRS.0b013e3182361efd.

Krause W. Drug-inducing gynaecomastia – a critical review. Andrologia. 2012 May;44 Suppl 1:621-6. doi:10.1111/j.1439-0272.2011.01240.x.

Nuttall FQ, Warrier RS, Gannon MC. Gynecomastia and drugs: a critical evaluation of the literature. Eur J Clin Pharmacol. 2015 May;71(5):569-578. doi:10.1007/s00228-015-1835-x.

Ahmed M, Kanji A, Begum T. Gynaecomastia: an unusual presenting symptom of bladder cancer. BMJ Case Rep. 2015 Jun 25;2015:bcr2015210649. doi:10.1136/bcr-2015-210649.

Mieritz MG, Rakêt LL, Hagen CP, et al. A Longitudinal Study of Growth, Sex Steroids, and IGF-1 in Boys With Physiological Gynecomastia. J Clin Endocrinol Metab. 2015 Oct;100(10):3752-3759. doi:10.1210/jc.2015-2836.

Hatton CK, Green GA, Ambrose PJ. Performance-enhancing drugs: understanding the risks. Phys Med Rehabil Clin N Am. 2014 Nov;25(4):897-913. doi:10.1016/j.pmr.2014.06.013.

Bowers SP, Pearlman NW, McIntyre RC, Finlayson CA, Huerd S. Cost-effective management of gynecomastia. Am J Surg. 1998;176:638-641. doi:10.1016/S0002-9610(98)00281-5.

Søeborg T, Frederiksen H, Fruekilde P, Johannsen TH, Juul A, Andersson AM. Serum concentrations of DHEA, DHEAS, 17α-hydroxyprogesterone, Δ4-androstenedione and testosterone in children determined by TurboFlow-LC-MS/MS. Clin Chim Acta. 2013 Apr 18;419:95-101. doi:10.1016/j.cca.2013.01.019.

Kaptanis S, Parvanta L, Beltran L. Testicular seminoma presenting as unilateral gynecomastia. Breast J. 2014 Jul-Aug;20(4):424-426. doi:10.1111/tbj.12287.

Nieschlag E, Vorona E. Mechanisms in endocrinology: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015 Aug;173(2):R47-58. doi:10.1530/EJE-15-0080.

Deepinder F, Braunstein GD. Drug-induced gynecomastia: an evidence-based review. Expert Opin Drug Saf. 2012 Sep;11(5):779-795. doi:10.1517/14740338.2012.712109.

Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012 Dec;32(12):1123-1140. doi:10.1002/phar.1138.

Brinton LA, Cook MB, McCormack V, et al. Anthropometric and hormonal risk factors for male breast cancer: male breast cancer pooling project results. J Natl Cancer Inst. 2014 Mar;106(3):djt465. doi:10.1093/jnci/djt465.

Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab. 1979 Feb;48(2):338-340. doi:10.1210/jcem-48-2-338.

Laitman Y, Keinan Boker L, Liphsitz I, et al. Cancer risks in Jewish male BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat. 2015 Apr;150(3):631-635. doi:10.1007/s10549-015-3340-4.

Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update. 2015 Jan-Feb;21(1):56-83. doi:10.1093/humupd/dmu042.

Mieritz MG, Christiansen P, Jensen MB, et al. Gynaecomastia in 786 adult men: clinical and biochemical findings. Eur J Endocrinol. 2017 May;176(5):555-566. doi:10.1530/EJE-16-0643.

Narula HS, Carlson HE. Gynaecomastia – pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014 Nov;10(11):684-698. doi:10.1038/nrendo.2014.139.

Ordaz DL, Thompson JK. Gynecomastia and psychological functioning: A review of the literature. Body Image. 2015 Sep;15:141-148. doi:10.1016/j.bodyim.2015.08.004.

Paris F, Gaspari L, Mbou F, et al. Endocrine and molecular investigations in a cohort of 25 adolescent males with prominent/persistent pubertal gynecomastia. Andrology. 2016 Mar;4(2):263-269. doi:10.1111/andr.12145.

Rew L, Young C, Harrison T, Caridi R. A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc. 2015 Aug;43:206-212. doi:10.1016/j.adolescence.2015.06.007.

Sarkar A, Bain J, Bhattacharya D, et al. Role of Combined Circumareolar Skin Excision and Liposuction in Management of High grade Gynaecomastia. J Cutan Aesthet Surg. 2014 Apr;7(2):112-116. doi: 10.4103/0974-2077.138354.