An Approach to Gynecomastia in Primary Care Clinics

Gynecomastia occurs more commonly in adult males than is often recognized and is, therefore, not evaluated. The workup should be based on the patient’s presentation and important clinical factors, including underlying medical disorders and medications. Patients without symptoms probably do not need additional evaluation unless an underlying clinical disorder is suspected. Ultrasonography of the breast is not routinely recommended. Gynecomastia will regress spontaneously in many patients but can be treated medically or surgically based on patient preference. It is not a premalignant condition and patients need this reassurance. Abstract Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient’s presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy.