EEA releases new clinical guideline on gynecomastia
The European Academy of Andrology (EAA) has released new clinical guidelines on the assessment and management of gynecomastia (GM). The guideline is published in the journal Andrology.
Gynecomastia is a benign proliferation of glandular tissue of the breast in males. It is a frequent condition with a reported prevalence of 32–65%, depending on the age and the criteria used for definition.
Gynecomastia of infancy and puberty are common, benign conditions resolving spontaneously in the majority of cases.Gynecomastia of adulthood is more prevalent among the elderly and proper investigation may reveal an underlying pathology in 45–50% of cases.
- The presence of an underlying pathology should be considered in GM of adulthood.
- The initial screening to rule out lipomastia, obvious breast cancer, or testicular cancer should be performed by a general practitioner or another non‐specialist.
- In cases where a thorough diagnostic workup is warranted the screening should be performed by a specialist.
- The medical history should include information on the onset and duration of Gynecomastia, sexual development and function, and administration or abuse of substances associated with GM.
- Physical examination should detect signs of under‐virilization or systemic disease.
- Breast examination should confirm the presence of palpable glandular tissue to discriminate GM from lipomastia (pseudo‐gynecomastia) and rule out the suspicion of malignant breast tumor.
- Physical examination should include the examination of the genitalia to rule out the presence of a palpable testicular tumor and to detect testicular atrophy.
- Genitalia examination should be aided by a testicular ultrasound, as the detection of a testicular tumor by palpation has low sensitivity.
- A set of evaluations may include T (testosterone), estradiol E2, SHBG (sex hormone-binding globulin), LH (luteinising hormone), FSH (follicle stimulating hormone), TSH (thyroid stimulating hormone), prolactin, hCG (human chorionic gonadotropin), AFP (alpha-foetal protein), and liver and renal function tests.
- Breast imaging should offer assistance, where the clinical examination is equivocal.
- If the clinical picture is suspicious for a malignant lesion, core needle biopsy should be performed.
- Watchful waiting should be done after treatment of underlying pathology or discontinuation of the administration/abuse of substances associated with GM.
- T treatment should be offered only to men with proven testosterone deficiency.
- The use of selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), or nonaromatizable androgens is not recommended in the treatment of GM in general.
- Surgical treatment is suggested only for patients with long‐lasting GM, which does not regress spontaneously or following medical therapy. The extent and type of surgery depend on the size of breast enlargement, and the amount of adipose tissue.
For detailed recommendations log on to https://doi.org/10.1111/andr.12636