Gynaecomastia

Definition/Description

Benign Proliferation of breast glandular tissue in the breast.

Gynaecomastia is the most common breast disorder in men. It occurs in up to one in three men at some time in their life. The condition is often transient, self-limiting or reversible and can usually be dealt with in primary care.

Red Flag Symptoms

  • Unilateral firm subareolar mass not typical of gynecomastia with or without skin changes or nipple distortion.
  • Unilateral eccentric mass.
  • Nipple changes.

Guidelines on Management

  • If red flag symptoms present – Refer to Breast clinic via 2WW
  • If no red flags present:
    • Review medications
    • Consider systemic disease / tumours – general examination, sexual characteristics
    • Check FBC, U+Es, LFTs, TSH, SHBG, Testosterone, Oestrodiol, Prolactin, HCG, AFP, LH
  • If there is a reversible cause, dealing with this early should reverse the gynaecomastia. However, if present for long time and fibrosis has occurred – then surgery may be the only option.
  • If hormonal abnormality found – REFER to ENDOCRINOLOGY
  • IF other underlying condition – REFER to appropriate speciality.

Do not refer

None

Referral Criteria/Information

Referral Information

If condition painful or distressing, then referral to breast clinic can be considered. However, IFR approval should be sought prior to referral.
 

Causes

  • Most cases are idiopathic.
  • Secondary to certain medication: H2 Antagonists / Anti androgens / Spironolactone / Antiretrovirals / Antipsychotics / Prednisolone/ Antidepressants / opiates. The BNF lists over 100 drugs that may cause it. A table of the main ones from Pharmaco-vigilance.eu is provided in appendix 1
  • Secondary to endocrine disorder or systemic disease:
    • Hormone secreting lung or other tumour
    • Liver disease e.g., NALFD and Alcohol related disease
    • Endocrine disorders such Hyperthyroidism, Congenital adrenal hyperplasia,
    • Genetic disorders.
  • Early onset gynaecomastia is often tender but will resolve in 3-4 months.
  • Obesity can also cause pseudo-gynaecomastia due to excess adipose tissue.

Additional Resources & Reference

Patient information leaflets / PDAs

What is gynaecomastia? - NHS (www.nhs.uk)

References

https://patient.info/doctor/gynaecomastia

Drug-induced gynecomastia - Pharmaco-vigilance.eu

Further reading

Gynaecomastia BMJ 2016;354:i4833 Thiruchelvam, Walker, Rose, Lewis & Al-Mufti

Appendix 1 Adapted from Pharmaco-vigilance.eu: 

Antiandrogens

Bicalutamide, flutamide, finasteride, dutasteride

Antihypertensive

Spironolactone, Eplerenone

Antiretroviral

Protease inhibitors (saquinavir, indinavir, nelfinavir, ritonavir, lopinavir), reverse transcriptase inhibitors (stavudine, zidovudine, lamivudine)

Environmental Exposure

Phenothrin (antiparasitical)

Exogenous Hormones

Oestrogens, prednisone (male teenagers)

Gastrointestinal Drugs

H2 histamine receptor blockers (cimetidine) Proton pump inhibitors (omeprazole)

Antifungal

Ketoconazole (prolonged oral use)

Antihypertensive

Spironolactone, Eplerenone ACE Inhibitors Calcium channel blockers (amlodipine, diltiazem, felodipine, nifedipine, verapamil)

Antipsychotic (first generation)

Haloperidol, olanzapine, paliperidone (high doses), risperidone (high doses), ziprasidone

Antiretroviral

Efavirenz

Chemotherapy Drugs

cisplatin, vincristine, procarbazine

Exogenous Hormones

Androgens (athletes abuse)

Cardiovascular Drugs

Phytoestrogens, sometimes used to prevent heart disease, are often soya-based

 

Responsible Consultant: Miss Jenny Piper

Responsible GP: Dr Ruth Guest

Responsible Pharmacist: Jamal Hussain

Associated Policies

There are no associated policies.

Specialties

York - Breast

Places covered by

  • Vale of York
Author:
Date created: 06/06/2025, 08:41
Last modified: 11/06/2025, 11:19
Date of review: 31/12/2025