EEA issues new guideline on gynaecomastia

  • Dawn O'Shea
  • Univadis Medical News
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The European Academy of Andrology (EAA) has published new clinical guidelines which include 15 recommendations on the assessment and management of gynaecomastia (GM).

The recommendations are:

  • Consider underlying pathology in GM of adulthood
  • GP or another non-specialist should rule out lipomastia, obvious breast cancer or testicular cancer
  • Thorough diagnostic workup, when warranted, should be performed by a specialist
  • Medical history should include information on onset and duration, sexual development and function and use of substances associated with GM
  • Examine for signs of under-virilisation or systemic disease
  • Breast exam should confirm the presence of palpable glandular tissue
  • Physical examination should include examination of the genitalia
  • Genitalia examination should be aided by testicular ultrasound
  • Testosterone (T), oestradiol (E2), sex hormone-binding globulin (SHBG), luteinising hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone (TSH), prolactin, human chorionic gonadotropin (hCG), alpha-foetal protein (AFP) and liver and renal function tests are appropriate
  • Breast imaging may offer assistance
  • Core needle biopsy for suspicious lesions
  • Watchful waiting after treatment of underlying pathology or discontinuation of substances associated with GM
  • T therapy only for men with proven deficiency
  • Avoid selective oestrogen receptor modulators (SERMs), aromatase inhibitors (AIs) or non-aromatisable androgens, in general
  • Surgical treatment only for patients with long-lasting GM