Intended for healthcare professionals

Practice 10-Minute-Consultation


BMJ 2022; 379 doi: (Published 20 October 2022) Cite this as: BMJ 2022;379:e069771
  1. James Daniels, general duties medical officer1,
  2. Amanda Brickstock, CT1 in psychiatry2,
  3. Rodger Charlton, general practitioner3
  1. 1British Army, UK
  2. 2Northwest London and West London Trusts, UK
  3. 3Hampton Surgery, London, UK
  1. Correspondence to J Daniels:
  • Accepted 30 September 2022

What you need to know

  • 20-25% of gynaecomastia cases are attributable to prescription medications or drug use. Stopping the causative agent removes the need for further investigation14

  • Breast cancer is an important differential. The mean age of diagnosis in men is 65, with an incidence of around 375 cases a year between 2016 and 2018414

  • Gynaecomastia is a presenting symptom in 7-11% of testicular cancer cases16

  • A two week wait referral to urology for a testicular ultrasound is recommended in men with raised oestradiol, B-hCG, or AFP5171920

A 59 year old man attends his GP describing a three month history of bilateral breast enlargement. He noticed his nipples were painful when the dog jumped up at him, and reports having put on weight and having lost interest in sex. He has also developed difficulties in producing and sustaining an erection over the previous 18 months.

Gynaecomastia is the benign development of male glandular breast tissue.123 It is a relatively common condition, affecting an estimated one third of men during their lifetime.124 In the early stages of development, if the cause is identified and treated, the condition is frequently reversible. Among adolescents with physiological gynaecomastia, the condition regresses without intervention in 90% of cases.5

The causes of gynaecomastia are physiological or non-physiological (table 1). Physiological gynaecomastia occurs in newborns, adolescents, and older adults. Maternal trans-placental oestrogen transfer has been implicated in the development of neonatal gynaecomastia, and a comparative lag in testosterone secretion during adolescence and declining free testosterone levels in senescence are associated with pubertal and old age presentations. Non-physiological causes include chronic disease, malignancy, and medication or drug use.6

View this table:
Table 1

Common causes of gynaecomastia %

Why do patients present?

Patients may present to their doctor for a variety of reasons. In …

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