The majority of gynaecomastia is pubertal with peak incidence at age 13 to 14 years, correlating to mid-puberty. Pubertal gynaecomastia will resolve within two to three years with completion of puberty in up to 90% of cases and can be managed with advice and reassurance.
Onset of puberty in males is defined by an increase in testicular volume to ≥ 4mL or genitalia Tanner stage 2. The normal age range for onset of puberty in males is between ages 9 and 14 years.
Consider pseudogynaecomastia or lipomastia, which is the appearance of breast tissue due to excess fat, particularly in people who are above healthy weight. Other causes of gynaecomastia include thyrotoxicosis, Klinefelter’s Syndrome and hypogonadism.
Initial assessment should include:
- Growth and pubertal assessment
- Clinical assessment of breast enlargement (breast tissue vs fat tissue)
- Assess for presence of galactorrhoea
- Assess for clinical features suggestive of Klinefelter’s Syndrome (tall stature, learning difficulties, small testes) or thyrotoxicosis (tachycardia, tremor, goitre, weight loss, thyroid eye signs)
Investigations to be considered
LH, FSH, Testosterone, Oestradiol, Prolactin, Thyroid function tests, LFTs
If advice is required to help with the interpretation of blood test results, then please refer via SCI Gateway (advice option), or email: loth.rhcypendocrine@nhs.scot
C.M & E.B – 28-7-26
Who to Refer
- Patients who are clinically or biochemically prepubertal
- Patients with clinical features of Klinefelter’s Syndrome or thyrotoxicosis
- Any concerns about abnormal blood results
- Patients with galactorrhoea.
Who not to Refer
- Young person with simple pubertal gynaecomastia.
How to refer
Please refer via SCI Gateway to RHCYP → Endocrinology
