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Gynaecomastia

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2022

Overview

These guidelines have been provided by the Endocrinology Team at NBT so pathways might be slightly different at UHBW

Definition

Benign enlargement of male breast tissue resulting from proliferation of the glandular component of the breast

Firm sub-areolar and ductal tissue will be palpable, as opposed to breast enlargement caused by excess adipose tissue (pseudogynaecomastia)

Important points

Results from relative oestrogen excess or testosterone deficiency leading to a high oestrogen:testosterone ratio

Who to refer

Routine Endocrine referral if biochemical evidence of hypogonadism or hyperprolactinaemia

Surgical treatment for gynaecomastia is not routinely commissioned in BNSSG CCG and is subject to the Breast Surgery (for males) individual funding policy.

Tamoxifen treatment is not routinely commissioned and is currently not on the BNSSG Formulary for this indication and so should not be prescribed.

Red Flags

If discreet breast mass, skin or nipple changes or axillary lymphadenopathy – Breast Urgent Suspected Cancer - USC (2WW).

If suspicious for testicular or adrenal malignancy – Urology Urgent Suspected Cancer - USC (2WW).

Before referral

Take a thorough history including duration of symptoms, symptoms of hypogonadism and recreational drug and alcohol use

Carry out a breast examination, general examination (for signs of hyperthyroidism, chronic liver disease and hypogonadism) and testicular examination (masses and small testes consistent with possible hypogonadism)

Review all medications and stop any possible drug that could be inducing gynaecomastia

(www.nottsapc.nhs.uk/media/1519/gynaecomastia-guideline.pdf)

If the underlying cause is not obvious, consider the following bloods:

LFTs and U&Es
TSH
LH/FSH, oestradiol, testosterone, SHBG
Prolactin

Resources

References

https://academic.oup.com/jcem/article/96/1/15/2833174

https://www.bmj.com/content/354/bmj.i4833

https://associationofbreastsurgery.org.uk/media/334381/abs-summary-statement-gynaecomastia-pdt-pictogram.pdf

Useful patient information;

https://breastcancernow.org/sites/default/files/publications/pdf/bcc155_gynaecomastia_2018_web_0.pdf

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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