Synopsis
Confirm true glandular gynaecomastia, distinguish it from adiposity and male breast cancer, identify medicine or systemic causes, and manage symptoms without unsafe withdrawal of essential treatment.
- True gynaecomastia is palpable benign glandular tissue extending concentrically beneath the nipple-areolar complex; diffuse fat without a glandular disc is pseudogynaecomastia.
- Physiological peaks occur in neonates, puberty and older age, but new adult-onset disease requires a medicine, substance and systemic-cause review.
- Representative contributors include spironolactone, bicalutamide or other anti-androgens, finasteride or dutasteride, cimetidine, some antipsychotics, opioids and anabolic steroids; essential treatment is changed only with its prescriber.
Investigation priorities
Distinguish subareolar glandular tissue from an eccentric suspicious lesion and adiposity.
Management branches
A 67-year-old develops tender bilateral subareolar glandular tissue three months after starting spironolactone for heart failure, with no eccentric mass, nipple change, node or endocrine warning feature.
- Confirm true concentric glandular enlargement and reconcile the timing of spironolactone, dose changes, other prescribed medicines and non-prescribed substances.
- Explain that spironolactone is a recognised contributor, but do not stop or reduce it independently; ask the heart-failure prescriber whether an evidence-based alternative or dose strategy is clinically acceptable for this individual.