Gynaecomastia

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Concerns of malignancy (hard firm mass or firm fixed lymph nodes), please refer to General Surgery under urgent referral.

Call the General Surgical registrar via the PCH Switchboard for advice on 6456 2222.

Introduction

Gynaecomastia is defined as abnormal breast tissue growth in males. It is a common condition with a lifetime occurrence of between 30 – 50% of males. There are three stages of life where gynaecomastia is more common and these relate to periods of peak hormonal change. These stages are the neonatal period, puberty and older adulthood.

Gynaecomastia can rarely be pathological secondary to drugs or testicular tumours.

Pre-referral investigations

Review medications, medical history, illicit drug use and examination of the testes to determine any pathology.
If gynaecomastia is thought to be pathological, please contact our Endocrinology Department for advice on further investigations.

Pre-referral management

When to refer

Refer to the Endocrinology Department if gynaecomastia is thought to be pathological.
Refer to the Plastic Surgery Department may be considered if there is no resolution after 12 months or if severe gynaecomastia is associated with significant psychological distress.

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
Urgent referrals (less than seven days) go to the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality.

Essential information to include in your referral

Family history of gynaecomastia
Medications including illicit drug use
Medical and surgical history
Approximate date of onset and impact on patient (physical and psychological)
Weight, height, stage of puberty and testicular size
Any relevant imaging reports and details of radiology service.

Useful resources

References

Andrology Australia. (2021). Male Breasts (gynecomastia). Retrieved March 15, 2021, from Healthy Male: https://www.healthymale.org.au/mens-health/male-breasts-gynecomastia
Health Direct. (2021, March). Gynecomastia. Retrieved March 15, 2021, from Health Direct: https://www.healthdirect.gov.au/gynecomastia
Nationwide Children's Hospital. (2019). Gynecomastia. Retrieved March 15, 2021, from Nationwide Children's Hospital: https://www.nationwidechildrens.org/conditions/gynecomastia

Reviewer/Team:	Dr Aris Siafarikas, Head of Deparment Endocrinology and Dr Savundra, Head of Department, Plastics	Last reviewed:	Apr 2021
		Review date:	Apr 2024
Endorsed by:	CPAC	Date:	July 2021

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