Gynecomastia.

Gynecomastia is common and may be asymptomatic. In most cases, a thorough history and physical examination, along with limited laboratory investigations, can help to exclude breast malignancy and serious underlying endocrine or systemic disease. Careful clinical observation may be all that is required in many cases, because gynecomastia often resolves spontaneously. Because gynecomastia is usually caused by an imbalance of androgenic and estrogenic effects on the breast, medical therapy may include antiestrogens, androgens, or aromatase inhibitors. Surgery is useful in the management of patients with long-standing symptomatic gynecomastia or when medical therapy is not successful.