Gynaecomastia Diagnosis: Processes Used for Evaluation and Assessment

diagnosing gynaecomastia

Gynaecomastia is a condition where there's an increase in the glandular tissue in male breasts, causing worry and discomfort for boys and men. This usually happens because of hormonal imbalances, commonly during important life stages like infancy, adolescence, and mid to late adulthood.

Around 70% of boys in early puberty may experience this because of natural hormone changes. Knowing the reasons and possible treatments is important because gynecomastia might go away on its own, but sometimes it needs treatment. This article delves into the various gynaecomastia test evaluation and assessment methods employed by healthcare professionals to diagnose gynecomastia across different age groups.

Process for Gynecomastia Diagnosis

Gynecomastia, the enlargement of glandular tissue in male breasts, often raises questions and concerns regarding its underlying causes and appropriate treatment. The diagnostic process for gynecomastia is a multifaceted journey that involves careful consideration of various factors.

The initial assessment of males with breast enlargement involves addressing pivotal questions to guide the gynaecomastia diagnosis.

Onset and Duration:

Determining the recent onset of gynecomastia provides crucial insights. Sudden enlargement may signal underlying issues, prompting further investigation.

Pain or Tenderness:

Pain or tenderness is a significant factor. Understanding associated discomfort helps in evaluating the nature and severity of the condition.

Glandular Proliferation or Fat Deposition:

Distinguishing between true glandular enlargement and pseudogynecomastia (resulting from fat deposits) is essential for accurate diagnosis and appropriate management.

Signs of Breast Cancer:

Vigilance for signs or symptoms of breast cancer is paramount. Identifying any suspicious indicators guides subsequent diagnostic steps.

Testicular Tumor:

Considering the potential association with testicular tumours is crucial, as certain conditions may manifest concurrently.

Patient Discomfort:

Assessing the impact of breast enlargement on the patient's well-being helps gauge the necessity for intervention and gynaecomastia surgery and other treatments.

Medical history

A detailed history-taking process is the foundation for a comprehensive evaluation, offering a wealth of information to guide subsequent diagnostic steps.

Onset and Duration:

Understanding when the breast enlargement began, and its duration provides crucial insights into the temporal aspect of the condition. The historical context aids in determining whether the onset was sudden or gradual and helps to understand gynaecomastia symptoms and treatment plans.

Symptoms and Changes:

Inquiring about pain, tenderness, changes in size, nipple discharge, and associated symptoms indicate critical details about the nature and progression of gynecomastia. The comprehensive overview contributes to a more accurate gynaecomastia diagnosis.

Medication and Systemic Factors:

Exploring medication history, systemic illnesses, and factors such as weight changes contributes to identifying potential underlying causes. Certain medications and systemic conditions can significantly influence hormonal balances, leading to gynecomastia.

Family History:

Assessing family history is pivotal in uncovering hereditary conditions or predispositions that may contribute to gynecomastia. Insights into familial patterns guide healthcare professionals in understanding the genetic aspects of the condition and provide the best medicine for gynaecomastia and guide for other treatment modalities.

Physical examination

The physical examination is pivotal in differentiating between various causes of breast enlargement, providing substantial insights into the nature of the condition and gynaecomastia surgery and other treatment modalities.

Differentiating True Gynecomastia:

The physical examination involves a meticulous assessment of the breast tissue's texture and firmness. Distinguishing true gynecomastia from pseudo gynecomastia, which results from fat deposits, is essential for accurate diagnosis and tailored treatment planning.

Breast Carcinoma Signs:

Recognition of signs of breast carcinoma, such as irregular masses, skin dimpling, and nipple retraction, is crucial during the physical examination. These indicators prompt further investigations to rule out malignancies.

Systemic Assessment:

A comprehensive examination includes assessing the abdomen, testicles, and signs indicative of liver, kidney, or thyroid diseases.

Laboratory tests

Laboratory gynaecomastia tests help in identifying hormonal imbalances and underlying medical conditions contributing to gynecomastia.

Hormonal testing:

  • Comprehensive hormone testing, including estrogen, testosterone, LH, FSH, and others, aids in understanding the hormonal profile associated with gynecomastia. Abnormalities in hormone levels provide valuable insights into potential causes.

Liver, Kidney, and Thyroid Function:

  • Evaluating organ function through liver, kidney, and thyroid function tests helps exclude potential medical conditions contributing to gynecomastia. Dysfunction in these organs can disrupt hormone metabolism, leading to breast tissue enlargement.

Imaging studies

Imaging studies provide visual insights into breast tissue composition and aid in differentiating benign conditions from malignancies.


Mammography, traditionally associated with breast cancer screening, can also reveal the composition of breast tissue. It aids in distinguishing between gynecomastia and other conditions like tumours and comprehending gynaecomastia symptoms and treatment.


  1. The patient is positioned in front of the mammography machine, and the breast is compressed between two plates for optimal image quality.
  2. Low-dose X-rays are then done to capture detailed pictures of the breast tissue, focusing on spotting any unusual masses, microcalcifications, or changes in structure.
  3. Radiologists analyse the mammographic images to determine the nature of breast tissue changes. Mammography's high sensitivity aids in reducing the need for unnecessary biopsies by reliably distinguishing between benign and malignant conditions.

Breast Ultrasonography:

Breast ultrasonography is a non-invasive imaging method that utilises sound waves to produce detailed images of the breast tissue.


  1. A gel is applied to the skin over the breast area for the transmission of sound waves.
  2. A handheld probe is moved over the breast, emitting sound waves and capturing echoes to create real-time images of the breast tissue.
  3. The resulting images provide detailed visualisations of the breast tissue, allowing healthcare professionals to assess the nature of changes. Breast ultrasound is advantageous for differentiating between glandular tissue and fatty deposits.

Scrotal USG and Abdominal CT:

Scrotal ultrasound (USG) and abdominal computerised tomography (CT) are additional imaging modalities that are utilised in specific cases where risk factors or symptoms suggest the need for further evaluation. These imaging methods help assess potential associations with testicular tumours or other abdominal pathologies.


  1. Scrotal Ultrasound:
  • Similar to breast ultrasound, a gel is applied to the scrotal area.
  • A handheld probe is used to capture images of the scrotal contents, including the testicles and surrounding structures.
  • The ultrasound images assist in evaluating the scrotum for abnormalities, providing insights into potential testicular tumours.
  1. Abdominal CT:
  • The patient may need to fast or follow specific preparation instructions before undergoing an abdominal CT scan.
  • In some cases, contrast materials are administered intravenously to enhance the visibility of abdominal structures.
  • The patient lies on a table that moves through the CT scanner, capturing cross-sectional images of the abdominal region.
  • The resulting images allow healthcare professionals to evaluate the abdomen for abnormalities, including potential associations with gynecomastia and provide the best medicine for gynaecomastia and a treatment plan.

Tissue Biopsy:

When physical and imaging findings are inconclusive or when there is a need for a definitive gynaecomastia diagnosis, a tissue biopsy becomes necessary. A percutaneous biopsy is one method employed in cases where differentiation between gynecomastia and breast cancer is challenging.

Percutaneous Biopsy Steps:

  1. The area of concern is identified using imaging guidance, often ultrasound or mammography.
  2. Local anaesthesia is administered to numb the biopsy site, ensuring minimal discomfort for the patient.
  3. A thin, hollow needle is inserted through the skin into the targeted area, guided by imaging techniques to ensure precision.
  4. The needle is used to retrieve a small sample of tissue from the suspicious area.
  5. The obtained tissue sample is sent to a pathology laboratory for detailed examination. Pathologists analyse the sample to determine whether it is benign or malignant, providing a definitive diagnosis.


Understanding gynecomastia is a multidimensional process that requires precision and attention to detail. By strategically addressing key questions, exploring medical history, conducting a thorough physical examination, utilising laboratory tests, employing imaging studies, and, when necessary, resorting to tissue biopsy, healthcare professionals can understand the complexities of gynecomastia.  This knowledge of gynaecomastia diagnosis forms the foundation for tailored treatment plans, ensuring that individuals with gynecomastia receive personalised care that addresses the underlying causes and promotes overall well-being.