Cost-effective management of gynecomastia

Background: Routine endocrine screening of idiopathic gynecomastia has been advocated, but may not be cost effective. We carried out a cost-benefit analysis of this approach. Methods: A retrospective study (1992 to 1997) of 87 adult males with symptomatic gynecomastia was performed. Results: Thirty-four (39%) patients had extrinsic causes; 53 (61%) were considered idiopathic. Forty-five idiopathic cases underwent endocrine testing: β human chorionic gonadotropin alone, 16; and β human chorionic gonadotropin, LH, estradiol, testosterone ± testicular ultrasound, 29. One (2%) occult Leydig cell testicular tumor was detected. Forty-four patients had normal studies and remain well after local excision. Conclusion: Routine endocrine evaluation of idiopathic gynecomastia is rarely productive; such testing is best done selectively.