Gynaecomastia (adolescent, adult)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Adolescent
Laboratory tests (only if warning sign or persistence beyond 24 months), at 8 am
- Serum creatinine with eGFR
- AST
- ALT
- GGT
- TSH
- LH
- FSH
- Oestradiol (male and child code)
- Total testosterone at 8 am (child code)
- SHBG
- Serum β-hCG
- Free or bioavailable testosteroneif neededThe SFEDP minimum tests include total and free testosterone at 8 am [2]; the EAA settles for total testosterone with SHBG [1].
- Serum prolactin (if LH and FSH low)if neededLow LH and FSH (central hypogonadism): look for hyperprolactinaemia; a hypothalamic-pituitary MRI completes the work-up [2].
- Karyotype (if LH and FSH raised)if neededHigh LH and FSH (primary hypogonadism): first rule out Klinefelter syndrome [2].
Do not order
- Hormone tests for typical pubertal gynaecomastia, with no warning sign: unnecessary [2].
Adult
Laboratory tests
- Total testosterone
- Oestradiol (male code)
- SHBG
- Bioavailable testosterone or calculated free testosterone (if total testosterone borderline)if needednon-French guidelineTotal testosterone to be interpreted with SHBG; in doubtful cases, free testosterone, preferably calculated or measured by equilibrium dialysis [1].
- LH
- FSH
- Serum prolactin
- TSH
- Serum β-hCG
- Alpha-fetoprotein
- AST
- ALT
- Serum albumin
- Serum creatinine with eGFR
- IGF-1 (if signs of acromegaly)if needednon-French guidelineThe 2026 Italian recommendations propose IGF-1 depending on the clinical picture, gynaecomastia being described in acromegaly [3]. The EAA does not cite it in its tests [1]. See the page “Acromegaly”.
- Testicular ultrasound, even if palpation is normal.
Do not order
- Routine breast imaging: proposed only if the clinical examination is equivocal; for a suspicious lesion, biopsy straight away [1].
Sources (11)
- Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines: gynecomastia evaluation and management. Andrology. 2019;7(6):778-793.
- Lusteau A, Villanueva C, Gay CL, Perge K. Gynécomastie chez l'enfant et l'adolescent. Pas à pas en pédiatrie, 2023 (article validé par la Société française d'endocrinologie et diabétologie pédiatrique, SFEDP).
- Pozza C, Selice R, Barbonetti A, Hasenmajer V, Lotti F, Menafra D, et al. Management of gynecomastia in adolescence and adults: the clinical practice guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS). J Endocrinol Invest. 2026;49(10):2583-2610.
- Dickson G. Gynecomastia. Am Fam Physician. 2012;85(7):716-722.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0727 (œstradiol homme et enfant), 0330 (œstradiol femme), 0357 et 1136 (testostérone), 0358 (SHBG).
- ANSM, Base de données publique des médicaments. Résumé des caractéristiques du produit ALDACTONE 25 mg (spironolactone), rubrique 4.8, mise à jour du 29/09/2026, consulté le 11 octobre 2026.
- García Rodríguez LA, Jick H. Risk of gynaecomastia associated with cimetidine, omeprazole, and other antiulcer drugs. BMJ. 1994;308(6927):503-6.
- ANSM, Base de données publique des médicaments. Résumé des caractéristiques du produit BICALUTAMIDE ACCORD 50 mg, rubrique 4.8, mise à jour du 29/09/2026, consulté le 11 octobre 2026.
- ANSM, Base de données publique des médicaments. Résumé des caractéristiques du produit MOPRAL 20 mg (oméprazole), rubrique 4.8, mise à jour du 29/09/2026, consulté le 11 octobre 2026.
- National Institute for Health and Care Excellence (NICE, Royaume-Uni). Suspected cancer: recognition and referral. NICE guideline NG12, partie cancer du sein (recommandations de 2015), consulté le 30 octobre 2026.
- Bromley HL, Preston M, Walter L, Dave R, Lord N, Wright P, et al. Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester. Ann R Coll Surg Engl. 2022;104(3):174-180.