Gynecomastia

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ReviewedChoose any

Tanner stageChoose oneFirst line

ExamChoose one

SizeChoose one

TendernessChoose any

Testicular examChoose one

Red flags presentChoose any

Red flags absentChoose any

Possible contributorsChoose any

AssessmentChoose one

PlanChoose any

SubstancesChoose any

MedicationChoose any

WeightChoose any

SupportChoose any

LabsChoose any

Testicular ultrasoundChoose any

Breast ultrasoundChoose any

ReferralChoose one

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Note when inserted as is

Gynecomastia
• Duration, pain, progression, pubertal status, medications, substances, and supplements reviewed
• Firm, mobile subareolar tissue on both sides, consistent with pubertal gynecomastia
• Normal testicular exam
• No hard or fixed mass, nipple discharge or skin changes, testicular mass or asymmetry, tissue larger than 5 cm, onset before puberty, or lasting more than 2 years
• Pubertal gynecomastia, expected to resolve within 6 months to 2 years
• Reassurance and watchful waiting given a typical exam
• Follow up in 6 months

Breast tissue in boys during puberty is very common, comes from normal hormone changes, and usually goes away on its own within 6 months to 2 years. Return precautions given including a hard lump, nipple discharge, skin changes over the breast, a lump in a testicle, rapid growth, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Tanner stage; size; tenderness
Exam (bilateral, one-sided, pseudogynecomastia)
Testicular exam
Red flags present or absent (hard mass, discharge or skin change, testicular mass, over 5 cm, prepubertal, over 2 years)
Contributors (marijuana, anabolic steroids, supplements, prescribed medications)
Pubertal, pseudo, needs evaluation
Reassurance and monitoring
Labs, testicular ultrasound, breast ultrasound; body image
Endocrinology; pediatric surgery for a suspicious mass; plastic surgery after 2 years

Return precautions in the template

a hard lumpnipple dischargeskin changes over the breasta lump in a testiclerapid growth

Sources

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (pages reviewed July 22, 2021; no later update notice)
HealthyChildren.org: Penile Adhesions and Skin Bridges
HealthyChildren.org: Varicocele
HealthyChildren.org: Delayed Puberty in Boys
International Evidence-based Guideline for PCOS (2023), adolescent recommendations. Peña AS et al., BMC Medicine 2025;23:151

Few formal guidelines cover this topic, so the template also leans on expert opinion.