Assessment in primary care
Most patients visit their General Practitioner who will usually carry out an examination (which may include testicular examination).
If a hard lump is detected, a distorted nipple, or an axillary (arm-pit) lump, the General Practitioner may request an urgent review in a breast cancer clinic.
The General Practitioner may consider arranging some blood tests (blood tests are not routinely needed for gynaecomastia in puberty). Baseline tests would include thyroid function tests (TFTs), electrolytes (U&E’s) and liver function tests (LFTs). If these are normal she or he, will usually request a hormone blood screen: which might include testosterone, LH, FSH, estradiol, beta-hCG, alpha-fetoprotein, SHBG, prolactin and dehydroepiandrosterone. Very occasionally patients may be referred for blood tests to look for a chromosomal abnormality.
In many patients, no identifiable cause is found.