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Investigations in patients presenting with symptoms and/or signs suggestive of breast cancer, prior to referral, is not recommended.
Blood tests are not necessary in pubertal boys nor in men on medication associated with gynaecomastia
For those with soft swelling which is unlikely to be due to breast malignancy consider:
Referral to endocrinology is recommended in the event of any abnormality of these hormone profiles; see table below.
|Hormone test result||Possible diagnoses|
|All normal||Idiopathic gynaecomastia|
|Low Testosterone with elevated LH||Primary hypogonadism; Klinefelter's syndrome|
|Low Testosterone with normal LH||Pituitary/hypothalamic disease|
|Elevated Testosterone with elevated Oestradiol||Androgen exposure; testicular tumour|
|Elevated Oestradiol with elevated SHBG||Oestrogen exposure; testicular/adrenal tumour|
|Elevated DHEA||Adrenal tumour|
|Elevated β-hCG||Testicular/ectopic tumour|
|Elevated Prolactin||Pituitary tumour; drug-related cause|
Once non-breast malignancies have been excluded (see table above), these patients can be reassured and do not require referral
Drug treatment of Gynaecomastia
Once non-breast malignancies have been excluded (see table above), these patients can be reassured and managed in primary care as outlined in the Management section. For advice on prescribing, please request advice via the Pre-Choice Triage service on e-Referrals.
The GP should refer via e-Referral Service
This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.
Publication date: November 2020