Differential Diagnosis and Workup for Male Gynecomastia:

Medications: spironolactone, ketoconazole, finasteride, alcohol, opiates, INH, steroids (testosterone, estrogen), atypical antipsychotics, essential oils (thanks Meghan for sharing details on lavender and tea tree oils!), androgen deprivation

Hypogonadism:  look for signs of decreased muscle mass, body hair, and testicular size, change in libido

Malignancy:

 - Breast cancer (increased risk if +FH, BRCA mutation, Klinefelter syndrome)

 - Testicular tumors (especially those that secrete beta-hcg or estradiol)

 - Adrenal tumors

Persistent pubertal gynecomastia (usually longstanding history of gynecomastia even as an adolescent)

Systemic disease

Cirrhosis

Renal disease

Thyroid disease



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