Gynecomastia: A continuing diagnostic dilemma

Breast enlargement in males can be a physiologic or idiopathic phenomenon occurring in newborns, adolescents, and possibly, normal elderly men; it can be the result of a feminizing state, or due to causes unknown.¹ There are many causes of feminizing states, but most fall into three categories: absolute increases in estrogen formation as a result of direct secretion by tumors, increased availability of estrogen precursors, as in cirrhosis, or rare instances of hereditary increase in extraglandular synthesis of estrogen; relative increases in the ratio of estrogen to androgen, as in testicular failure; and drugs. The drugs are usually estrogens themselves,.