To diagnose<unk> , a thorough history and physical examination are obtained by a physician. Important aspects of the physical examination include evaluation of the male breast tissue with palpation to evaluate for breast cancer and pseudogynecomastia (male breast tissue enlargement solely due to excess fatty tissue), evaluation of penile size and development, evaluation of testicular development and an assessment for masses that raise suspicion for testicular cancer, and proper development of secondary sex characteristics such as the amount and distribution of pubic and underarm hair.<unk>  usually presents with bilateral involvement of the breast tissue but may occur unilaterally as well. A review of the medications or illegal substances an individual takes may reveal the cause of<unk> . Recommended laboratory investigations to find the underlying cause of<unk>  include tests for aspartate transaminase and alanine transaminase to rule out liver disease, serum creatinine to determine if kidney damage is present, and thyroid-stimulating hormone levels to evaluate for hyperthyroidism. If these initial laboratory tests fail to uncover the cause of<unk> , then additional tests to evaluate for an underlying hormonal balance due to hypogonadism or a testicular tumor should be checked including total and free levels of testosterone, luteinizing hormone, follicle stimulating hormone, estradiol, serum beta human chorionic gonadotropin (β-hCG), and prolactin. High levels of prolactin are uncommon in people with<unk> . If β-hCG levels are abnormally high, then ultrasound of the testicles should be performed to check for signs of a hormone-secreting testicular tumor. Markers of testicular, adrenal, or other tumors such as urinary 17-ketosteroid or serum dehydroepiandrosterone may also be checked if there is evidence of hormonal imbalance on physical examination. If this evaluation does not reveal the cause of<unk> , then it is considered to be idiopathic<unk>  (of unclear cause). Differential diagnosis Other causes of male breast enlargement such as mastitis, breast cancer, pseudogynecomastia, lipoma, sebaceous cyst, dermoid cyst, hematoma, metastasis, ductal ectasia, fat necrosis, or a hamartoma are typically excluded before making the diagnosis. Another condition that may be confused with<unk>  is enlargement of the pectoralis muscles. Imaging Mammography is the method of choice for radiologic examination of male breast tissue in the diagnosis of<unk>  when breast cancer is suspected on physical examination. However, since breast cancer is a rare cause of breast tissue enlargement in men, mammography is rarely needed. If mammography is performed and does not reveal findings suggestive of breast cancer, further imaging is not typically necessary. If a tumor of the adrenal glands or the testes is thought to be responsible for the<unk> , ultrasound examination of these structures may be performed. Histology Early histological features expected to be seen on examination of<unk>  tissue attained by fine-needle aspiration biopsy include the following: proliferation and lengthening of the ducts, an increase in connective tissue, an increase in inflammation, and swelling surrounding the ducts, and an increase in fibroblasts in the connective tissue. Chronic<unk>  may show different histological features such as increased connective tissue fibrosis, an increase in the number of ducts, less inflammation than in the acute stage of<unk> , increased subareolar fat, and hyalinization of the stroma. When surgery is performed, the gland is routinely sent to the lab to confirm the presence of<unk>  and to check for tumors under a microscope. The utility of pathologic examination of breast tissue removed from male adolescent<unk>  patients has recently been questioned due to the rarity of breast cancer in this population. Classification The spectrum of<unk>  severity has been categorized into a grading system: * Grade I: Minor enlargement, no skin excess * Grade II: Moderate enlargement, no skin excess * Grade III: Moderate enlargement, skin excess * Grade IV: Marked enlargement, skin excess
Gynecomastia
Breast atrophy
Pattern hair loss
Post-vacation blues
Adipomastia
Trichomegaly
Breast hypertrophy
Clitoromegaly