Gynecomastia

Gynecomastia commonly occurs in boys, especially during early stages of puberty, because of an imbalance favoring estrogen over androgens. Although pubertal gynecomastia is usually benign and resolves on its own, it is important to identify any pathological causes. Evaluation should focus on differentiating true gynecomastia from pseudogynecomastia and identifying red flags through careful history-taking, pubertal assessment, and systemic examination. In typical pubertal cases, investigations are rarely needed and should be guided by clinical signs. Treatment mainly involves reassurance, monitoring, addressing underlying conditions, and stopping any offending drugs. Medical therapy may be considered for selected symptomatic or persistent cases, while surgery is reserved for severe or refractory gynecomastia.