Gynecomastia: Test and Diagnosis

Laboratory parameters of the 1st order – obligatory laboratory tests.

  • LH*
  • FSH*
  • Prolactin*
  • Estradiol*
  • Testosterone* (hypogonadism?)
  • Sex hormone binding globulin* (SHBG).
  • Dehydroepiandrosterone sulfate* (DHEAS)
  • Thyroid parameters – TSH (thyroid-stimulating hormone) – exclusion of hyperthyroidism (hyperthyroidism); this induces the peripheral conversion of testosterone to estrogens.
  • Liver parameters* – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT).
  • Renal parameters – urea, creatinine, possibly cystatin C or creatinine clearance – exclusion of renal insufficiency (kidney weakness).
  • Tumor markers (ß-HCG* , AFP* (alpha-fetoprotein), Ca 15-3 – exclusion of a mammary or testicular tumor (the gynecomastia may be the first symptom of a testicular tumor!).
  • Fine needle biopsy (removal of a tissue sample)/punch biopsy – if a carcinoma is suspected.

* Performed in pubertal gynecomastia according to the S1 guideline gynecomastia.

Laboratory parameters 2nd order – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification.