Monitoring
Asymptomatic men without an obvious cause should be re-examined in 6 months to confirm that gynaecomastia is stable or improving. In the absence of weight gain, or new drug or environmental exposure, an increase in breast size may indicate the presence of a new medical condition. Spontaneous regression occurs in adult men, although this is rare in controlled trials.
Asymptomatic physiological gynaecomastia or gynaecomastia of known cause
Needs no monitoring after the initial 6-month follow-up to assess stability. It may take 3 to 6 months after withdrawal of a drug or exposure, or treatment of an underlying disease, before gynaecomastia begins to respond.
Anti-oestrogen therapy should be monitored at 6-month intervals for potential adverse effects.
The hypothalamic-pituitary-testicular axis may not recover from exogenous androgen usage, even after 1 to 2 years of abstinence.[64]
Follow-up recommendations for patients undergoing testosterone replacement include:
Monitoring of haematocrit at 6-month intervals for erythrocytosis (especially in smokers)[64]
A digital rectal examination and prostate-specific antigen test annually
Evaluation of lipids at 6 months and 1 year after initiation of the testosterone.
Men with prostate cancer
Recurrence of gynaecomastia is possible if anti-oestrogen therapy is withdrawn. Radiation for gynaecomastia is less desirable, but it can be used if tamoxifen treatment fails or must be discontinued due to intolerance or hypersensitivity.
Surgery usually produces significant improvement in pain and/or appearance, although more than one surgical procedure may be needed. Surgical follow-up depends on the type of surgery, pathological findings, and any complications.
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