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Gynecomastia Tests: What Your Doctor Checks, and Why
Booking the appointment is the hard part. Once you're there, a gyno visit is usually short and simple. Here's exactly what a doctor checks, which tests you might get, and what each one is looking for.
Quick answer
A gyno visit starts with questions about your medicines, supplements and history, then an exam of your chest, armpits and testicles. Adults usually get blood tests: liver, kidney and thyroid, and hormones such as testosterone, estradiol, LH and FSH. Imaging isn't usually needed for typical gyno; if it is, men under 25 usually start with an ultrasound and men 25 and over with a mammogram.
On this page
The questions
Most of what a doctor learns comes from talking to you. American Family Physician says the history should rule out other causes of breast enlargement and review the use of medications, supplements and illicit drugs. Expect questions like:
- When did you first notice it, and has it changed?
- Is it sore? Has anything come out of the nipple?
- What medicines, supplements, gym products and drugs do you take, or have you taken?
- Have you used anabolic steroids?
- How much do you drink?
- Any weight change, tiredness, low sex drive or erection problems?
- Any family history of breast cancer?
Answer honestly, especially about steroids and recreational drugs. It changes which tests are useful.
The exam
The doctor will examine both sides of your chest, feeling for gland versus fat and checking the size, symmetry and firmness. American Family Physician says the exam should include the breasts, genitals, liver, lymph nodes and thyroid. That means the doctor will likely check your testicles, because rarely a testicular tumor can cause gyno. In teens, the doctor also notes how far puberty has progressed.
For teens with typical puberty gyno and nothing unusual, the exam may be the whole visit. The Seminars in Plastic Surgery review says that if development is normal for the boy's age, no further tests are needed.
The blood tests and what they look for
| Test | What it's checking |
|---|---|
| Liver enzymes | Liver disease, a known cause of gyno |
| Creatinine | Kidney function; long-term kidney failure is a cause |
| TSH | Thyroid; an overactive thyroid can cause gyno |
| Total and free testosterone | Low testosterone |
| Estradiol | Raised estrogen |
| LH and FSH | Whether a hormone problem starts in the testicles or the brain |
| Prolactin | A pituitary hormone some medicines raise |
| hCG and DHEA-S | Rare hormone-making tumors, if suspected |
From American Family Physician, 2012, and Seminars in Plastic Surgery, 2013. Your doctor chooses tests based on your history and exam; you won't necessarily get all of these.
Imaging: usually not needed
Most men with gyno don't need a scan. The American College of Radiology's guidance says men with typical gyno or chest fat don't usually need imaging. When the exam is unclear or worrying, it recommends:
- Under 25: start with an ultrasound, because breast cancer at this age is highly unlikely
- 25 and older, or a worrying exam at any age: start with a mammogram
American Family Physician adds that a testicular ultrasound may be done if there's a lump in a testicle, gyno larger than 5 centimeters, or gyno with no explanation. A needle sample of breast tissue is taken only if cancer is suspected.
How to prepare for the visit
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Make a list of everything you take
Prescriptions, over-the-counter drugs, supplements, protein and pre-workout products, skin and hair products, steroids and recreational drugs. Include anything from the last year or two.
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Write down the timeline
When you first noticed it, whether it's grown, whether it's sore.
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Take photos if it changes
If it's grown over weeks or months, photos in the same light help the doctor see the change.
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Bring your questions
Is it gland or fat? Could anything I take be causing it? Do I need blood tests? Is it likely to go away? When should I come back?
After the tests
If everything is normal, that's good news: nothing serious is causing it, and you can decide how to handle it on your own terms. Read will gyno go away for what to expect. If a cause is found, treating it can sometimes shrink the gyno, especially if it's new. And if your gyno bothers you enough to consider surgery, these same test results are what insurers ask for; see does insurance cover gynecomastia surgery.
Questions people ask
What blood tests are done for gynecomastia?
Commonly liver enzymes, creatinine and TSH, plus hormone tests such as total and free testosterone, estradiol, LH and FSH. Others, like prolactin, hCG or DHEA-S, are added if the history or exam suggests them.
Do I need an ultrasound for gynecomastia?
Not usually. Radiologists' guidance says typical gyno can be diagnosed by exam alone; a scan is for unclear or worrying cases, starting with ultrasound in younger men and mammography from 25.
Will the doctor check my testicles for gyno?
Usually, yes. American Family Physician says the exam should include the genitals, because a testicular tumor is a rare cause of gyno.
What kind of doctor should I see for gynecomastia?
Start with your family doctor or pediatrician. They may refer you to an endocrinologist for hormone problems, or a plastic surgeon if you want surgery.
Sources
- Dickson G. Gynecomastia. American Family Physician, 2012;85(7):716-722
- Lemaine V, Cayci C, Simmons PS, Petty P. Gynecomastia in adolescent males. Seminars in Plastic Surgery, 2013
- Mainiero MB, et al. ACR Appropriateness Criteria: evaluation of the symptomatic male breast. Journal of the American College of Radiology, 2015
Medical facts last checked against these sources on .
Medical disclaimer. I'm a guy who has lived with gyno, not a doctor. This page explains what published medical sources say, in plain words, so you can have a better conversation with your own doctor. It isn't medical advice, a diagnosis or a treatment plan. Don't start, stop or change any medication without talking to a doctor. If something on your chest is changing fast, hurts, or leaks fluid, get it checked.
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