Gynecomastia is the growth of the size of the male breast. It is a quite frequent finding. Patients asking for medical advice are usually being concerned of subjective complaints and the aesthetic problem. The gland is usually palpated when it goes beyond a diameter of 0.5 cm. Doctor, however, should explore the possibility, gynecomastia, be a symptom of malignancy event of another serious disease. We have to separate those cases where there is no pathological cause of those who will need special treatment.

The link between increased estrogen and the development of gynecomastia has been recognized for many years. It is particularly evident in the gynecomastia observed after the administration of estrogens, for therapeutic reasons, such as e.g. in prostate cancer. Endogenous overproduction of estrogen leads to the same result, as for example in testicular neoplasms. It was found, however, that even in cases of gynecomastia with normal estrogen levels, there are often low levels of androgens, especially testosterone. This led to the view that these two hormones have an opposite effect on the breast and that gynecomastia is a result of the estrogen/testosterone relationship. The observation that gynecomastia can also develop in situations where the levels of these hormones are normal, but there is a disturbance in the response of the specific tissue, (as for example in the congenital disorder of androgenic receptors), led to the concept that is valid today, that is , what ultimately determines the development of gynecomastia, is the net quotient of the estrogen/androgen ratio that effectively acts on the target organ. This quotient is determined by:

• Production of hormones
• Conversion of androgens to estrogens (eg in adipose tissue)
• SHBG levels
• Ability of target organs to respond to hormonal stimulus

GRADUATE COURSES IN ENDOCRINOLOGY AND DIABETES- DEPARTMENT OF ENDOCRINOLOGY DIABETES AND METABOLISM OF EVANGELISMOS GENERAL HOSPITAL OF ATHENS- 2004