Management of gynecomastia in adolescence and adults: the clinical practice guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS)

Purpose: Gynecomastia, defined as the benign proliferation of male breast glandular tissue, is a common condition in both adolescence and adulthood, often associated with physical discomfort and psychological distress. Despite its high prevalence, clinical management is frequently inconsistent and lacks standardized, evidence-based recommendations. Methods: The Italian Society of Andrology and Sexual Medicine (SIAMS) convened a multidisciplinary expert panel to develop updated clinical practice guidelines for the evaluation and management of gynecomastia. Recommendations were formulated based on a systematic review of the available literature and developed through expert consensus according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. The document was critically reviewed and approved by the SIAMS Executive Committee. Results: The guidelines address physiological, pharmacological, pathological, congenital, and genetic forms of gynecomastia, providing a structured diagnostic and therapeutic approach. Clinical assessment, including detailed history and examination, is the cornerstone of diagnosis, and should be complemented by targeted hormonal and imaging investigations when appropriate. Observation is recommended for physiological or recent-onset cases. Pharmacological therapy may be considered in selected idiopathic or painful forms, whereas testosterone replacement should be restricted to men with proven hypogonadism. Surgery is indicated for long-standing fibrotic gynecomastia or significant psychological distress. Psychological support is also advised, especially for adolescents. Conclusions: These SIAMS Guidelines provide an evidence-based, standardized framework for the diagnosis and management of gynecomastia, promoting individualized, multidisciplinary care and identifying priorities for future research.