Additional evaluation of increased estradiol in phenotypically male children and adolescents with gynecomastia

Our suggested initial laboratory evaluation for phenotypically male children and adolescents with unilateral or bilateral gynecomastia in whom a potential cause is not identified on history and physical examination includes measurement of early morning hCG, estradiol, LH, testosterone, and DHEAS. The reference range for hormones may vary by age, sexual maturity rating, and clinical laboratory. All patients may not fit into the categories in the algorithm above. Refer to UpToDate content on gynecomastia in children and adolescents for information about interpretation of other laboratory results and combinations.