ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2020;105(10):dgaa440. 10.1210/clinem/dgaa440 https://academic.oup.com/jcem/article/105/10/3134/5868100

In brief: Based on a 20-year Danish registry, this study reports a marked increase in incidence of gynecomastia between 1998 to 2017, 5-fold among post-pubertal males age 16–20 years, and 11-fold among males age 61–80 years.

Comment: Gynecomastia is a frequent condition affecting 32–65% of men depending on age and diagnostic criteria (1). It is considered to result from an imbalance between estrogens and androgens (2).

All Danish citizen are registered in a unique Danish National Patient Registry established in 1977. Reporting medical events is compulsory and provides exceptional data regarding national incidence of diseases. The authors documented an average 20-year incidence of gynecomastia of 3.4 per 10 000 men per year. All age groups showed a strong secular increase. The highest overall incidence was reported in postpubertal men (16-20 years) with a 5-fold increase in 20 years. A greater than 10-fold increase was documented in the age groups 10 to 15, 21 to 40, 41 to 60 and 61 to 80 years.

This is the first national report of increasing incidence in gynecomastia. Although gynecomastia is not a serious condition, it is a likely marker of a change in exogenous or endogenous sex steroid environment which is associated with other health risks such as prostate cancer or metabolic syndrome. Although data were not collected on risk factors, the authors suggest increasing obesity incidence (3) as well as abuse of anabolic steroids (4) as the likely main contributing factors and also raise the question of a role for endocrine-disrupting chemicals.

Reference: 1. Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N (2019) EAA clinical practice guidelines–gynecomastia evaluation and management. Andrology. 7(6):778–793.2. Rochefort H, Garcia M. (1983) The estrogenic and antiestrogenic activities of androgens in female target tissues. Pharmacol Ther. 23(2):193–216.3. World Health Organization. Global Health Observatory (GHO) data. Prevalence of obesity among adults. 2020. https://www.who.int/gho/ncd/risk_factors/overweight_obesity/obesity_adults/en/. Accessed March 26, 20204. Sagoe D, Torsheim T, Molde H, Andreassen C, Pallesen S. (2015) Anabolic-androgenic steroid use in the Nordic countries: a metaanalysis and meta-regression analysis. Nordisk Alkohol Nark. 32(1):7–20.