Pathogenesis of Gynecomastia

• Lewin suggested in 1941 that all gynecomastia is due either to increased estrogen secretion or to a decreased androgen/estrogen ratio, a remarkable deduction considering the paucity of evidence available at that time. Gabrilove and his colleagues have subsequently assembled a large body of evidence to support the concept of the androgen-estrogen ratio as the critical determinant in feminizing states in men. It is also our view that it is useful to consider gynecomastia as a disturbance in this hypothetical ratio.

• Wilson, Aiman, and MacDonald