title: Gynecomastia in subjects with sexual dysfunction.
abstract: OBJECTIVE
  To analyze possible relationships between gynecomastia and clinical and biochemical parameters in a large cohort of subjects with sexual dysfunction (SD).
  
  
  METHODS
  A consecutive series of 4,023 men attending our Outpatient Clinic for SD was retrospectively studied.
  
  
  RESULTS
  After excluding Klinefelter's syndrome patients, the prevalence of gynecomastia was 3.1 %. Subjects with gynecomastia had significantly lower testosterone (T) levels; the association retained statistical significance after adjusting for age and life-style. However, only 33.3 % of subjects with gynecomastia were hypogonadal. Gynecomastia was associated with delayed puberty, history of testicular or hepatic diseases, as well as cannabis abuse. Patients with gynecomastia more frequently reported sexual complaints, such as severe erectile dysfunction [odds ratio (OR) = 2.19 (1.26-3.86), p = 0.006], lower sexual desire and intercourse frequency [OR = 1.23 (1.06-1.58) and OR = 1.84 (1.22-2.78), respectively; both p < 0.05], orgasm difficulties [OR = 0.49 (0.28-0.83), p = 0.008], delayed ejaculation and lower ejaculate volume [OR = 1.89 (1.10-3.26) and OR = 1.51 (1.23-1.86), respectively; both p < 0.05]. Gynecomastia was also positively associated with severe obesity, lower testis volume and LH, and negatively with prostate-specific antigen levels. The further adjustment for T did not affect these results, except for obesity. After introducing body mass index as a further covariate, all the associations retained statistical significance, except for delayed ejaculation and ANDROTEST score. When considering gynecomastia severity, we found a step-wise, T-independent, decrease and increase of testis volume and LH, respectively. Gynecomastia was also associated with the use of several drugs in almost 40 % of our patients.
  
  
  CONCLUSIONS
  Gynecomastia is a rare condition in subjects with SD, and could indicate a testosterone deficiency that deserves further investigation.
authors: Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
authors: E
authors: E
authors: Maseroli
authors: G
authors: G
authors: Rastrelli
authors: G
authors: G
authors: Corona
authors: V
authors: V
authors: Boddi
authors: A M L
authors: AM
authors: Amato
authors: E
authors: E
authors: Mannucci
authors: G
authors: G
authors: Forti
authors: M
authors: M
authors: Maggi
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D006177:Gynecomastia / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D007713:Klinefelter Syndrome / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000453:epidemiology*; D013739:Testosterone / Q000097:blood*
chemical_list: D013739:Testosterone