{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:54:02Z","timestamp":1781844842473,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Gynecomastia is a benign enlargement of the male breast with multiple causes. This retrospective study evaluated whether serum estradiol (E2), testosterone (T), or the E2\/T ratio differed between patients and controls, while explicitly accounting for the limited hormonal subset and lack of statistical significance. Methods: We retrospectively reviewed 68 men with benign gynecomastia (1996\u20132000) and 10 healthy controls. Analyses were conducted in two predefined populations: a full etiologic cohort (n = 68) and a hormonal-analysis subset (37 patients and 10 controls). Serum E2 and T were measured in 37 patients and all controls, and the E2\/T ratio was calculated. The E2\/T ratio was analyzed primarily as a continuous variable rather than relying solely on a control-derived threshold. Results: Gynecomastia was most frequent in adult and middle-aged men. Idiopathic cases were most common, followed by drug-related, hormonal, and disease-related causes. The mean E2\/T ratio was higher in patients (12.0 \u00b1 1.8) than controls (7.1 \u00b1 0.5), but this difference did not reach statistical significance (E2: p = 0.21; T: p = 0.34; E2\/T: p = 0.07). Among tested patients, 13.5% had low T, 24.3% high E2, and 43.2% elevated E2\/T ratios. Liver disease and drugs such as H2 blockers and psychoactive agents contributed in some cases, while 50% were idiopathic. Conclusions: Because hormone comparisons were non-significant and based on a limited subset, these data do not support an independent association between gynecomastia and circulating E2, T, or the E2\/T ratio. Clinical evaluation should consider age, comorbidities, and medications in addition to hormonal factors.<\/jats:p>","DOI":"10.3390\/life16061010","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:38Z","timestamp":1781661518000},"page":"1010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gynecomastia: Etiological Analysis Beyond Hormonal Imbalance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4490-3610","authenticated-orcid":false,"given":"Jae Heon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Urology, Soonchunhyang University School of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8345-6686","authenticated-orcid":false,"given":"Miho","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Urology, Soonchunhyang University School of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kisoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Dong-A University College of Medicine, Busan 49201, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Hyuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Soonchunhyang University School of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0909-3341","authenticated-orcid":false,"given":"Yun Seob","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Urology, Soonchunhyang University School of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1677\/erc.0.0060315","article-title":"Aromatase and gynecomastia","volume":"6","author":"Braunstein","year":"1999","journal-title":"Endocr. 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