Incidence, Healthcare Utilization, and Costs of Gynecomastia Among Active-Duty U.S. Service Members, 2014-2023.

Abstract

Introduction: Gynecomastia is a common benign enlargement of male breast tissue that can cause pain, functional discomfort, and psychosocial distress. It is frequently observed in active-duty-aged males. However, the epidemiology, operative management, and burden in the Military Health System (MHS) are poorly defined. We aimed to quantify gynecomastia incidence, resource utilization, and associated costs in the MHS.

Materials and methods: The study population included all male active-duty U.S. service members with gynecomastia in the Military Health System Data Repository (MDR) from January 1, 2014, to December 31, 2023. Those with gynecomastia in the year before study start or a breast cancer diagnosis were excluded. Overall incidence was calculated in person-years (p-y). Surgical procedures, healthcare utilization, and costs were obtained from the MDR.

Results: During the study period, 22,103 service members were diagnosed with gynecomastia, primarily under 30 years old, non-Hispanic White, and enlisted. The incidence rate was 2.0 per 1,000 p-y. The Marine Corps had the highest rate overall (2.9 per 1,000 p-y). In total, 8,365 patients (37.8%) had a gynecomastia-related surgical procedure, and most were performed within the first 6 months after diagnosis (71.7%). From 2014 to 2023, there were 76,788 healthcare encounters with a gynecomastia diagnosis (9,139 surgical and 67,649 non-surgical), and most were outpatient (99.4%). In a sub-analysis of outpatient direct care, inflation-adjusted median costs were $12,482 (±$6,365) per surgical encounter and $285 (±$241) per non-surgical encounter. At minimum, the total estimated cost for patients diagnosed with gynecomastia during the study period was $90,028,666, with $76,529,018 attributable to surgical encounters and $13,499,648 to non-surgical encounters.

Conclusions: Gynecomastia is common among active-duty service members, with higher incidence and surgical utilization than reported in civilian populations. Within the MHS, one-third of affected service members underwent operative intervention, accounting for a disproportionate share of healthcare utilization and expenditures. These findings establish gynecomastia as a clinically and operationally relevant condition and provide a foundation for future investigation into factors associated with treatment patterns and resource utilization.