In assessing a 14-year-old male with right gynecomastia, what is the most appropriate next step?

In adolescents, gynecomastia, which is the enlargement of breast tissue, is often a benign and self-limiting condition due to hormonal changes that occur during puberty. In a 14-year-old male, the most appropriate next step is to observe and provide reassurance. This is primarily because the majority of cases of adolescent gynecomastia resolve spontaneously over time without the need for intervention.

During puberty, boys experience fluctuations in hormone levels, particularly an increase in estrogen relative to testosterone, which can lead to transient breast tissue proliferation. Unless the gynecomastia is associated with other concerning symptoms, such as significant pain, tenderness, or a persistent mass, watchful waiting is typically recommended. Providing reassurance to the patient and family about the commonality of this condition can help alleviate anxiety.

In cases where the gynecomastia does not resolve over time or is associated with other signs or symptoms indicating a potential underlying pathology, further investigation or referral to specialists could be warranted. However, for this scenario, where a 14-year-old male presents with gynecomastia without additional alarming findings, observation and reassurance is the best and most appropriate approach.