A 15-year-old boy is evaluated for gynecomastia that has continued to increase in size and discomfort during the past year. In addition, he also has moderate to severe acne that has not improved with topical therapies and systemic antibiotic drugs. He reports having some general fatigue as well as increased appetite, and he has gained 13 lb (5.9 kg) in the previous 7 months. There has been no fever, and apart from occasional headaches, he has no other complaints of pain. His personal and family medical history is otherwise normal. His only medications are minocycline and topical isotretinoin and clindamycin to treat his acne.

On physical examination the blood pressure is 156/98 mm Hg. He has extensive acne on his face, upper chest, and back. Examination of the breasts shows bilateral and mildly tender gynecomastia, with fibroglandular tissue measuring 10 cm in the right breast and 9 cm in the...

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