Could refeeding-associated gynaecomastia occur during recovery from anorexia nervosa? A hypothesis-generating review.

International andrology guidance discusses refeeding after starvation as a clinical setting associated with gynaecomastia, based on reports from starvation-refeeding settings outside anorexia nervosa (AN). A targeted search of PubMed, PsycINFO, and Google Scholar, last conducted on 27 July 2026, identified no indexed reports in male patients recovering from AN. We therefore advance the testable hypothesis that transient glandular breast tissue may occasionally occur but remain unrecognised during nutritional recovery; the available evidence does not establish occurrence, prevalence, or clinical significance in AN. Five endocrine transitions provide biological plausibility: non-uniform recovery of the hypothalamic-pituitary-gonadal axis, expansion of the adipose tissue compartment in which aromatase is expressed, a transient leptin rise, possible preservation of adrenal androgen precursor availability, and recovery of insulin-like growth factor 1. Direct human data in male AN support parts of the endocrine trajectory, whereas the proposed link to breast tissue relies largely on indirect human evidence and preclinical studies. Potential under-recognition could arise from misclassification as pseudogynaecomastia, patient-side under-reporting, and follow-up that ends before later endocrine recovery; no clinical detection window has been established. We propose retrospective review, prospective surveillance extending beyond acute refeeding, targeted endocrine evaluation of confirmed glandular tissue, and multicentre studies of prevalence, risk factors, natural history, psychological effects, and treatment engagement.