Physical,

Perform a thorough examination of the breasts, noting their size and consistency. Also determine the presence of any nipple discharge or axillary lymphadenopathy.

Differentiate between true gynecomastia and pseudogynecomastia. These 2 entities may be distinguished by having the patient lie on his back with his hands behind his head. The examiner then places a thumb on each side of the breast, and slowly brings the thumbs together. In true gynecomastia, a ridge of glandular tissue will be felt that is symmetrical to the nipple-areolar complex. With pseudogynecomastia, the fingers won't meet until they reach the nipple.
Gynecomastia can be detected when the size of the glandular tissue exceeds 0.5 cm in diameter.

Examine the testicles, noting their size and consistency. Carefully look for the presence of nodules or asymmetry.

Note signs of feminization, including typical body hair distribution and eunuchoid habitus.

Check for any stigmata of chronic liver disease, thyroid disease, or renal disease.

By the way if you are intersted the rest of the article was at,

http://emedicine.medscape.com/article/120858-overview