Management of physiological gynaecomastia with tamoxifen

Aims: We aimed to confirm suggestions that tamoxifen therapy alone may resolve physiological gynaecomastia. Methods: A prospective audit of the outcome of tamoxifen routinely given to men with physiological gynaecomastia was carried out at Nottingham. Men referred with gynaecomastia had clinical signs recorded, e.g., type (diffuse ‘fatty’ or retro-areolar ‘lump’), size and possible aetiology. They were offered oral tamoxifen 20 mg once daily for 6–12 weeks. On follow-up patients were assessed for complete resolution (CR), partial resolution where patient is satisfied with outcome (PR) or no resolution (NR). Success was either CR or PR. Results: Thirty-six men accepted tamoxifen for physiological gynaecomastia. Median age was 31 (range 18–64). Tenderness was present in 25 (71%) cases. Sixteen men (45%) had ‘fatty’ gynaecomastia and 20 had ‘lump’ gynaecomastia. Tamoxifen resolved the mass in 30 patients (83.3%; CR=22, PR=8) and tenderness in 21 cases (84%; CR=21, PR=0). Lump gynaecomastia was more responsive to tamoxifen than the fatty type (100% vs. 62.5%; P=0.0041). Conclusions: Oral tamoxifen is an effective treatment for physiological gynaecomastia, especially for the lump type.