Endocrine Abstracts

Introduction: Gynecomastia is defined as the benign proliferation of breast tissue in men. Although common, only a small portion of patients seek treatment, either for cosmetic reasons, pain, or tenderness. Tamoxifen has been proposed as an alternative to surgical treatment.

Methods : We conducted a retrospective study including all patients referred to our Endocrinology Department between January 2020 and April 2024 due to gynecomastia. Secondary causes were evaluated in every individual, including a thorough hormonal work-up. Patients with pain and/or tenderness, without identifiable reversible causes or contraindications, were selected and treated with tamoxifen 20 mg daily for a three-month period. Response to treatment was subsequently assessed clinically.

Results: A total of 41 patients with a median age of 52 years (range: 21-85) and a median duration of symptoms of 14 months (range: 4-53) were included. Bilateral breast enlargement was present in 25 patients (61.0%). Increased tenderness was reported by 26 patients (62.4%), and significant pain by 16 patients (39.0%). A secondary cause was identified in 18 cases (43.9%), with iatrogenic causes, primarily androgenic steroid use, being the most frequent. Fifteen patients (36.6%) were selected for treatment with tamoxifen. The median symptom duration in this group was 36 months (range: 3-48), and no secondary cause was identifiable in 53.3% of these patients. Thirteen patients reported resolution of tenderness, and eight noticed a decrease in breast size post-treatment. No side effects or relapses were observed. Patients not eligible for tamoxifen were referred to Plastic Surgery.

Conclusion: Gynecomastia has a significant psychological impact in patients’ lives and frequently causes pain and discomfort. Tamoxifen seems to be a safe and somewhat effective option and should be considered prior to surgery.