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Idiopathic gynecomastia, unilateral or bilateral, is a common physical finding in normal men. Successful treatment using tamoxifen (antiestrogen) and danazol (antiandrogen) has recently been reported. We compared the efficacy of tamoxifen and danazol in the treatment of idiopathic gynecomastia. We reviewed the clinical records of patients with idiopathic gynecomastia presenting to the Department of Surgery, University of Hong Kong, between August 1990 and September 1995. Medical treatment with either tamoxifen (20 mg/d) or danazol (400 mg/d) was offered and continued until a static response was achieved. The treatment response was compared. Sixty-eight patients with idiopathic gynecomastia were seen in the Breast Clinic. The median age was 39.5 years (range, 13-82), with a median duration of symptoms of 3 months (range, 1-90). The median size was 3 cm (range, 1-7). Twenty-three patients were treated with tamoxifen and 20 with danazol. Complete resolution of the gynecomastia was recorded in 18 patients (78.2%) treated with tamoxifen, whereas only 8 patients (40%) in the danazol group had complete resolution. Five patients, all from the tamoxifen group, developed recurrence of breast mass. In conclusion, hormonal manipulation is effective in the treatment of patients with idiopathic gynecomastia. Although the effect is more marked for tamoxifen compared with danazol, the relapse rate is higher for tamoxifen. Further prospective randomized studies would be useful in defining the role of these drugs in the management of patients with idiopathic gynecomastia.
GYNECOMASTIA, UNILATERAL OR bilateral, is a common physical finding in normal men.' It does not usually cause alarm unless it is symptomatic with pain. The other important reason for presentation is related to cosmesis, when it is causing much embarrassment and fear. Gynecomastia normally runs a benign course, but bilateral enlargement may signify underlying diseases especially testicular or adrenal tumors.2,3 Primary breast cancer, although a rare cause of gynecomastia, has to be ruled out, especially for unilateral involvement.2
In patients with idiopathic gynecomastia, the mode of treatment is commonly relief of symptomatic pain by analgesics. Surgery is usually recommended for gynecomastia that is cosmetically of psychologically disturbing. Recently, success with treatment by tamoxifen (antiestrogen) and danazol (antiandrogen) has been reported.18 However, there is no reported series in the literature to suggest whether one is superior to the other. In this study, we compared...