Use of Tamoxifen in Treatment of Pubertal Gynecomastia, Data from a Tertiary Care Hospital

Background: Pubertal gynecomastia is the most common breast swelling seen in adolescent males. It may affect up to 70% of male adolescents, with a peak age of appearance around 14 years. However, it may cause significant psychological disturbance, depression, and also mastalgia. Hence, we decided to analyze our data of tamoxifen treatment in pubertal gynecomastia. Methods: We did a retrospective study of all adolescent boys who presented to us with a history of unilateral or bilateral breast enlargement. We collected the data of all patients who were treated with tamoxifen 10 mg twice daily. Results: We included 45 patients in this study. The mean age of presentations was 14.2 years (standard deviation –3.8 years). Of these, 28 patients (62.2%) had bilateral gynecomastia and 17 patients (37.8%) had unilateral gynecomastia. The majority of them complained of mastalgia, i.e., 41 patients (91.1%). Of these 45 patients, 36 (80%) patients had complete response with disappearance of breast swelling with tamoxifen treatment. Five patients had considerable reduction in the size of swelling. Only four patients did not respond to the treatment, although they had mild reduction in size. Subsequently, these four patients underwent surgical resection since they had significant breast enlargement even after therapy. All patients with mastalgia responded to tamoxifen therapy with disappearance of pain within 3 months of treatment. Conclusion: Tamoxifen is safe for the treatment of pubertal gynecomastia. It is useful in not only in decreasing the pain but also causes complete disappearance of swelling in the significant number of patients if treatment is started early.