TREATMENT OF POSTORCHIECTOMY GYNECOMASTIA WITH TESTOLACTONE

A 33-year-old Caucasian male presented with unilateral gynecomastia af ter unilateral orchiectomy for a Leydig cell tumor. The serum estradio l (E(2)) level was elevated, the testosterone (T) level was normal, an d the gonadotropin levels were high-normal. The patient underwent unil ateral mastectomy for cosmetic purposes. Problems with mood and libido plus the development of gynecomastia in the contralateral breast caus ed him to seek further treatment. Testolactone (TL) at 400 mg/day affo rded complete resolution of his symp toms and gynecomastia, both of wh ich recurred when the drug was withdrawn and responded to resumption o f therapy, The serum E(2) level initially fell during TL therapy but r eturned to pretreatment levels after 1 month. The serum T, however, do ubled during treatment periods, increasing the androgen/estrogen ratio . Testolactone appears to effectively treat this condition by raising the androgen/estrogen ratio without lowering absolute E(2) levels.