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ich recurred when the drug was withdrawn and responded to resumption o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.