Comparison of tamoxifen with danazol in the management of idiopathic gynecomastia

Idiopathic gynecomastia, unilateral or bilateral, is a common physical find ing 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 r eviewed the clinical records of patients with idiopathic gynecomastia prese nting 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 wa s 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 ansi 20 with danazol. Complete resolution of th e 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 breas t mass. In conclusion, hormonal manipulation is effective in the treatment of patients with idiopathic gynecomastia. Although the effect is more marke d for tamoxifen compared with danazol, the relapse rate is higher for tamox ifen. Further prospective randomized studies would be useful in defining th e role of these drugs in the management of patients with idiopathic gynecom astia.