# Gynaecomastia (Adult)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Endocrine Society Guideline on Gynecomastia 2012 · Tamoxifen 20 mg Tablets SmPC sections 4.1-4.4 (eMC product 12524)
- Verified date: 2026-08

## Verified against

- Tamoxifen 20 mg Tablets SmPC sections 4.1-4.4 (eMC product 12524)

## Treatment metadata

- Tamoxifen — 20 mg — oral.solid

## Complete treatment card

```text
GYNAECOMASTIA (ADULT)
Sources: Endocrine Society Guideline on Gynecomastia 2012 · Tamoxifen 20 mg Tablets SmPC sections
         4.1-4.4 (eMC product 12524)
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (3)
    - Ask when it started and how long it has been there, and about any accompanying symptoms
    - It can be silent and turn up first on an MRI or CT of the chest done for another reason
    - Family and genetic history, prescribed medicines and recreational drug use all matter
  SIGNS - what you find (4)
    - Breast findings that count: the feel of the tissue, a mass, skin change, nipple discharge,
      unequal sides, and tenderness, plus the axilla  [nipple discharge]
    - Examine the testes for unequal size, a lump, enlargement or shrinkage
    - Check the head and neck for any abnormal lump or a thyroid abnormality
    - Pseudogynaecomastia is fat alone all round the areola, usually on both sides and unchanged in
      size for years
  TESTS (9)
    - A well man with no symptoms, a normal examination and breast tissue present over 12 months
      needs nothing further
    - A testicular lump calls for scrotal ultrasound plus testosterone, LH, oestradiol and DHEAS
    - A thyroid lump calls for thyroid function tests, thyroid ultrasound and an endocrine opinion
    - A palpable breast lump needs mammography or ultrasound and a biopsy, with a surgical opinion
      if indicated
    - With hypogonadism: LH and FSH, oestradiol, testosterone, DHEAS, a karyotype, and possibly an
      adrenal scan
    - An abdominal mass or an enlarged liver: liver function tests, LH and FSH, oestradiol,
      testosterone, DHEAS, and abdominal CT if needed
    - Kidney and liver function should be checked
    - Thyroid studies when an overactive thyroid is suspected
    - Men who are developing female characteristics need endocrine and genetic testing
  IF NOT THIS - what else fits (3)
    - Breast cancer
    - Lymphoma
    - Dermoid cyst
  Source  StatPearls "Gynecomastia" - disease-level clinical article
  Status  traced to the source above

1. TAMOXIFEN                                              [1st line]
   Adult    10-20 mg once daily for 3-6 months for painful, recent-onset (<6 months) glandular
            gynaecomastia x 3-6 months
   Peds     Specialist pediatric/adolescent endocrinology evaluation
   Source   Tamoxifen 20 mg Tablets SmPC sections 4.1-4.4 (eMC product 12524)
   Why      Selective oestrogen-receptor modulator that blocks oestrogen's proliferative effect on
            glandular breast tissue, used for painful, recent-onset gynaecomastia once secondary
            causes such as drug-induced, testicular, hepatic, or hypogonadal causes have been
            excluded.
   Caution  First exclude secondary causes: drug-induced (spironolactone, digoxin, finasteride),
            testicular tumor, hepatic failure, or hypogonadism.
            Pubertal gynaecomastia is physiological and usually resolves spontaneously within 1-2
            years without medical therapy.
            Gynaecomastia is not a licensed indication. The label covers breast cancer, its
            prevention, and ovulation induction - nothing else. This is an off-label use with
            reasonable evidence behind it, but say so.
            Two to three times the clot risk. Stop it at least six weeks before planned surgery or
            any long stretch of immobility.
            There is an increased risk of deep vein thrombosis and thromboembolism.
   Egypt    TAMOXIFEN 20 MG 20 TABS.         TECHNOPHARMA        68.00 EGP (3.40/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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