Parker L N, Gray D R, Lai M K, Levin E R
Metabolism. 1986 Aug;35(8):705-8. doi: 10.1016/0026-0495(86)90237-4.
Benign asymptomatic or painful enlargement of the male breast is a common problem, postulated to be due to an increased estrogen/testosterone ration or due to increased estrogenic or decreased androgenic stimulation via estrogen or androgen receptor interactions. Treatment at present consists of analgesic medication or surgery. However, treatment directed against the preponderance of estrogenic stimulation would seem to represent a more specific form of therapy. In the present double-blind crossover study, one-month courses of a placebo or the antiestrogen tamoxifen (10 mg given orally bid) were compared in random order. Seven of ten patients experienced a decrease in the size of their gynecomastia due to tamoxifen (P less than 0.005). Overall, the decrease for gynecomastia for the whole group was significant (P less than 0.01). There was no beneficial effect of placebo (P greater than 0.1). Additionally, all four patients with painful gynecomastia experienced symptomatic relief. There was no toxicity. The reduction of breast size was partial and may indicate the need for a longer course of therapy. A followup examination was performed in eight out of ten patients nine months to one year after discontinuing placebo and tamoxifen. There were no significant changes from the end of the initial study period except for one tamoxifen responder who developed a recurrence of breast tenderness after six months, and one nonresponder who demonstrated an increase in breast size and a new onset of tenderness after ten months. Therefore, antiestrogenic treatment with tamoxifen may represent a safe and effective mode of treatment for selected cases of cosmetically disturbing or painful gynecomastia.
男性乳房良性无症状或疼痛性增大是一个常见问题，据推测是由于雌激素/睾酮比值增加，或通过雌激素或雄激素受体相互作用导致雌激素刺激增加或雄激素刺激减少所致。目前的治疗方法包括止痛药物或手术。然而，针对雌激素刺激占优势的治疗似乎代表了一种更具特异性的治疗形式。在本双盲交叉研究中，对安慰剂或抗雌激素他莫昔芬（口服10mg，每日两次）进行了为期一个月的疗程比较，给药顺序随机。十名患者中有七名因他莫昔芬治疗导致男性乳房增生大小减小（P小于0.005）。总体而言，整个组的男性乳房增生减小具有显著性（P小于0.01）。安慰剂无有益效果（P大于0.1）。此外，所有四名患有疼痛性男性乳房增生的患者症状均得到缓解。未出现毒性反应。乳房大小的减小是部分性的，可能表明需要更长疗程的治疗。在停用安慰剂和他莫昔芬九个月至一年后，对十名患者中的八名进行了随访检查。除了一名他莫昔芬治疗有反应者在六个月后出现乳房压痛复发，以及一名无反应者在十个月后乳房大小增加且出现新的压痛外，与初始研究期末相比无显著变化。因此，他莫昔芬抗雌激素治疗可能是治疗某些美容方面令人困扰或疼痛性男性乳房增生病例的一种安全有效的治疗方式。
