TREATMENT OF POSTORCHIECTOMY GYNECOMASTIA WITH TESTOLACTONE

A 33-year-old Caucasian male presented with unilateral gynecomastia after unilateral orchiectomy for a Leydig cell tumor. The serum estradiol (E(2)) level was elevated, the testosterone (T) level was normal, and the gonadotropin levels were high-normal. The patient underwent unilateral mastectomy for cosmetic purposes. Problems with mood and libido plus the development of gynecomastia in the contralateral breast caused him to seek further treatment. Testolactone (TL) at 400 mg/day afforded complete resolution of his symp toms and gynecomastia, both of which recurred when the drug was withdrawn and responded to resumption of therapy, The serum E(2) level initially fell during TL therapy but returned to pretreatment levels after 1 month. The serum T, however, doubled 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.