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Gynaecomastia affects half of the male population at some stage in their life. Only a small proportion of them would require treatment for cosmetic appearance or to relieve pain and tenderness. Recently, tamoxifen has shown some promising results in the management of gynaecomastia. To assess the efficacy of tamoxifen, we carried out a retrospective study of all men treated for gynaecomastia with particular emphasis on those treated medically. Men with painful gynaecomastia were given 10 mg of tamoxifen for 3 months. Response to treatment was categorised as good, moderate and no response. Thirteen men (median age 36) were placed on tamoxifen. Ten patients responded well to tamoxifen. One patient developed calf tenderness and stopped the medication. No other adverse effects were reported. Two patients could not be followed up. Tamoxifen appears safe and effective in men with painful idiopathic or physiological gynaecomastia and should be considered as an initial option before contemplating surgery.