BJU international
July 14, 2026 · via Europe PMC
Gynaecomastia secondary to transdermal oestradiol used for androgen deprivation therapy: informed reality vs subjective fear.
Sears C, Watson R, Brown E, Abbas B, Schellhammer P, Wassersug R.
AI summary — for doctors, generated from the abstract only
Breast growth from transdermal oestradiol for ADT is likely mild, usually below an A cup, and mastalgia is usually transient.
What was studied
Literature summary using five studies of 480 trans women on exogenous oestrogen to estimate expected breast growth and pain in men with prostate cancer on transdermal oestradiol.
Key findings
- Breast development is typically less than an A cup, mostly in the first year.
- Mastalgia is common but mostly transient, helped by topical anti-inflammatories, with neurectomy for severe cases.
Clinical relevance
Helps in counseling men considering oestradiol ADT, an option with potential benefits over LHRH agonists.
Who should care
Limitations
Extrapolation from trans women, who differ from older men with prostate cancer, and no direct prostate cancer data.
Use these estimates to reassure patients about gynaecomastia when discussing transdermal oestradiol.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
To provide information that can aid patients with prostate cancer (PCa) and their uro-oncologists in shared decision-making discussions about androgen deprivation therapy (ADT), with transdermal oestradiol (tE2) as one option. We do so by summarising recent literature on breast growth in genetic males undergoing treatment with exogenous E2. Based on the amount of breast development observed in this population, we estimate the maximum amount of breast growth that patients with PCa can expect, if they elect tE2 for ADT. We also present data on risks and management of mastalgia associated with tE2.
Methods
We summarise findings from five studies involving a total of 480 trans women (i.e., genetic males) undergoing gender-affirming hormone treatment with exogenous oestrogen.
Results
Exogenous E2 typically induces less than an A-cup size among trans women. The majority of breast growth occurs within the first year of treatment. We present this evidence to illustrate that the degree of gynaecomastia patients with PCa can expect if they elect tE2 for ADT is quite modest. This information can allay the often-heightened concern patients with PCa and their uro-oncologists may have regarding gynaecomastia induced by tE2 when used for ADT.
Conclusion
Development of breast tissue in genetic males taking exogenous E2 tends to be mild and typically results in less than A-cup size. Mastalgia in the form of breast and nipple sensitivity is common with E2 treatment in patients with PCa but is transient in most cases, responds to topical anti-inflammatory agents, and can be managed with neurectomy in severe cases. This information can help clinicians provide accurate counselling and mitigate misconceptions that may dissuade patients from considering tE2 for their ADT.
DOI
10.1111/bju.70374
PMID
42446241
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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