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Pubertal gynaecomastia affects up to 70% of male adolescents, with the highest prevalence occurring at 14 years of age. While spontaneous regression occurs in 90% of cases within three years, until then, symptoms of mastodynia and psychological distress are prevalent in some patients prior to surgical treatment. Tamoxifen, a selective oestrogen receptor modulator (SERM), given at 20 mg daily for six months, was found to be a safe, well-tolerated and effective alternative treatment to current therapeutic options of watchful waiting (no management) and invasive cosmetic surgery. No adverse effects were observed in hormonal and auxological studies. The patient presented was able to avoid undergoing surgery, which should be reserved for persistent gynaecomastia present at the end of puberty after failing a trial of tamoxifen. Randomised controlled trials (RCTs) are needed for definitive therapeutic recommendations.

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Adolescents present to paediatric health settings with drug- and alcohol-related issues, including associated harms. These comprise, but are not limited to, physical and sexual assault, family conflict, mood and behavioural concerns (including psychosis), and forensic issues. Early intervention aims to reduce long-term risks such as dependence in adulthood. Specialist adolescent drug and alcohol services may assist in identifying and engaging these high-risk and often complex young people in developmentally appropriate treatment.