What dose and fractionation do you use for gynecomastia prophylaxis?

As I answered on a previous thread to a question that was similarly posed, philosophically I would prefer electrons (less integral dose/more focused - IMHO) as opposed to photons. In terms of dose, it seem these days less is better with single fraction especially. Hence, the NICE (European) guidelines recommend 8Gy.

It seems the intervention measures for this issue seems to be headed for the drug route with SERMS drugs -> raloxifene and Tamoxifen, the main drivers in this regard.

Again, I am in ...

I treated a patient a few years ago who developed gynecomastia and mammodynia while take both leuprolide and enzalutamide.

I went with 20 Gy in 5 fractions using an en face electron setup. There was moderate reduction of the gynecomastia (it was not prominent to begin with) and complete resolution of the mammodynia.

At the time, the papers I found showed the highest benefit levels with that fractionation.

With enzalutamide and bicalutamide, in the setting of leuprolide, the gynecomastia rates ...