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A 43-year-old man had a 10-year history of HIV-1 infection and was receiving combination antiretroviral therapy. Three months after starting megestrol [megestrol acetate] 800 mg/day for loss of appetite, he presented with painless and symmetrical growth of both breasts, which were slightly sensitive when palpated. An ultrasound revealed homogeneous breasts with no nodules. Treatment with megestrol was discontinued, and the man's gynaecomastia resolved within a few weeks.Author CommentThe stability of antiretrovirals in the case presented here, the absence of a connection between the antiretrovirals and gynaecomastia, together with the chronological connection following the introduction of megestrol and the fact that it cleared when it was suspended, all indicate that megestrol was the cause of the gynaecomastia.