Methylphenidate drugs is prescribed in attention deficit disorder and hyperactivity. Among its rare side effects, include alterations in the gynecological. We report a clinical case and review current evidence regarding the tolerability this drug in this area.

We performed a PubMed search of articles published in English of different types (case reports or case/controls studies). We collected the clinical practice guidelines conclusions regarding adverse drug reactions.

Our patient is a 14-year-old male diagnosed of ADHD treated with methylphenidate (0.8–1 mg\kg). He developed bilateral and asymmetric gynecomastia under this treatment plan so a referral was made to rule out other causes of this event. After performing several work up tests, it was concluded that this clinical presentation was caused by methylphenidate. Hence, we initiated crossed titration swapping this drug to atomoxetine. Four months later, he was mentally stable and he experimented a volumetric decrease as concerns his gynecomastia.

As regards methylphenidate, in 2009 a couple of cases in which alterations in the sexual sphere presented with the oros presentation were reported. There are series of reported pharmacological side effects (gynecomastia) and also denoted an improvement of the same months after drug discontinuation.

Gynecological clinic secondary to the use of psychotropic drugs in ADHD is uncommon. In line with our case, the current evidence suggests a drug suspension as adverse effects are usually reversible (although it may take several months to complete recovery). Further studies are needed to understand the mechanisms underlying these tolerability issues.

The authors have not supplied their declaration of competing interest.