ish - bl u ish ▁dis color ation ▁of ▁the ▁ur ine , ▁and ▁he p atic ▁changes . ▁Because ▁fl ut am ide ▁is ▁a ▁pure ▁anti andro gen , ▁unlike ▁ster oid al ▁anti and rog ens ▁like ▁cy pro ter one ▁ac et ate ▁and ▁meg est rol ▁ac et ate ▁( which ▁addition ally ▁possess ▁pro gest ogen ic ▁activity ), ▁it ▁does ▁not ▁appear ▁to ▁have ▁a ▁risk ▁of ▁card i ov asc ular ▁side ▁effects ▁( e . g ., ▁th rom bo emb ol ism ) ▁or ▁fluid ▁ret ention . ▁ ▁Gy ne com ast ia ▁Fl ut am ide , ▁as ▁a ▁mon other apy , ▁causes ▁gy ne com ast ia ▁in ▁ 3 0 ▁to ▁ 7 9 % ▁of ▁men , ▁and ▁also ▁produces ▁breast ▁tend ern ess . ▁However , ▁more ▁than ▁ 9 0 % ▁of ▁cases ▁of ▁gy ne com ast ia ▁with ▁NS A As ▁including ▁fl ut am ide ▁are ▁m ild ▁to ▁moder ate . ▁Tam ox ifen , ▁a ▁select ive ▁est ro gen ▁re ceptor ▁mod ulator ▁( SER M ) ▁with ▁pre domin antly ▁anti estro gen ic ▁actions , ▁can ▁counter act ▁fl ut am ide - indu ced ▁gy ne com ast ia ▁and ▁breast ▁pain ▁in ▁men . ▁ ▁Di arr he a ▁Di arr he a ▁is ▁more ▁common ▁and ▁sometimes ▁more ▁severe ▁with ▁fl ut am ide ▁than ▁with ▁other ▁NS A As . ▁In ▁a ▁compar