More than 90% of male breast cancers (MBC) are estrogen receptor positive but unfortunately over 40% are either stage III or stage IV at the time of presentation. This means that for a substantial proportion of patients, endocrine therapy will be used in a palliative role in the management of MBC. Tamoxifen is the main first line agent that is given for both adjuvant treatment and control of advanced disease. Although effective it can be more toxic in men than in women so that a significant proportion of males will become non-compliant. It is important that non-adherence is recognised and whenever possible second line therapy is instituted with either aromatase inhibitors or LHRH analogues. International collaboration in randomised trials will be necessary to determine the future endocrine therapies for MBC.