If there is no "knot" you may have a harder time convincing the doctor that you have gyno. In regards to it on ly being puffy, yes, try the Letro/Nolva combo and see if it helps first.
When I used that combo in the past, I would run the Letro @ 2.5mg/d with 40-80mg/d of Nolva until the puffiness subsided. At that point, I would drop the Letro down to 1.25mg EOD and the Nolva down to 20-40mg/d.
You will eventually have to fool around with Letro dosing as it is one STRONG compound. If E2 levels get suppressed too much, then you will lose sex drive and also get joint pains.
No big deal as long as you do some trial and error moves.
BMJ