Finasteride or Proscar

[Frank Z]

I would be interested in hearing from anyone that has been on Finasteride (Proscar) and if that effected their existing gynecomastia. I have relatively severe BPH and will be starting on Finasteride 5mg/day in about two weeks. I had previously been on Flomax which improved my urinary problems a great deal early on but the benefits faded after about 9 months. The urologist is now suggesting a minimum 6-12 month regiment of Finasteride before considering one of several different surgical options for my enlarged prostate. I have had BPH for more than 20 years but it has gotten significantly worse in recent years. Over the last year I have been getting up 4-5 times a night to use the bathroom. My PSA is normal and I have been thoroughly checked for more serious problems such as prostate or bladder cancer. BTW I am currently 52 years old.

I am well aware that gynecomastia is a known side effect of Finasteride but the statistics I have found indicate that only 1%-3% of patients taking Finasteride experience gynecomastia. I am especially interested in hearing from people that started taking the drug after they developed gynecomastia. I would be interested in knowing what dose you were on, if you experienced further growth, and how long after starting the meds did the growth start. If you stopped taking it due to additional growth did the gynecomastia revert to its previous state?

I guess what I am getting at is if one already has gynecomastia and they start taking Finasteride would they be more susceptible to experiencing this side effect than someone that did not already have it (so the 1%-3% statistic could me misleading)?

I would also be interested in hearing from anyone that feels that their gynecomastia is strictly a result of taking Finasteride (did not have the condition prior to taking the drug).

One more thing, is there any known connection between gynecomastia and BPH? In other words, are you more likely to experience gynecomastia if you have BPH (or vice versa)?

Thank you in advance for any input you may have on this.

Frank Z

[headheldhigh01]

not to pre-empt replies but have seen it discussed in past, you might try site search for past threads too while you're waiting. 

[Frank Z]

Headheldhigh01 - Thank you for your response. I spent quite a bit of time searching the forums regarding this and did find many posts from individuals that felt Finasteride was the cause of the onset of their gynecomastia however I did not see any commenting about their experiences starting on Finasteride with existing gynecomastia. I'm really interested in hearing from anyone that started on Finastride with established gynecomastia. That's the situation I find myself in. I am wondering if one is more susceptible to the side effects if they already have the condition.

Thanks,

Frank Z

[MammaryMan]

I have been on Avodart (a more complete 5-alpha-reductase inhibitor than finasteride)or Proscar for fifteen years. About half of the men in our prostate cancer support group experience some degree on gynecomastia while on one of these drugs. The gyno is usually permanent - it most often does not go away when the drug is stopped. Some men are not affected at all. One recommendation to reduce gynecomastia before what is called Androgen Deprivation Therapy (of which Avodart or Proscar is a part of) is to have a short course of radiation to the mammary glands. But again, this does not always work.

[Frank Z]

MammaryMan - Thank you for sharing the information about the experience of those in your prostate cancer support group. That certainly seems like a very large percentage that have developed gynecomastia. I may need to think about this some more before starting on the Finasteride! BTW my urologist first indicated that he was going to put me on Avodart but later said he was going to prescribe the Finasteride. I will ask him why he changed.

I am assuming that you are battling prostate cancer. I pray that your treatment is successful!

Thanks,

Frank Z

[startofnewlife]

I had gyne for 8 years before starting propecia. Didnt make it worse. Had gyne op 4 months ago and hasnt come back. Phew 

[Dr. Elliot Jacobs]

The makers of Propecia, Merck, write in their "warnings" box of the possibility of "swelling of the breasts."  This is misleading.  Swelling would connote a temporary condition -- but this is not the case.  Breast enlargement stimulated by Propecia is actual breast growth -- which becomes permanent and is not improved by stopping Propecia -- surgery would be needed.  They do not indicate what percent of men using Propecia will have this side effect.

My experience with Propecia in my patients is as follows:

A:Those who had a flat chest and then developed gyne after taking Propecia are advised that surgery will remove the gyne but they must stop Propecia or risk recurrence of their gyne.

B:Those who had pre-existing gyne, then began Propecia and experienced further growth of their gyne -- advised to stop the Propecia or risk recurrence of their gyne after gyne surgery.

C: Those who had pre-existing gyne, began Propecia and experienced no further growth of their gyne -- advised surgery can remove their gyne and they can continue on Propecia with caution.

There are no medical studies to back up the above observations and obviously Merck would be reluctant to sponsor such studies.  Thus the observations are simply that -- observations gleaned from dozens of my patients who have taken Propecia.

BTW, MammaryMan, I have never heard of a "short course of radiation" to the breast as prophylaxis against gyne development.  To my mind, radiation to cancer prone tissue (even in a man)is lunacy.

Hope this helps.

Dr Jacobs

[nipsofpeace]

Dr. Jacobs, is it possible for someone who has had gynecomastia surgery and then starts taking Propecia to still have the potential for breast tissue development to occur again?

I've finally gotten rid of my boobs, but my hair is thinning and receding and I'm not sure what to do about it.  (I have never taken Finasteride/Propecia before.)

[Dr. Elliot Jacobs]

This is the ultimate dilemma and unfortunately there are no answers.  You are basically in the category of considering use of Propecia and with it the possibility of developing gyne as a side effect.  Unfortunately, there are no ways to test you ahead of time as to whether you might be one of the people who do develop gyne as a side effect -- it is entirely random.  And once you take it and perhaps do develop gyne, then your only option is additional surgery.

It is important to understand that gyne surgery basically re-contours your chest and removes both fat and breast tissue.  But not all breast tissue is removed -- it is scattered and pervasive across the chest. In fact, if a surgeon attempted to remove all the breast tissue, your chest would be mutilated. And any remaining breast tissue will retain its ability to be stimulated and to grow with the use of Propecia.

You are therefore left with the difficult decision to treat your hair loss with Propecia -- and risk a recurrence of your gyne -- or continue to lose your hair because there are virtually no other medications that can do what Propecia does.

It becomes a crap shoot -- sorry.

Dr Jacobs

[nipsofpeace]

This is the ultimate dilemma and unfortunately there are no answers.  You are basically in the category of considering use of Propecia and with it the possibility of developing gyne as a side effect.  Unfortunately, there are no ways to test you ahead of time as to whether you might be one of the people who do develop gyne as a side effect -- it is entirely random.  And once you take it and perhaps do develop gyne, then your only option is additional surgery.

It is important to understand that gyne surgery basically re-contours your chest and removes both fat and breast tissue.  But not all breast tissue is removed -- it is scattered and pervasive across the chest. In fact, if a surgeon attempted to remove all the breast tissue, your chest would be mutilated. And any remaining breast tissue will retain its ability to be stimulated and to grow with the use of Propecia.

You are therefore left with the difficult decision to treat your hair loss with Propecia -- and risk a recurrence of your gyne -- or continue to lose your hair because there are virtually no other medications that can do what Propecia does.

It becomes a crap shoot -- sorry.

Dr Jacobs

Thanks for the detailed reply.

Curse these genetics.

[startofnewlife]

Minoxidil is also effective for hair loss

[Dr. Elliot Jacobs]

Minoxidil is a solution which is applied to the scalp.  If effective at all, it only works for receding hair at the temples.  Propecia, if it is tolerated, is a much better solution -- it works for thinning hair over the entire scalp.  It doesn't restore lost hair -- it just cuts the losses.

Dr Jacobs

[MammaryMan]

BTW my urologist first indicated that he was going to put me on Avodart but later said he was going to prescribe the Finasteride. I will ask him why he changed.

Finasteride is generic and cheap. Avodart is expensive. If finasteride can do the job, there is no need for Avodart. While on the drug for a while you can ask the doc to check your serum dihydrotestosterone (DHT). I believe 5 ng/dL is a good target. If finasteride is not achieving that level you can switch to Avodart. Also relief of symptoms would be a good indication it is working, but remember it usually takes several months for the either of the drugs to start to take effect.

[Frank Z]

Dr. Jacobs,

Thank you so much for taking the time to respond and provide additional information. As a follow-up, based on your experience have you seen any evidence that a person would be more likely to experience the side effect of gynecomastia from finasteride if they already have established gynecomastia?
 
Thanks

[Dr. Elliot Jacobs]

There are no medical studies to answer your question.

I can only provide anecdotal experience from my patients.  To date, if you already have gynecomastia, you still stand a chance of enlarging your gynecomastia if you should take Propecia.  I cannot provide estimate or percentages, however -- this is unknown.

Sorry can't be more definitive.

Dr Jacobs