Continue Propecia/Finateride after Gyne surgery

[regularguy]

hi guys

does any one here on finasteride/propecia had finasteride induced or normal gyne and had them removed? are you continuing the medication afterwards? if so did gyne come back again?

i had a mild case of gyne since puberty. started propecia/1mg finasteride 12 years ago due to hair loss (at 24 years old). i don't know if my gyne got worse due the medication (i don't think so). i'm going for my gyne surgery in 2 weeks. i'm just curious what finasteride might cause afterwards.

any of you who's still taking finasteride after surgery, i'd really appreciate if you share your experience with fellow readers in this forum.

thank you very much. :-)

[Paa_Paw]

This is a very ticklish issue and it comes up from time to time so a search of the site may interest you.

Obviously there are a large number of men who take these medications without any ill effect. For others, the side effects of the drugs are a real problem. The low dosage of finasteride (Propecia) used to treat male pattern baldness is probably on the low end of the side effect scale while the larger dosages (Proscar) used to treat enlarged prostate seems to be a bit more problematic. This would certainly seem to make the case that the potential for problems is dosage related. It should be kept in mind that breast tenderness and/or enlargement are not the worst of the potential side effects. A quick search will get you a complete list of the potential side effects.

My own attitude is probably somewhat cynical. Men shave for several reasons, not the least of which is that a man with a smooth shaven face appears younger. More and more often, men remove their body hair, this too gives a more youthful appearance. Now maintaining the hairline of a teenager seems to be the goal of many young men again to maintain the image of youth. I suppose the time is not far off when a man will be able to retain the appearance of a 12 year old but if it means having the problems of early puberty (like gynecomastia) and having the libido of a child who would want it?

You'll find that a surprising number of young women look at our hairy bodies and balding heads as indicators of virility. As a rather hirsute and bald man who is the father of 8, I think this opinion may have merit.

My own slanted view aside, I do not think it is vanity to want to look your best. The decision is ultimately one that you alone can make, I do not know of anyone who is totally without bias on this issue.

[Dr. Elliot Jacobs]

I have had a number of patients in this situation.  It boils down to the following:

Some men do have a side effect of gynecomastia when taking Propecia.  What is most important is to determine if the gyne preceeded the Propecia and if the gyne became worse while on Propecia.  If you had gyne first, then took Propecia and no new growth occurred, then it is my opinion, that no growth would occur if you stayed on Propecia after your gyne surgery.  And this has been my observation in about 12 patients.

On the other hand, if you never had gyne, or had gyne plus added gyne growth while on Propecia, then it is unknown if your gyne would recur if you had gyne surgery and stayed on Propecia. 

There are absolutely no medical or drug studies on this specific situation -- so no doctor can be definitive on the subject.

In essence, if you had no side effects of Propecia prior to gyne surgery, then you should be OK.  If you did have side effects (ie growth of gyne), then continuing on Propecia after gyne surgery might be problematic and you might risk a chance of re-growth.  Then it becomes a decision of removing your gyne or having a full head of hair.  Your choice.

Dr Jacobs

[headheldhigh01]

that's probably good advice, although i admit i dislike gyne enough i'd be wary of the extra risk myself. 

[Dr. Cruise]

This is not an uncommon issue amoung my gynecomastia patients. As Dr. Jacobs pointed out it come down to 1) how much does the Propecia cause your gynecomastia, 2) How much does the Procecia help prevent hair loss. Only you can weigh the relative degrees and importances of the two.

As a side note, I have not seen gynecomastia recurrence from low dose finisteride (Propecia 1mg). I do believe that during gynecomastia correction we, as surgeons, remove not only the breast tissue  but also the local stem cells that may convert breast tissue upon stimulation. This is a very long discussion as there are stem cells in the blood as well but the upshot of it is I believe you do get considerable insurance against recurrence by having the gynecomastia surgery.

[DrBermant]

hi guys

does any one here on finasteride/propecia had finasteride induced or normal gyne and had them removed? are you continuing the medication afterwards? if so did gyne come back again?

i had a mild case of gyne since puberty. started propecia/1mg finasteride 12 years ago due to hair loss (at 24 years old). i don't know if my gyne got worse due the medication (i don't think so). i'm going for my gyne surgery in 2 weeks. i'm just curious what finasteride might cause afterwards.

any of you who's still taking finasteride after surgery, i'd really appreciate if you share your experience with fellow readers in this forum.

thank you very much. :-)

Some of my patients never had gynecomastia until they started finasteride. Some started the medication, developed tenderness and growth, stopped the medication, tenderness and swelling subsided, restarted the medication and the symptoms and growth recurred. I have also seen patients who developed gynecomastia during puberty and had not changes after starting the medication years later. Which patients have the reaction to the medication is not fully predictable. There is no guarantee that any of many drugs and medications that cause gynecomastia might not cause regrowth in the future.

I caution each of my patients that surgery does not typically stop male breast growth.

If there is a problem with growing breasts, recurrence can happen.  Any of these medical problems and or these medications can cause gynecomastia. So, if you want to get worried about regrowth, you could get yourself evaluated for each of these conditions to see if they could be a factor. 

If you are using something that can stimulate breast regrowth, shreds of gland remain behind with any surgical technique.  It is just not practical to remove all elements of gland.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest. Take a look at the Anatomy of Gynecomastia to see what I mean.  Even with a radical mastectomy (a disfiguring technique used for some male breast cancer problems), some gland can remain.  Surgery also does not prevent weight gain in the chest.  Men tend to put weight on the belly and chest regions.  I educate each of my patients that this surgery will not prevent further breast growth.  It is like changing/fixing a tire with a nail.  Fixing/changing the tire will not prevent you from getting a new nail in that tire.

Regrowth of gland from stimulation can occur where shreds of gland remain behind. This can be behind the areola, along the deeper edges or margins of a zone of excision. 

I take care of many patients with gynecomastia, as many as 8 in one day alone.  With all the gynecomastia surgery I have done, it is very rare to have regrowth for patients I have sculpted.  One patient (who had surgery on only side by another doctor) came to me with pro hormone induced gynecomastia that only came back on the side that had no surgery.  His growth was massive on the one side and none on the other.  His surgery by that other doctor had left a massive crater - the skin was adherent against the chest wall with normal fat surrounding the ugly deformity.  One side looked like the deformity seen here.  The other side was almost a B cup breast so tender that I could barely examine it.  As with each patient who presented to me with current breast growth, he was referred for an endocrinology evaluation and stabilization before considering surgery.  I do not know if such radical surgery was a factor or not.   Even if it did, removing all fat under the skin just gives an unnatural look.

Here is another example of Gynecomastia Breast Regrowth on my site.  Caution this is a graphic picture of the massive gland regrowth removed on the operating table.

This patient is rather unusual. He was a misdiagnosed genetic female who has lived his entire life as a male.  His birth certificate says male as does his driver's license. Yes, a terrible mistake labeling him male made from birth and early on not recognizing his Congenital Adrenal Hyperplasia.  His body has been exposed to high levels of androgens and estrogen since within his mother's womb. This results in an a condition better called Intersex than the older phrase Hermaphroditism.

I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and my Red Flag Evaluation System before surgery, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention and stabilizing the problem(s) causing gynecomastia, when possible, is much better.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction