Breast Enlargement from Propecia
I have been taking Propecia since I was 28, in varying doses from .25mg to 1mg. I have seen a huge benefit from it, but I have also seen some increase in breast tissue along with some pain in the breast area. My doctor has asked me to stop taking it to see if the pain subsides, and I have stopped for about a month but it has made little difference in terms of pain. What has changed is that my hair has thinned dramatically, mostly in the crown area.
My doctor would like me to continue off of Propecia for another month or so to rule it out as a culprit, but I’m concerned that I may lose a lot of hair permanently. Can you give me any idea of how permanent the hair loss is that I am experiencing now? If I’m off Propecia for two months, am I likely not to get back to near the same levels of hair that I had while I was on it?
If you were my patient, I would probably tell you to stay on the Propecia (unless you are willing to lose your hair and then not get it back). Hair lost after stopping Propecia might regrow for some, but I would expect that once the hair is gone, it won’t return.
Breast enlargement resulting from Propecia does not go away simply by stopping the drug. The breast tissue should be treated by a person knowledgeable in this field, first examined carefully to make sure that there is no breast cancer. Then consider treating it as a typical gynecomastia case with surgery and possibly liposuction done by someone experienced.
I am now working with such an experienced doctor at my office who treats this condition, which can occur with or without Propecia use.
Dr rassman,
You say the hair that was there on propecia would very soon be lost permanently – how is this true? I always thought that the follicles remained ‘alive’ for up to two years after there was hair growth?? and if there were terminal hair there then wouldnt it miniaturise slowly rather than just fall out for good? Confused!
I was just wondering about the doctor saying that going off the medication does not reverse breast enlargement. That is, frankly, a bit scary. Websites like Livestrong.org (not exactly Encyclopedia Brittanica but I’m tempted to trust it) say that all the side effects of propecia are reversible. Can you clarify?
https://www.livestrong.com/article/117660-reversible-side-effects-propecia/
Swollen nipples and other mild gynecomastia symptoms can be reversed simply by increasing DHT levels. The problem is if actual fibrous tissue develops in which case you’d need to be medically treated to reduce the tissue. In the worst scenarios you’d require a surgical removal of the tissue.
So it is reversible it’s just not always going to go away simply by ceasing propecia.
Does tenderness come first? In other words if you feel the beginning of symptoms can you usually jump ship before you start amassing significant breast tissue to warrant surgery? Expensive surgery seems problematic.
Generally tenderness is the first symptom, followed by itching, tingling or a notable puffiness around the nipple. There are different types of gynecomastia from puffy rings around the nipple to very hard solid swollen lumps under the nipple. Every individual is different in their reaction, though I’ve only ever seen surgery required in those who either had a long term pubescent hormonal issue or who abused anabolic steroids for long periods of time. Normally if you discontinue the propecia soon enough you won’t ever reach the severe stages. Though I would always suggest you speak to your Doctor if there’s concern. You can be prescribed a mild AI (aromatase inhibitor) which will block the estrogen conversion in your body and stop the nipples swelling or growing tissue and can even reverse tissue development in some men.
Surgery is only normally required in guys who’ve shown severe symptoms for over a year or more or who have permanent ongoing hormonal imbalances (such as those with testicular damage etc).
Breast tenderness and swollen nipples are caused by the body converting male androgens to feminine estrogens or progestins normally. Propecia blocks a certain amount of DHT. DHT is the main androgen which blocks estrogen from coupling in the breast tissues of men. If you discontinue propecia (or even try reducing the dose to 0.5mg or less) the DHT won’t be as low and it can actively block the estrogen in the breast area. I recently cut my dose down to 0.5mg daily and have kept the same hair regrowth so far and had a reduction in chest and belly fat, which is common with better DHT production.
So yes, as long as you haven’t ignored the symptoms for months or years, they will generally be reversible simply by cutting down or stopping propecia. I was actually trying to re-assure you that if it didn’t there are medications to reverse swollen nipples and surgery if it’s extremely severe. It’s not a condition you’re stuck with by any means.
Thanks, that helps!
Sorry one more question. Paul, you’ve been very helpful. I was wondering are you a doctor or do you work for NHI/the blog? Or are you a fellow concerned citizen, so to speak? Wouldn’t really matter either way, just curious. Thanks!
Hi Chris,
I’m not a Doctor nor do I work for the NHI/Blog. I’m an athlete who has worked with many medical research groups and dates an endocrinologist! So please don’t take my advice as a Doctor’s advice – but I do work with a lot of guys advising them on hormone testing and outreach work to young athletes who are thinking of/getting involved in steroids and nutritional supplements. I advise several athletic organizations on the current trends in AAS and designer ergogens.
Sadly I’ve seen breast enlargement in many men who either have a general hormone imbalance during puberty or who have used anabolic steroids (or even legally available pro-hormone supplements) and I am sadly aware of the treatments that are required.
I started to lose some of my hairline at 28 and started on Propecia and minoxidil which, luckily for me, has, so far, reversed this loss and restored my hairline entirely. I’m always aware this might not last forever and started reading this blog to prepare for a possible hair transplant in future years.
I’m aware that there is a disconnect between the athletic community and Doctors who work with athletes who are well aware of hormonal conditions and those working in the hairloss field who often have a detailed working knowledge of DHT and hairloss – but there is often a problem joining up these specialities, so that propecia users can experience some symptoms similar to steroid-using athletes (bizarrely because one is blocking DHT and the other is using products that can be based on DHT but can result in lower DHT over time)but people often don’t understand what to do.
Dr Rassman mentions he now works with an endocrine specialist who offers treatment for this condition. I think that’s a great step. The issue I’d state is that it is possible, if you want to cut down or cease Propecia use that androgen levels will rebound and gynecomastia early symptoms will be reversed without treatment. It depends what you cite as gynecomastia really. Tingling, swollen nipples will often be diagnosed as gynecomastia but it’s really a ‘pre-gyno’ condition that will self-modify when serum DHT returns to normal. If that fails, prescribing an AI medication will generally treat the condition directly and is a cheap option compared to surgery. Surgery is often advised by surgeons (not maliciously it’s simply surgeons are often quickly led to the idea of surgery!) when it’s premature.
It’s the same with hairloss. There are good surgeons who’ll try to examine your hairloss, determine if it’s really MPB or just a maturing hairline, how bad the loss is, and generally attempt medical intervention before suggesting a hair transplant procedure. There are surgeons who want to leap right into HT without those initial steps. Same with things like Gynecomastia (although it’s a very small surgery overall) – the best treatment course will check hormone levels, look at changes that can be made naturally, introduce medical treatments where appropriate and only suggest surgery if the condition warrants it.
Sorry for the long answer!
No need to apologize, it’s really interesting to know. As a mid 20s guy debating whether to go on propecia I’m curious since you started at 28, how old are you now?