Response to Request for Patient Photographs
I cannot provide photographs of patients with gynecomastia following finasteride use, as I do not have access to or the ability to display clinical images.
What I Can Tell You About Finasteride-Induced Gynecomastia
Incidence and Clinical Presentation
Gynecomastia from low-dose finasteride (1 mg daily for androgenetic alopecia) is documented but appears significantly underreported. 1
- The FDA label reports breast enlargement in 0.5% of patients in Year 1 and 1.8% in Years 2-4 of finasteride treatment, with breast tenderness occurring in 0.4% and 0.7% respectively 2
- Only 8 cases of gynecomastia were formally reported with low-dose finasteride between 1997 and 2024, suggesting substantial underreporting 1
- In the MTOPS study using 5 mg finasteride, gynecomastia occurred in 2.2% of patients on finasteride monotherapy versus 0.7% on placebo 2
Physical Examination Findings
True gynecomastia presents as a soft, rubbery, or firm mobile mass directly under the nipple-areolar complex, often painful especially when present for less than 6 months. 3
- Bilateral involvement occurs in approximately 50% of cases 3, 4
- Must differentiate from pseudogynecomastia (fatty tissue rather than glandular enlargement), particularly in patients with elevated BMI 3, 5
Clinical Course and Persistence
Gynecomastia from finasteride can persist even after drug discontinuation and may become irreversible due to fibrosis. 1
- One documented case showed persistent gynecomastia 5 months after stopping finasteride, requiring bilateral mammoplasty after failing 6 months of raloxifene therapy 1
- Gynecomastia persisting beyond 12 months often becomes fibrotic and less responsive to medical therapy 5, 6
- Early intervention when finasteride-induced gynecomastia first develops is critical to prevent fibrosis and irreversibility 1
Important Clinical Caveat
Physicians prescribing finasteride for androgenetic alopecia should counsel patients specifically about gynecomastia risk before initiating therapy, as this complication may be inadequately communicated to patients. 1, 7