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Gyno from Finasteride

Finasteride Gynecomastia – How To Prevent Yourself From Getting Gyno On Finasteride

A huge concern for many individuals before getting on Finasteride, and while they are actually on it, is the possibility of getting Gynecomastia (gyno).

What Is Gynecomastia

Gynecomastia is swollen male breast tissue that develops in boys or men.

Gynecomastia is also commonly referred to as “man boobs”, or “bitch tits”.

What Causes Gynecomastia

Gynecomastia is typically the result of chronically elevated Estrogen levels.

Gynecomastia can also develop in men when there is a decrease in Free Testosterone, causing a hormonal imbalance via a state of Estrogen dominance.

There is a certain amount of Estrogen a man needs to function optimally, and despite what many believe, having 0 Estrogen would actually screw you up and lead to a huge array of negative side effects, so don’t go Gung Ho popping Letrozole like candy thinking it is the solution here.

The longer someone’s Estrogen is left out of range on the high end, the more breast tissue development will occur, and the amount that occurs is relative to how high those Estrogen levels are above the normal range.

How Does Finasteride Cause Gynecomastia

I get really annoyed when I hear people talking about how Finasteride causes Gyno and to stay away because it will give you bitch tits, and so on and so forth.

If you get Gyno from Propecia/Finasteride, it is literally the result of poor hormone management, and nothing else.

This is what you need to understand.

Read this carefully.

This is exactly what happens when you take Finasteride in steps:

  • Finasteride inhibits the enzyme 5-alpha reductase, which is the enzyme that regulates the conversion of Testosterone into the far more androgenic hormone dihydrotestosterone (DHT).
  • Dihydrotestosterone(DHT), or 5α-dihydrotestosterone (5α-DHT) is far more potent of an androgen than Testosterone, and when it binds to the hair follicles it can cause severe miniaturization of those hair follicles, which is the primary mechanism behind what causes permanent hair loss.
  • When you inhibit the conversion of Testosterone to DHT with Finasteride (the point of using it for hair loss prevention purposes), you are left with more circulating Testosterone because it has been inhibited from converting into DHT to a significant extent (by Finasteride).
  • Testosterone doesn’t just convert to DHT, it also aromatizes into Estrogen, and when you have more Testosterone circulating in the body that means there is more Testosterone aromatizing into Estrogen as well.
  • The official brochure from the manufacturer of Propecia, Merck, states that “mean circulating levels of testosterone and estradiol were increased by approximately 15%“. Estradiol is another word for Estrogen.

So, you have less DHT in your body, but you now have a bit more Testosterone and Estrogen.

And remember at the start of the article, chronically elevated Estrogen will lead to the development of breast tissue.

How To Know If Your Estrogen Levels Are Elevated Enough To Induce Gynecomastia

If you don’t have baseline blood work before taking a drug that affects your hormonal profile significantly, your doctor has already failed you, and this is why you need to know WTF you are doing before you just trust that every doctor knows how hormones work.

To be frank, the vast majority of doctors have zero clue what they are doing when it comes to hormone management, so you need to understand how to read your blood work yourself inside out.

For your Estrogen levels in particular, the standard reference range (what is considered “normal”) in men is 15-40 pg/mL.

The reference range on your blood work will very likely differ slightly, and may even be in a different unit of measurement, as every country has their own guidelines dictating what a “normal male” should be at.

This is what you need to know and remember:

The golden sweet spot for Estrogen levels in men is between 20-30 pg/mL.

If you keep your Estrogen in that range forever, you will never get Gyno from Finasteride.

If you prevent your Estrogen from getting out of range, it is physically impossible to start developing breast tissue from Finasteride usage.

This is assuming that other endogenous hormones are also at healthy levels in the body, but I will delve into that later in the article as that is a less common occurrence.

So, the first thing you need to do is go get a blood test.

See what your Estrogen levels are, and make sure you get a copy of the test for you to analyze yourself, don’t let a doctor relay it back to you and just tell you “it’s fine,” because half the time they haven’t the faintest idea what “fine” really is.

They’ll tell you your Testosterone levels are “fine” even if they are on the very lowest end of “normal”, when in reality that would only be “normal” for someone who is on the brink of dying in old age.

Anyways, rant over.

Get your blood work done.

Get a Sensitive Estradiol Assay, and if the results aren't in pg/mL, use this Estradiol conversion calculator to convert it into pg/mL.

If your levels are above 40 pg/mL, I would advise using an Aromatase Inhibitor to lower those levels.

What Are Aromatase Inhibitors

Aromatase Inhibitors (AIs) are drugs that were designed to treat of breast cancer in postmenopausal women and Gynecomastia in men.

Aromatase Inhibitors inhibit the action of the enzyme aromatase.

As mentioned, the Testosterone in your body aromatizes into Estrogen, and it is accomplished via the enzyme aromatase.

When you use an Aromatase Inhibitor, you quite literally, inhibit the enzyme aromatase from doing its’ job, thereby allowing you to reduce the amount of aromatization occurring in your body, and lowering circulating Estrogen levels.

So, if you are already out of range, you should be on an AI.

If you are on the cusp of being out of range and you hop on Finasteride which raises your Estrogen levels a decent amount, you will likely need an AI.

If your Estrogen levels are already in range while you are on Finasteride, then you DO NOT need to worry about getting Gyno.

The goal is to keep Estrogen in the sweet spot forever. If it never gets elevated, you cannot get Finasteride induced Gyno, end of story.

I believe the sweet spot is 20-30 pg/mL and that is where I keep my levels year round to not only feel amazing, but prevent any unwanted side effects or impairment to my physiological functions and quality of life that could occur from Estrogen levels that are too low, or too high.

Which Aromatase Inhibitor Should I Use For Estrogen Management

To save you a bunch of time researching these, and this is something you will only learn from personal experience, this is the breakdown of all of the most relevant AI’s you will need to know about.

Which Aromatase Inhibitor Is Weakest And Which Is The Strongest:

  • Arimistane (greatest margin of error, weakest aromatase inhibitor)
  • Aromasin (high margin of error, fairly strong aromatase inhibitor)
  • Arimidex (low margin of error, fairly easy to crash Estrogen unless on a high dose of aromatizing compounds, very strong aromatase inhibitor)
  • Letrozole (minimal margin of error, VERY easy to crash Estrogen by accident, even on tons of aromatizing compounds, the strongest aromatase inhibitor)

If you aren’t on a bunch of aromatizing drugs (like using exogenous Testosterone or other aromatizing Steroids), you will more than likely only need Arimistane or Aromasin.

I’d recommend a low dose of Aromasin.

Note, a LOW dose of Aromasin.

If you’re not taking a bunch of drugs that aromatize, and you’re just dealing with slight systemic elevation of Estrogen from Finasteride usage, you DO NOT need a crazy dosage.

The dosage will depend entirely on your blood work, and there is no set in stone “use this dose and you will get to 20-30 pg/mL Estrogen”.

No, it doesn’t work like that.

You need to experiment, start low, and taper up slowly as necessary with constant blood work evaluation.

If you are only a few pg/mL above 40, you don’t need to be hitting yourself with 12.5 mg everyday.

If your Estrogen levels are closer to 100 though, then that may not be the case and you may need a dose like that.

It’s all going to be individually dependent.

But what I would do, in general, as you likely don’t have severely elevated Estrogen if you aren’t on additional steroids, is to start with 12.5 mg Aromasin (also called Exemestane) once on Monday, and once on Thursday.

This is conservative, and likely won’t crash your levels.

Get bloods done afterwards, and see where your Estrogen levels lie.

If they are out of range still, gauge how much they have decreased, and then make a judgment call on how many more days of dosing to add.

If your levels were 60 pg/mL and you took 12.5 mg Aromasin twice per week and it brought them down to 43 for example, then you might want to try 12.5 mg Aromasin once every other day.

These are all hypothetical examples of course, but that is the approach I’d take.

Once your Estrogen levels are brought down into range, you will never have to worry about Gynecomastia from Finasteride again.

Getting Gynecomastia Even With Low Estrogen Levels On Finasteride

This is a rarer occurrence, but there is evidence to support that some individuals experience a reduction in Free Testosterone while on Finasteride, despite Total Testosterone increasing by roughly 15%.

Free Testosterone is actually the marker we care about, as that is unbound Testosterone that we can utilize, as opposed to Total Testosterone which is simply the total amount of Testosterone in the body, including the majority of it which is bound by Sex Hormone Binding Globulin (SHBG) and Albumin.

Free Testosterone is the only biologically active Testosterone in the body we can actually make use of.

Even if Total Testosterone goes up, if Free Testosterone doesn't go up in parallel to it, you just have a higher level of present Testosterone in the body, but none of that is actually biologically active.

In the majority of Finasteride's clinical studies, there was no effect on SHBG, and Total Testosterone and Estrogen increased by approximately 15% [R, R].

However, in some studies there was a noted drop of Free Testosterone, despite the increase in Total Testosterone [R, R].

A drop in biologically active Free Testosterone with a concurrent 15% increase in Estrogen levels in the body can lead to a hormonal imbalance.

Anytime the tightly regulated balance of Testosterone:Estrogen is disrupted and Estrogen is too high relative to Testosterone than it should be, a man becomes more prone to developing Gynecomastia.

It doesn't matter if that imbalance occurs via an increase in Estrogen (the most common way gyno occurs), or a decrease in Free Testosterone relative to Estrogen.

If the body is in a state of Estrogen dominance, gyno can develop.

DHT antagonizes SHBG and lowers it, which is partially why men will use DHT derivatives like Proviron to improve their Free Testosterone levels alongside their Testosterone replacement therapy (TRT), and the data supports that lowering systemic DHT (what Finasteride does) would theoretically increase SHBG [R].

When SHBG increases, that increases the amount of Total Testosterone that becomes bound and is no longer bioactive or usable, consequently lowering Free Testosterone.

If you fall into the unfortunate predicament of still experiencing Gyno development even with Estradiol levels at 20-30 pg/mL, you will still likely be able to prevent Gyno with an AI, as AI's will decrease SHBG and Estrogen in the body, while increasing Total Testosterone and Free Testosterone [R].

You just have to be careful about potentially creating low Estrogen side effects, as Estrogen is still a necessary hormone in the male body to mediate other physiological functions.

Long term AI usage also has its own potential implications in regards to how it affects lipid levels in the body.

Frankly, an AI is only a quick first line of defense to get your gyno under control immediately.

You should seriously evaluate your diet and lifestyle choices as there are ways to inhibit aromatase naturally that are sustainable long term without the deleterious outcomes long-term AI use could have.

AI's aren't healthy to use, so ideally you would want to transition off of it once you get your diet, lifestyle, and/or body composition in check to prevent Estrogen dominance from being an issue.

If for some reason you cannot prevent Gyno onset with an AI by manually keeping your levels close to 20 pg/mL (rare, but I've heard of some anecdotal cases of this), you will have to consider incorporating SERMs like Nolvadex or Raloxifene to prevent Estrogen from binding to the receptors in breast tissue, which would then make it physically impossible to exacerbate Gynecomastia.

Raloxifene is superior to Nolvadex in my personal opinion, and should be the SERM of choice for those who fall into that scenario.

Disclaimer: The information included in this article is intended for entertainment and informational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

25 thoughts on “Finasteride Gynecomastia – How To Prevent Yourself From Getting Gyno On Finasteride”

  1. Ok i am on TRT 250 mg a week split into 2 pins of Pharmacutical Watson Test cep and I also take Propecia 1 mg a day ….My E is between 47 to as high as 53 test range says less than 39 pg/ml so im high …test was not the sensitive Assy but i always seem to be in this high range for almost a year . I am starting to notice some Gyno issues what dose of Armasin would you recomend and same for the Armistane ?.Thanks , G

    1. I’d start with 12.5 mg Aromasin E3D personally if I was at 53 pg/mL and then I’d get bloods done again after a couple weeks.

        1. Do i take it on the day i Pin ? I pin about every 3 .5 days ,so day of or after since you said E3 Days ?

  2. So what is the mechanism that AI keeps the estrogen down, even after stopping using them? If person naturally has high aromatase, wouldn’t it just continue after stopping the AI?

    1. Nothing keeps your Estrogen down after you stop using them. If you are prone to high estrogen, you need to be on an AI forever to keep that Estrogen in range. Granted, there are exceptions factoring in lowered T levels as you age, resulting in lower Estrogen, and Aromasin being a suicidal inhibitor which can long-term cause a permanent reduction, but in general, ongoing maintenance would be necessary.

  3. Hey man thanks for all the info. Just got my blood test results it says my estradiol is 32 pg/ml. Is that still alright? Testosterone is 30.3 nmol/l. which is on the high side apparently. Also have noticed some fat gains.I’ve been on finasteride for about two years. I haven’t had any side effects but sometimes don’t get morning wood and erections seem weaker at times but everything still works pretty much normal.

    1. What’s your Free T? Total T and E2 looks good. 32 isn’t bad at all. Your fat gain wouldn’t be Fin related, it would be lifestyle and diet related.

  4. Do you use finasteride yourself?? I use minoxodil and ketanazole shampoo.. and i really havent lost any hair after this.. I tryed finasteride but i got sides like very bad workouts.. minor strength loss and was incredible sore in every muscle.. that i did not use to be. I stopped it and after that everyhting was good again.. i Wanted to take ru588.. but cant get it here where i live.

  5. Hey Derek,

    I need to be able to utilize Finasteride in order to stabilize hairloss, making a hair transplant an option. Finasteirde, initially, never gave me any gyno-related issues.
    However, last winter I tried Dutasteride to try to maximize results and developed fairly bad gyno in just a month. I’ve been off ever since but tried to get back onto Finasteride a couple weeks ago and the gyno that stabilized after stopping dut began to wreak havoc again. I need an AI that’s authentic. Aromasin would be my preference but don’t know where to find it. Is this something my doctor HAS to prescribe to me? If you’re aware of an effacacious website that I can order from, please let me know.

    Thanks, Collin

  6. Hey Derek,

    Subscriber here. Great content you have! I have a small question.

    I am on Fin and my total T raised 10-15% (from 12.9 nmol/l to 16.3).
    I also tested my oestradiol and Free T when on Fin (not tested those before Fin), E2 (36.5 pg/mL) and Free T (11.05 Ng/mL).

    I already have small gyno (before Fin) is it a good idea to take AI to prevent to make it worse because of my high E2?

    1. Taking an AI will hurt your hair, I would try and lower aromatase via natural means first before resorting to an AI. There are lots of foods that are good for that, getting leaner, among several other lifestyle interventions you can try.

  7. Hello Derek.

    A great supporter of your blogs related to androgenetic alopecia here. I am 37.5 years old, first noticed the symptoms of AA when I was 19 years old. I have used everything available for the treatment of AA, including minoxidil 2% and 5%, saw palmetto, biotin, coconut, olive and almond oil, B, C vitamins, magnesium, zinc, cysteine, greek seed, all shampoos that fights AA (ketoconazole, Niacin, Dercos etc). Despite my diffuse hairloss, I managed to maintain my hairline (no bald spots).
    I first started using Finasteride 1 mg 10 months ago (from 1 December 2018). I had mild side effects (the erection was not as long as before, everything else was OK) and by the start of 10 months of finasteride usage I had OUTSTANDING RESULTS with increased hair density, especially in the part of the crown. But in my 10,5th month of use, I began to notice that my nipples became sensitive and a fatty tissue formed beneath them, and on 03 October 2019 I stopped using Fin.
    I had a blood test examination on 07 October 2019, with FSH, LH, Prolactine, SDHA in normal range, but Estradiol was at 64 pg/mol and Testosterone was 10,80 ng/ml.
    My questions are:
    1. Should I use AI for combating the breast tenderness (and reversing the slight enlargement with fat tissue beneath them), and would you recommend between Raloxifene or Anastrazol, or perhaps something else?
    2. Would you advise going back to Finasteride treatment (because of the extraordinary results) AFTER withdrawal of gynecomastia symptoms? Is it advisable to use Fin in cycles, eg. 6 months treatment then 1-2 months break, or is it better to use Fin continuously without interruption with occasional use of AI for keeping under control the estrogen?

    Thank you for the reply and keep up the good work.

    Andrej

    1. 1) An AI would nip the issue in the bud while you fix the other lifestyle factors that could exacerbate this. If you use it though, that’s up to you.
      2) That’s your call man. While you’re on it, you have significant protection from DHT, while you’re not on it, you don’t.

  8. Really appreciate your fast response and your efforts to raise awareness among all of us who are fighting AA.

    Аs far as I have come to understand from one of your blogs, using CERMs, not AI, is a therapy (except for surgery) for existing Gyno and its reversal. Given that I started to feel the symptoms of Gyno (and feel really spooked about it) about a month ago and there is visible, but not drastic formation of fatty tissue under both nipples, would your personal choice be using CERM like Anastrazole (Arimidex) or Raloxifene (Evista)? Or other?

    And what dose would you recommend?

    Feel encouraged and continue to motivate us all.
    Best,
    Andrej

    1. Hi Derek.

      It would really mean a lot to me to receive your answer to the previous question, after you look at the blood test results above (Estradiol was at 64 pg/mol and Testosterone was 10,80 ng/ml, everything else in normal range).
      Thank you for your time. I really appreciate your support and advice.

      Best,
      Andrej

  9. Hey Derek,

    I am currently using 1mg per day for two weeks and I have noticed that my nipples are way more sensitive than it used to be. Another side-effect that I noticed some kind of tenderness and burning sensation on my breast. Therefore, I am looking for ways to counteract the side-effects before its too late. I would like your 2 cents on what you think about grape seeds extract and high doses of zinc to adress this issue

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