Attempting to assist people who experience gyno on finasteride

So I am seeing increasing posts of people getting gyno sensations on finasteride online, and the people in the comments seem to have no clue what they’re talking about.

As someone who’s been dealing with this for years since day one, I know how frustrating it can be.

I cannot comment advice on everyone’s posts so I will try to write out what helped me and there is a worrying lack of info on this.

The issue is due to the ratio of androgrens to estrogen. When taking finasteride e2 goes up while DHT goes down which completely throws off the ratio in some people.

With fin there are two major causes of gyno: either high estrogen or low dht. Dht binds to the receptors in the breast and with less dht floating about in tissues due to finasteride, this allows e2 to attach instead.

I am also like you. I am sensitive to finasteride and at most dosages it give me chest swelling and pain as well as burning nips.

Initially as a first stage noobie approach i’d recommend microdosing fin with supplement such as DIM and zinc, but clearly that wont work for you.

I’d recommend you get blood tests done (while you have side effects and preferable before) to find out if you have high estrogen and/or low testosterone and/or high shbg. I personally got sick of messing around with dosages and frequency of fin all the time for years and eventually found out my issues were due to high estrodial.

I worked with an endo and my bloods while i was experiencing gyno sides showed that my estrodial shoots up like crazy on finasteride. I eventually just addressed this with the low dose of an aromatase inhibitor (anastrazole) and it has worked very well. I can get away with small doses very infrequently and take fin just fine with no chest issues. Right now im on 0.5mg fin but plan to up this in the future.

I know a few guys that do this too. Unfortunately gyno on fin is so rare that there is little to no info on what to do if you get this issue, but people are starting to get more educated. Back when i first had this issue the only thing people really said was “oh it’s extremely rare”, like thanks for the useless information.

The other issue is if your gyno is due to low dht. This is a bit more complicated to address and i dont have much advice on how to combat this. All i can think of that should work is addressing with a SERM like tamoxifen. But bear in mind i really dont know anything about SERMs like dosage or frequency, and it can have side effects too.

No matter what you decide to do it is important you work with an endochrinologist.

I think it is just easier to figure it out the issue and address it rather than fucking with bullshit like 0.001% topical fin and getting sides anyway with no results. And in my experience topical gave the same sides so it being marketed as a lower side effect option is bullshit imo

Just so you know:

Aromatase inhibitor- Lowers e2.

SERM- Prevents e2 from binding to the breast receptors and causing gyno

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Thanks for the post mate. Did your endocrinologist say this would be sustainable? I heard AIs can mess with your lipids long term.

Also how did you go about finding an endocrinologist that can help you with this? The one I’ve seen when I first got gyno wasn’t much help

I have high test, highish SHBG and pretty average e2 when not on any compounds (30 pg/ml), so not too clear why even at super low topical concentrations I get chest sides

Hey mate. So pretty much I ordered the anastrazole online in 2022. Lets say it wasn’t entirely via ‘normal channels’. But it is pharma grade and the exact same as what is prescribed in my country.

I pretty much had it on hand just in case but never actually took it and tried my best to avoid it as long as possible.

Fast forward to 2024, i was seeing and endo and got my bloods for the first time while i was experiencing these chest sides and found out my e2 was high as hell. At that point i thought fck it, let me experiment here until my next appointment.

I took about 3 doses of 0.25mg anastrazole each spread out a couple days apart, and the sides went away and somehow stayed away for months. Didnt even need to take any more til around august. It takes a few days to notice symptom relief in my case. it wont improve overnight,

I then upped my fin dose to 0.5mg daily and take ai very infrequently and only when needed. Sometimes 0.25mg every week or two, maybe even 0.125. Luckily this works for me.

I did tell my endo about me using it and she didnt seem to really care tbh lol. but she did refer me to an andrologist who i am currently on a waiting list to see. Once that goes through i will definitely ask him more about it.

About lipids there is no way to know for 100% certainty. We know on the breast cancer dosage of 1mg a day and crushing e2 that yes it affects lipids.
However there are no studies at low doses.

This is my complete theory off my head here. I think the best way to go about using ais is to lower ur e2 for symptom relief while still keeping it high as possible. I sort of think of it as a threshold. Due to finasteride, ur body is producing more e2 than it naturally would, so if you lower it to a safe ‘natural’ threshold then you should be able to avoid side effects. If you are more reliant on dht and start needing to crush e2 below the safe threshold to prevent gyno then you will run into issues.

So i believe low doses like this wont affect my lipids. I sometimes dont even need any ai for over two weeks. It seems chest inflammation due to e2 takes a while to return even when e2 rises, at least in my case.

Even if lipids are somewhat affected, i made a personal choice that i am okay with that. In my opinion keeping my hair is of extreme importance to me, so i am willing to take this risk if it allows me to use finasteride.

As for having normal e2 levels on paper, it is more about what is going on in the individual tissues rather than the blood. We have no idea what dht and e2 levels are in the breast and other body tissues unfortunately. This explains why some people dont get sides on 0.5mg fin as opposed to 1mg when on paper they block pretty much the same serum dht. We just dont know what is going on in the tissues

Cheers for the reply - any reason you went for anastrozole and not a weaker AI?

I mean to my knowledge there is no weaker ai.

Letrozole is way stronger.

Aromasin is a suicidal inhibitor and actually directly causes hairloss via a different mechanism to e2, so this is pointless for us

Ah okay thanks, I was aware aromasin was a suicidal inhibitor so it’s worse if you overshoot, but not that it could potentially even make things worse through another mechanism.

The MPMD article on gyno with finasteride also mentioned Arimistane as the weakest AI, but think that may be a suicidal inhibitor as well so same could apply.

Sorry for the late response I didn’t see this.

Yeah I am aware of the article you’re speaking about. I saw it a couple years ago.

The thing is that article is extremely old and I think mpmd wrote it back when he was body building.

But yeah it’s a pretty bad recommendation on his part and I think he should update it. He recommended a stupid dose of something like 12.5mg arimistane EOD if i remember correctly. That would fuck someone up

Also arimistane metabolises into an androgenic compound that destroys the hair. Maybe at low doses this won’t have an effect but I dont wanna take that risk