Farkas Hal Steven, Jee Youn Hee, Szymczuk Vivian, Leschek Ellen Werber
College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA.
Children's National Hospital, Endocrinology and Diabetes, Washington, DC 20010, USA.
JCEM Case Rep. 2024 Apr 24;2(5):luae050. doi: 10.1210/jcemcr/luae050. eCollection 2024 May.
We report a case of persistent gynecomastia in a healthy 20-year-old man after 1 month of low-dose finasteride. Finasteride was discontinued after 2 months, and gynecomastia was unchanged 5 months after drug withdrawal. The gynecomastia regressed but did not resolve after 6 months of treatment with raloxifene, a selective estrogen receptor modulator. One year later, bilateral mammoplasty was performed to remove the remaining breast tissue. Finasteride, a 5-alpha-reductase inhibitor, is widely used for the treatment of androgenetic alopecia. Gynecomastia is an expected side effect of this therapy given its mechanism of action. However, only 8 cases of gynecomastia have been reported with low-dose (1 mg daily) finasteride treatment since its approval for androgenetic alopecia in 1997. This raises the concern that gynecomastia resulting from low-dose finasteride is significantly underreported, causing inadequately informed patients. Further, because of the risk of gynecomastia, it is important for prescribing physicians to counsel patients regarding this complication and to consider early intervention when finasteride-induced gynecomastia first arises to prevent fibrosis and thus irreversible gynecomastia.
我们报告一例健康的20岁男性在服用低剂量非那雄胺1个月后出现持续性男性乳房增生的病例。2个月后停用非那雄胺，停药5个月后男性乳房增生情况未变。使用选择性雌激素受体调节剂雷洛昔芬治疗6个月后，男性乳房增生有所消退但未完全消除。1年后，进行了双侧乳房成形术以切除剩余的乳腺组织。非那雄胺是一种5α-还原酶抑制剂，广泛用于治疗雄激素性脱发。鉴于其作用机制，男性乳房增生是该疗法预期的副作用。然而，自1997年非那雄胺被批准用于治疗雄激素性脱发以来，仅有8例关于低剂量（每日1毫克）非那雄胺治疗导致男性乳房增生的病例报告。这引发了人们的担忧，即低剂量非那雄胺导致的男性乳房增生可能被严重漏报，使患者了解不足。此外，由于存在男性乳房增生的风险，开处方的医生向患者咨询这种并发症并在非那雄胺引起的男性乳房增生首次出现时考虑早期干预以防止纤维化从而避免不可逆的男性乳房增生非常重要。
