ArcaMax

DEAR DR. ROACH: I am an 88-year-old male who has been taking tamsulosin twice daily for several years because of benign prostatic hyperplasia (BPH). In October 2023, my urologist added finasteride once daily. One year later, in October 2024, I developed extreme tenderness on my left breast that wrapped around my left side.

I had a routine visit with my cardiologist who told me it was a side effect of finasteride. The cardiologist told me to stop taking it immediately and advise my urologist about my decision. I advised his nurse, who advised him, but I heard nothing further from him.

My cardiologist advised me that the tenderness would be gone in a week or so. It abated but still hasn't gone away completely. I spoke with my primary care physician several weeks after the side effects lingered. She emphatically said that the side effects would go away but didn't say when.

What is your opinion about these lingering side effects? -- W.R.

ANSWER: Finasteride works by blocking the enzyme that converts regular testosterone to dihydrotestosterone (DHT). DHT is active in enlarging the prostate and affecting hair follicles, which leads to male pattern baldness. Thus, finasteride is used for these two conditions.

Most men don't get side effects, but enlargement of breast tissue (gynecomastia) is a known side effect of finasteride. About 3% of men will develop gynecomastia with the usual 5-mg dose of finasteride that is used for prostate enlargement, compared to 1.8% of men on a placebo. The breast tissue can be affected on one or both sides and is sometimes painful. It usually goes away after stopping the medicine.

Unfortunately, there are cases where the breast enlargement does not go away, even after months have passed. Medications such as tamoxifen or raloxifene have been successful, but some men have had to get the breast tissue removed. A combination of surgical excision and liposuction is the standard way of removing unwanted breast tissue in men.

DEAR DR. ROACH: I'm 80 and in very good physical shape. I walk 10-20 miles or more on hiking trails weekly, even though I have a pacemaker.

I fell down our stairs hauling boxes and hurt my knee. I developed a Baker's cyst on the back of it that is the size of a tennis ball. I have gone to an orthopedic doctor and had an ultrasound and x-rays done, but nothing showed up.

As I understand it, a Baker's cyst comes about because of excess fluid in the knee, but they can't find the cause of the excess fluid. Is it a torn meniscus, arthritis, or a torn ligament like an ACL? Can I have an MRI done on my knee if I have a pacemaker?

Would it be be smart to get a second opinion to find the cause and recommended treatment, like surgery? I can only walk to the mailbox, and I'm in a lot of pain. -- J.E.

ANSWER: A Baker's cyst is a fluid-filled sac behind the knee. In older adults, they are nearly always a result of knee damage. Almost every patient I've had with a Baker's cyst has had osteoarthritis of the knee, but they can occur as a result of an injury, such as the fall you had.

Many people with Baker's cysts have no symptoms, but if they are painful like yours, orthopedic surgeons will usually try an injection. However, given your injury, I am a bit surprised they didn't order an MRI, which can usually be done in people with newer pacemakers. (Talk to your cardiologist about this.)

If your cardiologist gives the OK, it's fine to go back to your first orthopedic surgeon and ask them about it. In severe cases, surgery can be done.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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