Post-finasteride syndrome: a surmountable challenge for clinicians

Post-finasteride syndrome is a constellation of persistent sexual, neurological, physical and mental side effects manifested in clinical symptoms which develop and persist in some patients during and/or after discontinuing finasteride.

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Volume 113, Issue 1, Pages 21–50

Author:

Abdulmaged M. Traish, Ph.D.

Abstract:

Post-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) or benign prostatic hyperplasia. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. To date, there are no evidence-based effective treatments for PFS. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. Based on the existing body of evidence in the contemporary clinical literature, the author believes that finasteride and dutasteride induce a constellation of persistent sexual, neurological and physical adverse side effects, in a subset of men. These constellations of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities.


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Luis Hoyos
Luis Hoyos about 2 months ago

I read with much interest this article and I congratulate the author. Potential long-lasting effects from 5alpha reductase inhibitors is concerning. I wonder whether there is a dose-related effect and whether smaller doses may suffice for the treatment of alopecia while at the same time decreasing the risk of potential sexual side-effects. At the same time I am puzzled by the role of DHT on fertility and sexual function in males and I wish there were more data about fertility since there are many young males on this medication. Based on my understanding, it seems like the fertility side-effects are patient specific and reversible. I would be interested in knowing the opinion of the author in terms of post-5alpha reductase inhibitors effects in regards to fertility.