Post-finasteride syndrome - a true clinical entity?

madman · Feb 28, 2025

This review critically examines Post-Finasteride Syndrome (PFS), a condition eventually reported by men who have used finasteride for androgenetic alopecia or benign prostatic enlargement and experienced persistent adverse effects after discontinuation. We explore the clinical manifestations, including sexual dysfunction, neuropsychiatric symptoms, and physical changes, that collectively challenge both diagnosis and management. This review evaluates the evidence for PFS, discusses potential mechanisms including neurobiological alterations, genetic predispositions, and addresses the controversies surrounding its existence and recognition by the medical community. Emphasis is placed on the role of patient education and the need for thorough risk assessment before prescribing finasteride. Although contrasting data from literature, men treated with finasteride could develop a plethora of non-neglectable physical and psychological symptoms identifying PFS. A multidisciplinary approach to research, policymaking, and patient advocacy is essential to better understand, diagnose, and manage PFS, underlining the necessity for greater awareness and scientific inquiry into this contentious and impactful syndrome.

MAIN MECHANISM OF FINASTERIDE AND CLINICAL APPLICATIONS

COMMON SIDE EVENTS RELATED TO FINASTERIDE

FROM COMMON SIDE EFFECTS TO THE COMPLEXITIES OF A SYNDROME

* Biological basis
* Post-discontinuation symptoms in human populations

AIMING TO DEFINE PFS

PREVALENCE

POTENTIAL MECHANISMS OF PFS

NOCEBO EFFECT AND CONTROVERSIES

POPULATIONS AT RISK

CONCLUSION

In conclusion, PFS represents a complex and multifaceted entity, challenging clinicians and researchers alike in its diagnosis, management, and understanding. This complexity necessitates a multidisciplinary approach, integrating insights from urology, psychiatry, and pharmacology to effectively address the diverse manifestations of PFS. It is crucial to acknowledge that the responsibility for managing and identifying PFS extends beyond urologists, involving a range of healthcare professionals. The recognition of potential risk factors, such as personality disorders and genetic predispositions, emphasizes the need for personalized patient assessments before initiating finasteride treatment. Moving forward, this demands a heightened focus on patient education, careful monitoring for adverse effects, and exploration of alternative therapeutic options which could help avoid prescription of finasteride. The goal is to optimize treatment outcomes while minimizing the risk of PFS, thereby improving patient care for conditions treated with finasteride.

madman · Feb 28, 2025

Table 1. Constellation of symptoms in post-finasteride syndrome.

madman · Feb 28, 2025

Table 2. Pertinent studies reporting post-finasteride syndrome.

madman · Feb 28, 2025

Table 3. Risk assessment and clinical suggestions for patients potentially affected by post-finasteride syndrome.

madman · Feb 28, 2025

Table 4. Future directions.

madman · Feb 28, 2025

Thread 'Finasteride and Antidepressant Induced Sexual Dysfunction in Men'

Jul 20, 2023

Maria Uloko, MD, discusses symptoms, causes, and treatments for post-finasteride syndrome (PFS) and post-SSRI sexual dysfunction (PSSD) in men. She explains the controversy behind the PFS diagnosis and discusses the attention it has gathered in urology, citing the NIH’s inclusion of PFS in its 2015 list of Rare and Genetic Diseases. Dr. Uloko also explores various SSRIs and how increased serotonin activity can lead to PSSD. She ultimately recommends a biopsychosocial approach for both conditions and strongly advocates for patient validation during treatment....