Post-finasteride syndrome: a surmountable challenge for clinicians

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. (Fertil Steril Ò 2020;113:21-50. Ó2019 by American Society for Reproductive Medicine.

Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors

“…Gur et al [30] report instead that the true prevalence of sexual side effects with 5-ARI treatment is currently unknown. (D) There have been recent reports of persistent sexual dysfunction after discontinuation of finasteride treatment [32,56,60,97,99,100,129,131,134,141,147,149,166,170,237]. Several authors have considered gynecomastia as a sexual dysfunction.…”

An Uncontrolled Case Series Using a Botanically Derived, β-Cyclodextrin Inclusion Complex in Two Androgenetic Alopecia-Affected Male Subjects

“…Although clinically effective against pattern hair loss in statistically significant cohort trials, the published literature also reports serious negative side effects that appear to persist even after discontinuation of the drug. These side effects include loss of libido, ejaculatory dysfunction, disorders of the penis and testes, gynecomastia, and cognitive symptoms including suicidal ideation [16].…”

Treatment with <em>Malva verticillata</em> Seed Extracts Alleviates Alopecia via Activation of Wnt/β-catenin Signaling

“…Hair loss treatments using Food and Drug Administration-approved medications like minoxidil and finasteride impose several side effects [13][14][15][16][17][18]. Therefore, natural substances as alternatives and safe substitutes have garnered research interest.…”