Overview

The Post-Finasteride Syndrome Foundation is dedicated to funding research on the characterization, underlying biologic mechanisms and treatments of post-finasteride syndrome (PFS). A secondary goal is to increase global public awareness of PFS.

Often life-altering, PFS is characterized by devastating sexual, neurological, and physical side effects that persist in men who have taken the 5-alpha reductase type II enzyme inhibitor finasteride.

Finasteride is prescribed for the treatment of hair loss under the brand name Propecia (and generics) and for the treatment of enlarged prostate under the brand name Proscar (and generics).

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Syndrome

Post Finasteride Syndrome

The most common persistent side effects of finasteride are loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronie’s disease, penile shrinkage, gynecomastia, muscle atrophy, cognitive impairment, insomnia, severely dry skin and tinnitus. These can last for years after stopping the drug. [more…]

Research

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The PFS Foundation’s primary objective is to help establish medical consensus and acceptance of PFS by promoting scientific and clinical research. Research initiatives focus on uncovering underlying biologic mechanisms for the syndrome and its persistent side effects at a molecular level. [more…]

Publications

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The PFS Foundation serves as a central resource for published research on the condition, including recent studies in JAMA Dermatology and Pharmacotherapy. We aim to facilitate collaborative efforts amongst health care professionals and leading scientists worldwide.  [more…]

Medical Awareness

 

shalendar-bhasin
Symptomatic finasteride users had “significantly lower International Index of Erectile Function composite score” and “significantly lower scores for each of its domains of erectile function, sexual desire, orgasmic function, intercourse satisfaction, and overall satisfaction”… There exists “a significant positive correlation between a subset of Beck Depression Inventory scores related to negative attitude and blood oxygen level dependent activity.”

Characteristics of Men Who Report Persistent Sexual Symptoms after Finasteride Use for Hair Loss: Shalendar Bhasin, MD, The Journal of Clinical Endocrinology & Metabolism, September 2016

 

Steve-Belknap
About one percent of young, healthy men experience persistent sexual dysfunction after taking finasteride for male pattern hair loss… Available toxicity information from clinical trials of finasteride in men with [androgenic alopecia] is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: Steven M. Belknap, MD. JAMA Dermatology, April 1, 2015

 

A.M. Traish
Our findings suggest that finasteride therapy is associated with undesirable and, in some cases, detrimental sexual side effects and reduced quality of life… The argument that the benefits of [finasteride] outweigh the risks is slowly eroding in the face of new emerging scientific evidence from preclinical and clinical studies. The available data demonstrate that such drugs do pose serious adverse effects, especially in a subset of men who may have the predisposition to be affected severely… Physicians need to be aware of the adverse side effects of these drugs and are encouraged to share this information with their patients prior to commencing therapy with finasteride.

Abdulmaged M. Traish, PhD, Prof. of Biochemistry and Urology, Boston University School of Medicine

 

Dr.-Nelson-Novick-1
My yardstick for treating any patient is, what would I do if this were my own son? Ten years ago, I would have answered differently. But now I would not feel comfortable recommending Propecia to a young, sexually active man.

Nelson Novick, MD, Clinical Professor of Dermatology, Mount Sinai School of Medicine, New York

 

Roberto-Melcangi-2
[W]e have evaluated in male rats the effects of a subchronic treatment with low doses of finasteride…and the consequences of its withdrawal…on neuroactive steroid levels… Interestingly, at the withdrawal, some of these effects persisted, and different changes in neuroactive steroid levels, and in the expression of receptors, were also detected. Altogether these findings suggest that the block of the enzyme 5alpha-reductase by finasteride treatment may have broad consequences for the nervous system.

 

— Roberto Melcangi, PhD, Professor of Endocrinology, University of Milano.

 

Jan Tytgat. MD
I don’t think it’s very responsible for dermatologists to use [finasteride] to combat hair loss.  You must know that this molecule, finasteride, has been the subject of more than 2,600 scientific articles found in trustworthy databases.  And they all say, You may be able to reduce baldness, but it comes with a serious risk of impotence, ejaculation problems, testicular pain and, just as bad, a risk of breast cancer.

 

— Jan Tytgat, PhD, Professor of Toxicology and Pharmacology, KU Leuven University.

 

Carlo-Trombetta
Concern regarding adverse effects of finasteride is increasing. We aimed to determine the type and frequency of symptoms in men having long-term sexual and non-sexual side effects after finasteride treatment… The most frequent sexual symptoms…were loss of penis sensitivity (87.3%), decreased ejaculatory force (82.3%), and low penile temperature (78.5%). The most frequent non-sexual symptoms were reduced feeling of life pleasure or emotions (75.9%); lack of mental concentration (72.2%), and loss of muscle tone/mass (51.9%)…Further studies are necessary to investigate the pathophysiological and biochemical pathways leading to the post-finasteride syndrome.

— Carlo Trombetta, MD, Urological Hospital, Department of Medical, Surgical and Health Sciences, University of Trieste.

 

Dirk Michielsen. MD
It’s awful when a patient doesn’t know what’s happening, and takes a medication for a specific purpose, but then develops side effects that may be more damaging than its positive effects. The patient needs to know that, and to be able to say, I’m stopping now. That’s the responsibility of the doctor who prescribes the medication, or the pharmacist who supplies it.

 

— Dirk Michielsen, MD, Professor of Urology, Ziekenhuis University.

 

Christine A Ganzer
In this pilot study, we sought to characterize sexual and nonsexual adverse effects that men reported experiencing at least 3 months after stopping the medication… Responses from 131 generally healthy men (mean age, 24 years) who had taken finasteride for male pattern hair loss was included in the analysis. The most notable finding was that adverse effects persisted in each of the domains, indicating the possible presence of a “post-finasteride syndrome.

Christine A Ganzer, PhD, Assistant Professor, City University of New York

 

Dr.-Seth-Cohen
Propecia is a scary drug that should be cautiously used after exhausting all other treatments for [male pattern baldness]. [It] irreversibly binds to the enzyme 5 alpha reductase…turning the enzyme off causing DHT levels to plummet close to zero. Signs of post-finasteride syndrome include mood swings, mental fog, depression, anxiety, erectile dysfunction, orgasm and ejaculation dysfunction… We have no idea who might be affected worse by it. Some men taking Propecia for MPB seem to have little to no side effects, whereas others suffer for years. In addition, many doctors don’t understand or even recognize PFS as a real disease and these patients will suffer alone.”

Seth D. Cohen, MD, MPH, Department of Dermatology, NYU Langone Medical Center, New York City

 

Silvia Giatti, PhD Department of Biomolecular Pharmacology, The University of Milan
The effects in the brain of finasteride…have been poorly explored. Therefore, the effects of a subchronic treatment of finasteride…and the consequences of its withdrawal on neuroactive steroid levels…have been evaluated in male rats…One month after the last treatment… changes in neuroactive steroid levels, steroid receptors…and GABA-A receptor subunits…were detected. These findings suggest that finasteride treatment may have broad consequences for brain function.

Silvia Giatti, PhD, Department of Biomolecular Pharmacology, The University of Milan

 

Andrew-Rynne
Post-finasteride syndrome is now a recognized condition, affecting as many as 20 per cent of those taking finasteride… The persistent sexual side-effects of finasteride may manifest after varying periods of taking the drug, or not until the drug is discontinued. It is not known why some men are susceptible to the potential adverse effects of finasteride, while others—the majority—are not affected… Further research is needed on who is susceptible to the persistent, adverse side-effects of finasteride and on the underlying mechanisms of the medication.

Andrew Rynne, MD, Clane General Hospital, Kildare, Ireland

 

Christina-Di-Loreto
Treatment of young subjects is of increasing concern due to accumulating evidence that daily use of oral finasteride has several severe adverse effects… Since finasteride inhibits T conversion into DHT, which is responsible for most androgen activity, it is plausible that prolonged finasteride use in predisposed individuals could simulate the effects of aging in young men. Since some of the effects of androgen inhibition cannot be reversed once local androgen levels are re-established, it is temping to speculate that patients could still suffer from adverse sexual effects several months or even permanently after finasteride discontinuation.

Carla Di Loreto, PhD, Department of Medical and Biological Sciences, School of Medicine, University of Udine, Udine, Italy

 

Michael-Irwig
Persistent adverse effects of finasteride in younger men include erectile dysfunction, low libido, lack of orgasms, depression, and decreased alcohol consumption. One study has found lower levels of several neurosteroids in this population. Out of the various persistent side effects, erectile dysfunction and decreased alcohol consumption have been the most studied in animal models. Further research is needed on who is susceptible to the persistent adverse side effects of finasteride and on the underlying mechanisms of the medication.

Michael S. Irwig, MD, Associate Professor of Medicine, Director of Andrology, George Washington University

 

Donatella Caruso
Observations performed in a subset of patients treated for male pattern hair loss indicate that persistent sexual side effects as well as anxious/depressive symptomatology have been reported even after discontinuation of finasteride treatment.

Donatella Caruso, PhD, Associate Professor, Department of Pharmacology and Biomolecular Sciences, University of Milan

 

Dr.-Matthew-Bruhin
Post-finasteride syndrome is a serious state of permanent sexual, mental and physical side effects which do not resolve after quitting the drug… It is also surmised by the few specialists in the medical field that a type of receptor or “brain damage” has occurred… Men suffering from PFS are plagued with many physical, mental, and emotional symptoms that have led to long-term depression, marital problems and divorce, and now several reported cases of suicide.

Matthew Bruhin, PhD, psychotherapist, San Diego, Calif.

 

Erika-Cecchin-1
Finasteride is a steroid 5-alpha-reductase inhibitor, approved for the treatment of androgenetic alopecia and benign prostate hyperplasia. In some patients the treatment is associated with adverse side effects that could become persistent after therapy discontinuation, resulting in the so-called post-finasteride syndrome (PFS).

Erika Cecchin, PhD, Experimental and Clinical Pharmacology Unit CRO National Cancer Institute, Pordenone, Italy

 

Irwin Goldstein
We are becoming more and more aware of persistent sexual health problems occurring as a result of the use of 5-alpha reductase inhibitors, finasteride, and dutasteride, in a subset of patients. What is even more alarming is that in addition to persistent sexual issues, there are persistent central cognitive issues and concerns of persistent depression.

Irwin Goldstein, MD, Editor-in-Chief of the Journal of Sexual Medicine