Doctors & Researchers Speaking Out

While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy… Two subjects (8%) committed suicide during or after the study.

—Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia: Translational Andrology and Urology, April 2020

There’s significant pathology associated with taking finasteride. We used to think it was just in those main structures—folicles for hair, prostate—but now we know there’s profound potential impact, centrally, in your nervous system. It can affect your sex drive, your sexual performance, etc., etc… I think about one in 10 guys will have appreciable issues with [finasteride]. I definitely see it. That’s why I never use it in my practice… There are people I know who have [PFS] permanently.

—The Drive podcast with Peter Attia, MD: October 6, 2023

An important pattern of symptoms was common among all cases who committed suicide in the setting of finasteride use: insomnia and persistent sexual dysfunction after medication discontinuation. Insomnia and fatigue/tiredness were some of the most debilitating symptoms… Men under 40 years of age who use finasteride for alopecia are at risk of suicide if they develop persistent sexual adverse effects and insomnia.

—Finasteride and Suicide: A Postmarketing Case Series: Dermatology, January 14, 2020

Much of the medical community has yet to recognize [PFS] as a real clinical entity. Our… analysis indicates that, nonetheless, [PFS] is clearly a problem that is important to the general public that warrants intervention. Thus, it is inappropriate to dismiss this condition.

—Global online interest in finasteride sexual side effects, International Journal of Impotence Research: September 13, 2022

For a better understanding of the existing relations between hormonal and cerebral symptoms, a consistent cross-consultation is needed between urologists, sexologists, endocrinologists, and dermatologists on one end, and psychiatrists, neurologists and researchers on the other hand… A very interesting and promising development is the identification of genetically influenced metabotypes, so called GIMS, that represent the genetic basis of chemical individuality, which gave new biological insights. With the help of these GIMS it was possible to prove a consistent genetic association between greater 5α-reductase activity and the risk of male-pattern hair loss.

—The Post-Finasteride Syndrome: Possible Etiological Mechanisms and Symptoms: International Journal of Impotence Research, September 11, 2023

One must be very careful with [finastseride], as it’s sometimes prescribed quickly, without always informing patients of its risks, or of what to do in the event of sexual problems. So I urge you, if you’re about to take finasteride, or if you’re already doing so, contact your dermatologist or the doctor who prescribed if for you so you can benefit from regular monitoring… Also, if symptoms appear, the right decisions can be made, to avoid sexual problems that could last longer.

—Post-Finasteride Syndrome: The Price to Pay for Keeping Your Hair? Dr. Sebastien Beley’s YouTube channel, December 29, 2023

I certainly have a number of patients that complain of low libido, erectile dysfunction—this post-finasteride syndrome… Some men do have resolution when they stop. But there is this permanence in some handful of men. They’ve done MRI imaging to try and understand, anatomically, what’s going on. There’s still a lot of unknowns about it.  It can be permanent in some men, so they come in and see me in clinic… I think the exact mechanism of what’s going on here, what’s changing—we need more understanding of the exact pathophysiology, more neurochemical understanding.

Yikes! That’s my only response [to PFS]. Permanent effects on sexual health…to maintain one’s hair. [A]s I understand it, there’s nothing that can predict if someone will have post-finasteride syndrome… People go and take these drugs to try and grow their hair.  And oftentimes the have erectile dysfunction and other issues… I’m not a clinician, but my encouragement is always for people to approach these drugs with a real level of seriousness, if not caution.

—Dr. Michael Eisenberg: Improving Male Sexual Health, Function & Fertility: Huberman Lab Podcast, November 5, 2023

Urologists prescribing 5-ARIs should be aware of the recent addition of suicide and [suicidal ideation] risk to the list of side effects. A mental health screen should be performed and appropriate resources provided to patients commencing treatment. Furthermore, a review should be arranged with the general practitioner to assess new-onset mental health or SI symptoms.

—US Food and Drug Administration Warning Regarding Finasteride and Suicidal Ideation: What Should Urologists Know? European Urology Open Science, June 2023

It’s still unclear to what extent the lower systemic [finasteride] exposure translates into a lower risk of side effects. Although sexual side effects did not occur more frequently than with placebo…due to the small patient collective…hardly any reliable statements can be made. However, such side effects must always be expected. Although topical finasteride is not approved as a medicinal product in the USA, it is marketed as an over-the-counter medicinal product through telemedicine portals such as forhims.com. In this context, the Post-Finasteride Syndrome Foundation, when asked by the DAZ editors, points out that they are also aware of numerous cases of [PFS from] topical application.

—Hair Growth with Consequences: Deutsche Apotheker Zeitung, March 10, 2023

The FDA put a warning label on finasteride that there may be some association with suicidal behavior or suicidal ideation, so I think it’s good that this these side effects are gaining some traction people are going to be aware of it. There’s lots of stories of people taking this drug but not having a discussion of what the possible side effects are, and then experiencing them as a result. So what can you do before you start taking something like finasteride—you want to look at your sex hormones. If someone has low, or even a borderline-low, testosterone, pushing androgens down further is probably not a good idea.

—How To Prevent Post Finasteride Syndrome: The Gillett Health Podcast, October 3, 2022

Taking finasetride is like walking a tightrope. You know that this medicine may not be your best friend… When you go cold turkey, you have a chance of unleashing a cascade of unintended consquences, like tossing a grenade in a hormonal playground. There is a sudden surge of hormones, a Pandora’s box that is opened, and symptoms come back with a vengance. When you stop finasteride, a person may feel that, within seven to 14 days, the side effects have gone away. He is much more healthy, his libido has come back. But the side effects returning to normal in this short time is just a mirage.

—Finasteride: Going Cold Turkey: Hair Transplant of India, October 5, 2024

What I’m seeing—and what a lot of physicians miss because they don’t look for it or take a  ood medical history—is post-finasteride syndrome. It’s the constellation of symptoms after using this drug, even in small doses, for the hair. Symptoms include poor libido, erectile dysfunction, abnormal ejaculation and even psychological issues like depression… It can be permanent and that’s the scary, scary piece. Each man is very specific and personal—like personal fingerprint medicine, I call it—so you have to talk to a doctor. You want to be careful.

—Post-Finasteride Syndrome: Warning! Anabolic Doc, October 1, 2019

It’s Monday, which means it’s time for a poll! In evaluating fertility, how do you counsel men taking finasteride for hair loss?… Results are up! Seems that almost half of urologists instruct their patients to stop finasteride!

● Stop finasteride: 45.6%
● OK to keep taking: 17.5%
● It depends: 36.8%

—Society for the Study of Male Reproduction (via Twitter): October 11, 2022

Sobering @nypost story on Propecia users experiencing memory loss, ED, suicidal thoughts after using the drug; illustrates the challenge in postmarket Rx safety surveillance and in getting good evidence on [adverse events] from [Randomized controlled trials] [on hormone therapy]

—Referring, via Twitter, to Propecia users claim drug causes memory loss, ED, suicidal thoughts: August 31, 2022

The side effects of 5-ARI, related to the sexual sphere, mainly include erectile dysfunction and decreased libido and, less frequently, ejaculation disorders, decreased semen volume, decreased penis size, gynecomastia…muscle atrophy, fatigue, dry skin, cognitive disorders, depression, etc. are also reported… Post-finasteride syndrome is defined as the persistence of sexual, physical and psychological symptoms that appear with the use of the drug and that persist over time after stopping treatment… The persistence of these side effects causes anxiety, depression and alteration in their quality of life in patients. It is important to consider these side effects and inform the patient of the possibility of their appearance, and their possible persistence over time after stopping treatment.

—Post-finasteride syndrome, an entity to take into account in the treatment of patients with benign prostatic hyperplasia: LiveMed, July 7, 2022

As prescribers, our primary duty is to do no harm. Health care professionals should keep themselves abreast of these potential signals and, accordingly, conduct a full evaluation and a detailed, personalized risk-benefit assessment for patients before each prescription of finasteride.

—Ongoing Concerns Regarding Finasteride for the Treatment of Male-Pattern Androgenetic Alopecia: JAMA Dermatology, November 2020

Not a fan of finasteride, but I dig tamsulosin and mirabegron. Cool report from @doximity

—Statement via Twitter, April 15, 2023

An increasing number of compelling reports of the post-finasteride syndrome in clinical literature has resulted in the update of the labelling of finasteride to include the risk of depression and persistent sexual dysfunction, by regulatory agencies such as the Swedish Medical Products Agency, Medicine Health Care Products Regulatory Agency and the US FDA. Males who are trying to conceive should be counselled on the post-finasteride syndrome.

—Review of dermatologic medications and impact on male fertility, sexual dysfunction and teratogenicity: Andrology, July 25, 2022

As of 2018, 15,000 cases of adverse reactions to finasteride were reported to the WHO—which is a huge number to begin with. And the interesting thing is that the average age of this group was 32 to 34 years old… This drug for young men must be taken off the market.

—Documentary on German network NDR titled Side Effects of Finasteride Are Underestimated: January 25, 2021

The treatment of PFS is quite difficult. The reason is, we don’t know exactly what caused this syndrome. And if you don’t know the mechanism of the cause, you cannot treat the cause… What I’m doing with my patient is, first of all, promoting a healthy lifestyle. At the same time, supporting the sexual dysfunction with medication. Sometimes we even use psychotherapy to deal with those complaints.

—What Is Post-Finasteride Syndrome, and How Do You Treat It? International Society for Sexual Medicine, May 5, 2023

The exact cause of PFS is not fully understood. However, the wide localization of the 5-ARI enzyme in the body, including the brain, bones, and muscles, leads to the reduction of DHT in related tissues. Genetic variability and alterations in the gut microbiota have also been suggested as potential contributing factors… Post-finasteride syndrome is a complex condition that requires further research and understanding. Collaborative efforts among researchers, health-care professionals, and patient advocacy groups are essential to develop evidence-based guidelines and novel therapeutic approaches.

—Understanding Post-Finasteride Syndrome: A Deep Dive into a Rare Sexual Dysfunction: AskFabio, October 9, 2023

The effort to find a solution for PFS has been made more difficult due to the fact that some medical professionals do not acknowledge that PFS exists. There’s an inherent danger to overlooking the effects of PFS. The issue lies less in the sexual complications (which are more widely reported) and more in the mental/psychological complications. 60% of men in their 60s will encounter erectile dysfunction in their lifetime, which can often be managed with a healthier lifestyle or specific medications. However, the reported cases of anxiety and depression that PFS caused men and women is particularly concerning, and can affect not just the mind but the entire body.

—What Is Post-Finasteride Syndrome? RCSM Blog, May 2023

Case 1: 27-year-old male without any clinical or surgical antecedent of relevance. Between January and July of 2014, he was under treatment with finasteride 1mg/day for androgenetic alopecia, without any adverse effects. After a non-protected sexual relationship and the necessity to initiate prophylactic antiretroviral treatment, he suspended the intake of finasteride because of digestive intolerance, and resuming its use in September of 2014. After twenty days, he began showing signs of low libido and less morning erections, as well as penile shrinking, therefore decided to discontinue the drug 10 days later.

—Post-Finasteride Syndrome: About 2 Cases and Review of the Literature: Andrology-Open Access, December 2016

The symptoms of post-finasteride are no joke and prevention is the best thing to do here as there are no known “cures.” Means to manage some symptoms exist and will require extensive work and support with medical experts, groups, and more—but it’s best to not end up in that place in the first instance.

—The Devastating Effects of Finasteride: Post-Finasteride Syndrome: The Men’s Health Clinic: November 16, 2021

No studies have yet confirmed how long PFS symptoms can last. One research study found that side effects could persist for 40 months or more after stopping finasteride use, though this was just until the time of the interview. Symptoms may have persisted for longer. In these cases, the men surveyed had taken finasteride for an average of 28 months.

—Post-Finasteride Syndrome: Should You Be Worried? Wimpole Clinic Blog, September 15, 2023

Taking finasteride can cause severe side effects and lead to post-finasteride syndrome. Therefore, it is very important to be informed of the risks involved prior to starting the medication… One of the most concerning side effects is sexual dysfunction, resulting in low libido, impotence, and loss of orgasm. The seriousness of these side effects could make the use of finasteride considerably less appealing… Those suffering from the syndrome were reported to be healthy young men until they started taking the drug finasteride for hair loss.

Finasteride.

—Response, via Twitter, when asked, “Every doc has that one medication they hate that almost everyone else is fine with and it’s so funny to hear them rant about it, regardless of which medication it is”: February 16, 2023.

Yes this is scary. Finasteride for hair loss is also a risk.

—Statement via X, August 23, 2023

Finasteride is used as a treatment for male pattern hair loss, and is offered and marketed by “medical hair centres” throughout the world without mention of the possible complications. Its use can have serious side effects, [including]: sexual dysfunction including erectile dysfunction, neuroinflammation, insomnia,panic attacks, depression, suicidal idealization [and] reduced muscle mass. Post-finasteride-syndrome has been referred to as a “man-made myth” and a “delusional disorder.” But it’s real and has a growing body of research to prove it.

—Recovering from Post-Finasteride Syndrome: Fairfield Nutrition Blog, August 22, 2022

Post-finasteride syndrome is kind of a controversial diagnosis in the world of urology. But even though we find it controversial, our patients do not. Patients that are suffering from this condition don’t necessarily want to wade into the weeds of, Is real or is it not? Because they are really experiencing symptoms. Within the world of sexual medicine, we have opened our minds to the fact that PFS does exist.

—Common Drug-Induced Sexual Dysfunction in Men: 30th Annual Perspectives in Urology, March 10, 2023

Post finasteride syndrome is real. And can be devastating to men and their partners.

—Statement via X, August 24, 2023

[W]e have assessed and compared for the first time the impact of…finasteride and minoxidil…on male reproduction. Two reproductive organs of adult murine models, testis and epididymis, in addition to testis/epididymis-related cells, were focused on this investigation… We can conclude that finasteride and minoxidil harm the testis and testis-derivate cell cultures. Furthermore, our outcomes revealed that finasteride can damage the epididymis in murine models. It is apparent that both medications act as hormone disruptors, cause oxidative stress, and directly or indirectly affect the BTB in the testicular tissue, thus preventing it from functioning normally.

—Comparative Effects of Finasteride and Minoxidil on the Male Reproductive Organs: Toxicology and Applied Pharmacology, November 1, 2023

There are growing amounts of data available on the impact of finasteride on sexual and mood disorders. This coexistence of adverse events should be considered rather as a distinct syndrome with its own pathogenesis than a random co-occurrence of signs. Post-marketing follow-ups suggested the possibility of persistent symptoms after drug discontinuation, which is referred to as PFS. Despite the lack of final proof, the presence of severe and persistent side effects caused by the treatment of an aesthetic problem raises great concern for the clinician. A low estimated prevalence of PFS cannot be an excuse for nonvigilance since the drug is used by millions of relatively young and healthy individuals. The potential risk of adverse effects, including the length of treatment, should be carefully discussed with each patient before the onset of treatment.

—Post-finasteride syndrome: Does it really exist? The Aging Male, January 16, 2019

Prevention is always better than cure, especially in conditions like this, where so little is known about the causative mechanism of the condition… Avoiding the use of this drug in persons inclined towards mental disorders and sexual dysfunction is the key to the prevention of PFS. [I]t is essential to create practical advocacy regarding the patient’s eligibility for the treatment with finasteride and counsel these persons on possible risks and alternative drugs for treating their conditions and how you should proceed in case of side effects.

—Post Finasteride Syndrome: An Overview: iCliniq, March 29, 2023

Post Retinoid Sexual Dysfunction, Post Finasteride Syndrome and Post SSRI Sexual Dysfunction are devastating conditions that must be taken seriously by the medical field. We need research on the underlying cause and focus on treatment. Anyone find a solution?

—Statement via X, July 9, 2023

Finasteride is an effective medication for treating hormonal alopecia, but it can have adverse psychiatric and psychological effects in some patients… Numerous studies show that more than half of the population that uses this medication has some psychiatric pathology, anxiety and depression, insomnia, suicide risk, and/or sexual dysfunction… Likewise, if the patient has some underlying psychiatric pathology or if he has a family history for the same reason, he is at risk of developing post-finasteride syndrome.

—How Finasteride can affect your mental and sexual health, Andrologica Blog, February 26, 2023

Beware of post-finasteride syndrome (PFS), tell your patients about it before prescription. Targeted education of prescribing doctors is the key.

—Statement via Twittter: January 29, 2023

Damn near over the counter, via [H]ims.

—Referring, via Twitter, to Propecia users claim drug causes memory loss, ED, suicidal thoughts: August 31, 2022

Finasteride.

—Response, via Twitter, when asked, “Every doc has that one medication they hate that almost everyone else is fine with and it’s so funny to hear them rant about it, regardless of which medication it is”: February 16, 2023.

Finasteride inhibits Type II 5(alpha)-reductase, which metabolizes testosterone to the potent androgen 5(alpha)-dihydrotestosterone. FDA is concerned that use of finasteride by pediatric patients may pose long-term safety risks regarding growth, development and sexual function.

—FDA response to Merck & Co.’s citizen petition requesting that finasteride be added to the List of Approved Drugs for Which Additional Pediatric Information May Produce Health Benefits in the Pediatric Population: May 2000

A greatly under-recognised and often devastating condition: “Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin.”

—Referring, via Twitter, to Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin: Sept. 7, 2022

I am writing this letter because I wanted to tell you about my nephew, Eric Rodriguez. Eric died a year-and-a-half ago at the age of 33 by suicide. It was 2007 when Eric took Propecia. As he later told his parents, he took it for a few months, but stopped because the side effects scared him. He had read the warning label in 2007 that sexual side effects could occur while he was taking the medication, but he expected that they would disappear once he stopped. However, the symptoms did not disappear. Instead they became worse, and he experienced other symptoms that the label did not address… He only told his parents about 10 months before he died because he could no longer hide it from them.

—Letter to the FDA in support of the PFS Foundation’s Citizen Petition: October 4, 2017

The Food and Drug Administration Adverse Event Reporting System (FAERS) was queried to identify medications with the highest frequency of ED adverse event reports from 2010-2020… The top 20 medications with the highest frequency of ED were included in the disproportionality analysis… Of these 20 medications, there were 6,142 reports of ED and 5-alpha reductase inhibitors (5-ARIs) accounted for 2,823 (46%) of these reports… Seven medications showed significant levels of disproportionate reporting but finasteride and dutasteride had the highest PRRs: 110.03 (103.14-117.39) and 9.40 (7.83-11.05) respectively… Physicians and patients should be familiar with medications that are associated with ED.

—Medications Most Commonly Associated with Erectile Dysfunction: The Journal of Urology, May 15, 2022

Medical communities and societies are recently beginning to realize the scope and burden of this problem. Until the actual pathophysiology of PFS is determined and effective therapies are discovered, we all have to think twice before prescribing a 5ARIs for our patients with either BPH and/or AGA… Considering the thousands of sufferers who already have PFS, the scientific world immediately needs to conduct more research to determine how to effectively treat this horrible symptom complex.

—Post-Finasteride Syndrome: An Underestimated Phenomenon: UIrology and Andrology, September 15, 2016

If there’s any history of previous anxiety disorder, or depression, then…because of the recently described side effects, patients ought not to have [finasteride], or not to try the drug. And equally, if there’s any previous history of swelling of breast tissue–whats called gynocemastia–or any history of erectile problems or libido problems, then [patients] are probably best to avoid [the drug] and trying other treatments for their hair loss.

—Just how safe is the hair-loss drug taken by millions of men? The Mail+, March 4, 2023

Health Canada recently recommended adding a warning to products containing [finasteride]… While being administered the above-mentioned drug, patients may develop muscle weakness and stiffness, which in turn may cause pain to the patient, damage to muscle tissue and an increase in kinase enzymes. Accordingly, Health Canada and the UAE Ministry of Health recommend that companies that produce products containing [finasteride] add the above-mentioned warning to the internal leaflet of their products.

—Adding a warning to pharmaceutical preparations containing the medicinal substance finasteride: Administrative Circular No. (2009) of 2017

It’s not Finasteride, it’s Disasteride! I’ve had my own experience developing post-finasteride IBS and microscopic colitis (which fortunately resolved after being prescribed Budesonide). I took finasteride 5 mg for more than 7 years for BPH. After discontinuing finasteride, I plan to have a bipolar TURP, which I should have considered years ago—correct the structural problem rather than taking finasteride indefinitely (which my urologist recommended!). I’ve been warning everyone I encounter who is still on finasteride for BPH of the potential serious long-term consequences!

—Email to the PFS Foundation, August 9, 2023

[Propecia] has the sexual side effects, like erectile dysfunction, which can affect men for years. It’s something the drug companies had to disclose over the last decade: “Difficulty achieving an erection that continues after stopping the medication,” side effects that may even be permanent. Up to 20 percent of subjects reporting persistent sexual dysfunction for six or more years after stopping the drug, suggesting the possibility that it may never go away.

—Pills for Hair Growth: YouTube, June 2022

Do not use finasteride (Propecia, Proscar) for hair loss. There is accumulating evidence that it negatively impacts male fertility.  You may instead use topical minoxidil (Rogaine), which has no known negative effects on male fertility.

—Men’s Health and Fertility Lifestyle Information: Weill Cornell Medicine Center

These drugs are poison. They barely help LUTS, cause bad sexual side effects, cause false reassurance in those with an elevated/rising PSA, and now this. I know @CanesDavid agrees.

—Responding, via Twitter, to the study Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide: December 24, 2022

Completely. I can’t think of a single patient of mine for whom this drug made the difference in their voiding symptoms. 

—Responding, via Twitter, to the study Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide: December 24, 2022

I strong[ly] agree with you, using p=0.06 to [say] that no association between suicide and finasteride is a very careless decision. That may [be] very harmful for the users. Based on data of this study, I will strong[ly] recommend to my patients [that] using finasteride has the probability of suicide…higher than 22% than no use. And this sequence for me is very clinically significan[t].

—Responding, via Twitter, to the study Association of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide: December 25, 2022

I have a good friend who, with the best of intentions, told me about his positive hair plug experience and wanted to make [sure] I didn’t miss my window of opportunity for treatment. The finasteride was a deal breaker for me, will not commit to that for life. Bring on the BIC!

—Statement, via Twitter: November 22, 2022

Many have never recovered sexual functioning, not worth the risk. I will never prescribe finasteride.

—Statement, via Twitter: December 4, 2022

In December 2018, I treated Óscar (not his real name), a 28-year-old man who was distressed by a number of symptoms associated with finasteride, a drug he had been taking for 12 months for alopecia, as prescribed by his dermatologist. He had stopped treatment 10 months earlier, but symptoms that affected his quality of life persisted—decreased libido, depression and disassociation “between his brain and his genitals”… From December 2018 until now, I have treated about 50 young men from all over Spain who have been on finasteride for alopecia and whose symptoms persisted in the physical, sexual and psychological spheres.

—Post-Finasteride Syndrome: An Endocrinologist’s View Endocrinologist and Pediatrician: August 2022

[A]gree. I think we need to put the [PCPT] trial concerns to rest. [W]e also need to stop prescribing finasteride.

—Response via Twitter to statements about the Prostate Cancer Prevention Trial concluding that 5-ARIs can cause prostate cancer: May 2022

Patients and doctors remain largely unaware of the long-term consequences of this drug on the nervous system and mental health.  Unfortunately, some of the side effects of finasteride are more serious and persistent than the original condition it is intended to treat… [W]e encountered a surprising association between finasteride use and presence of optic neuropathy or retinopathy… To worsen the situation, the neuropsychiatric impact of finasteride—changes in mood and behavior—can alter practitioner perceptions about affected patients, resulting in a psychosomatic diagnosis.

—A Letter Regarding Finasteride: SouthBayRetina.com, May 2021

Drugs to shrink the prostate (dutasteride, finasteride) shouldn’t be used for years on end because it can negatively impact the heart. 

—Statement (via Twitter): April 12, 2022

Many clinicians are unaware of the scope of the persistent physical and psychological adverse effects of finasteride while it is in usage and despite its discontinuation. The treating clinician should have knowledge and awareness about the higher prevalence of depression and sexual dysfunction in the subset of men seeking treatment for AGA in comparison to the general population. Hence, it is mandatory to ask about patients’ histories of preexisting depression or sexual dysfunction before starting finasteride treatment.

—Post-Finasteride Syndrome: Current Views and Where do We Stand? Annals of Medical and Health Sciences Research, January 2022

In 2012, the FDA asked pharmaceutical manufacturers to update finasteride’s package insert. The FDA asked them to include a warning about side effects that can continue after stopping treatment. This warning is now mentioned in finasteride’s package insert. But that warning isn’t prominently featured. Some have petitioned the FDA to include post-finasteride syndrome as a “boxed warning.” This is the most serious warning given about a medication.

—What Is Post-Finasteride Syndrome?: October 27, 2021

Don’t take finasteride it’s the WORST!!! 

—Statement (via Twitter) to research colleague: October 27, 2021

If topical finasteride causes severe neurocognitive problems, shouldn’t we be quite worried about the millions getting the pill form?

—Referring, via Twitter, to Propecia users claim drug causes memory loss, ED, suicidal thoughts: August 31, 2022

While finasteride may reduce incidence of BPH and/or change the incidence or type of prostate cancer one gets, it also seems to increase the risk of self harm and/or suicide in both younger and older men.

—Statement via Twitter to fellow clinicians: June 5, 2022

I wanted to take a minute to talk to you about post-finasteride syndrome since more and more men are coming in with complaints after taking finasteride. While you still don’t hear much about it PFS as we call it is something we should at least call attention to… [I]t’s really important that men are informed about PFS so that they can decide whether or not they actually take finasteride.

—Utah Men’s Health YouTube channel: July 11, 2019

Patients who are having emotional issues on finasteride, at the one-milligram dose, young men, need to be removed from finasteride. It’s really important that they get the appropriate counseling.

—The Top 20 Hair Loss Studies of 2020: Donovan Medical (YouTube), December 11, 2020

We are certainly very cautious, because we see the side effects [of finasteride]. We wouldn’t recommend that any man take the drug, especially not young men. The longer they take it, the greater the risk of experiencing persistent side effects, including after they’ve stopped.

—Do Anti-Baldness Remedies Make You Impotent? Swiss TV network SRF, May 7, 2018

[T]his represents the largest demographic study over 15 years of [dry eye disease] patients on finasteride, demonstrating an association with finasteride usage and [meibomian gland dysfunction], conjunctival, and corneal abnormalities. The androgen sensitive meibomian glands may be altered in those taking anti-androgen medications, and especially finasteride given its unique potency and targeted effects compared to other anti-androgenics. This study reinforces the importance of considering the long-term effects of finasteride use on DED as part of the systemic sequelae of androgen depletion and provides anticipatory guidance for patients and ophthalmologists.

—The effect of finasteride on dry eye disease, Investigative Ophthalmology & Visual Science: June 2022

I will not prescribe finasteride to young men with MPB because of the potential side effects. In my clinical experience, the length of time on the medication does not correlate with the severity or duration of the side effects. There are numerous hormonal and nonhormonal treatment options for men with PFS.

—Playing with your sex hormones with Propecia use can play with your sex life: Pelvic Health & Rehabilitation, July 16, 2015

Nowadays some young men prefer to take fina[steride] AND duta[steride] to try to keep their hair. And they know the risks but prefer the hair. It’s insane. (I got my hair transplant at 36). Never mind mess with my precious and pleasant DHT. (my prostate is checked and fine)

—Statement (via Twitter) to medical colleague: January 19, 2022

I have patients ask about [finasteride] all the time and I always discuss the risks of sexual dysfunction at length but it’s amazing how many guys seem not to care.

—Statement (via Twitter) to medical colleague: January 19, 2022

In association with adverse sexual effects and depression, suicidal ideation and behavior have sometimes been associated with finasteride treatment. In 2017, the European Medical Agency recommended adding warnings of potential risk of suicidal ideation to product information for finasteride. Importantly, adverse effects associated with finasteride can persist even after discontinuing its use, leading to what has been termed post-finasteride syndrome, including sexual, physical, and psychiatric symptoms, including depression, anxiety, cognitive impairment, and suicidal ideation. These observations encouraged the present systematic review of the research literature pertaining to changes in mood and possible increases in suicidal ideation and behavior in association with or following treatment with finasteride… This systematic review of reports concerning adverse psychiatric effects of finasteride treatment supports the conclusion that such treatment is significantly associated with risk of clinical depression, as well as high rates of sexual dysfunction and evidence of increased risk of suicidal ideation and perhaps of suicidal behavior.

                                                 —Risk of Depression Associated With Finasteride Treatment: Journal of Clinical Psychoparmacology, March 31, 2021

Finasteride (Proscar, Avodart, dutasteride) is absolute garbage on a serious note! Don’t let any man you know take that poison! 

—Statement (via Twitter): March 8, 2022

This is the first analysis, to our knowledge, of suicidality and psychological adverse events in association with finasteride in VigiBase, an international pharmacovigilance database…These findings could raise concern that younger men with alopecia may be especially at risk for suicidality compared with the general population…Clinicians should pay greater attention to the psychological adverse effects of finasteride when prescribing them, especially in the younger population using the drug for hair loss.

—Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride: JAMA Dermatology, November 2020

Post finasteride syndrome is so real! Hundreds of patients coming to #sandiegosexualmedicine with this. Often have low t. Make sure to check dht also! Some recommend andractim, available in Europe (and online). Shockwave therapy for ED. Can take years to get better for some!

—Statement (via Twitter) in response to Jagan Kansal, MD’s tweet, “Thoughts on propecia in young guys causing decreased libido, possibly permanent?” November 13, 2020

Men who take finasteride for baldness or receding hairlines can develop sexual dysfunction. Don’t risk your future children for a little hair.

—Response (via Twitter) to the top 20 adverse reactions to finasteride filed with the FDA: April 23, 2021

The Bottom Line: It is important to know that those who experience hair loss are more likely to report depression, so clinical trials are needed to conclusively determine whether finasteride causes depression and anxiety. However, studies have documented depression and anxiety among finasteride patients, along with sexual side effects, and symptoms can persist for months or years after stopping the drug.

—Taking Propecia or Proscar to Prevent Hair Loss is Associated with Depression, Anxiety, and Sexual Problems: National Center for Health Research website, 2021

PFS can start shortly after starting the medication and can possibly last months to years after stopping. Decreasing the dosage strength is unlikely to reduce the risk of PFS. Patients considering using these medications should be very careful and speak to a Urologist in person about risks, benefits, and indications of treatment.

—What is Post-Finasteride Syndrome? HTX Urology website, December 2019

Literally a drug looking for any reason to still exist. And can we talk about the real risks of cognitive decline with them???

—Response via Twitter to the Karolinska Institutet study Association of 5α-Reductase Inhibitors With Prostate Cancer Mortality: May 31, 2022

[Y]ou need to understand that hair[-loss] is not a life-threatening condition. However, it can affect general appearance. Every dermatologist has their own way of treating the condition. In my opinion, I do not recommend using finasteride for the treatment of hair loss as its side effects are more dangerous. So I suggest you continue with Minoxidil and multivitamins. In the [long] term, if nothing works out, then go for a hair transplant rather than using Finasteride.

—Response (via iCliniq) to the mother of a 23-year-old male whose dermatologist prescribed finasteride: May 13, 2022

Due to the risk of sexual side effects, clinicians should exercise caution when treating AGA patients with finasteride. In addition, there is a recognized conglomerate of sexual side effects accompanied by neuropsychiatric effects including depression that have been grouped into a term known as post-finasteride syndrome.

—Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics: November 2021

Until the actual pathophysiology of PFS is determined and effective therapies are discovered, we all have to think twice before prescribing a 5ARIs for our patients with either BPH and/or AGA. Meanwhile, professional organizations may provide educational materials for physicians in order to increase their awareness regarding the scope of these persistent catastrophic adverse effects of finasteride and dutasteride. Considering the thousands of sufferers who already have PFS, the scientific world immediately needs to conduct more research to determine how to effectively treat this horrible symptom complex.

—Post-Finasteride Syndrome: An Underestimated Phenomenon: Urology and Andrology, September 2016

You wipe a drug off the earth… mine is finasteride… Go! That little pill messed me up pretty good…  Very few [primary care physicians] are starting proscar or avodart. Keep sexual side effects in mind!

—Challenge to fellow health professionals via Twitter: October 26, 2021

Treatment with finasteride and dutasteride is thought to potentially improve male pattern baldness. But be careful, friends. It’s not to be used without medical supervision. There are serious side effects that need to be considered!

—Statement via Twitter, February 10, 2022

Emerging post-marketing reports of persistent depression and sexual side effects have led to growing concerns about the safety of 5α-reductase inhibitors and prompted product labeling changes in many regulatory jurisdictions. Since 2008, at least 17 countries including the United Kingdom and the United States have warned prescribers of the potential for depression, sexual side effects, or both with finasteride.

—Post-Finasteride Syndrome: Efforts to explain persistent symptoms are undermined by poor long term data on harms: The BMJ, August 9, 2019

Finasteride USERS BEWARE!!!  I stop just about every patient that comes to me on this medication.

—Reaction (via Twitter) to publication of the study Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride, in JAMA Dermatology, January 19, 2021

There are currently no satisfactory treatment options for post-finasteride syndrome. Transdermal substitution of dihydrotestosterone led to an improvement in sexual symptoms in two placebo-controlled studies. However, cognitive functions, depression, and quality of life were not improved. When prescribing antidepressants, the advantages and disadvantages must be carefully weighed, as some antidepressants may improve the symptoms of depression but have an unfavorable effect on sexual function.

—Successful Finasteride Treatment Can Lead to Permanent Problems: Deutsche Apotheker Zeitung, April 2018

I have done an analysis of reported neuropsychiatric adverse effect of finasteride to the FDA (based on FAERS data) which may be of interest to you. It shows a much higher signal in comparison with other drugs used for alopecia or suspected to affect mood… I’m surprised the FDA has not done these simple comparisons to explore safety signals for finasteride.

—Letter to the PFS Foundation, March 2, 2022

Androstanediol glucoronide is a hormone derived from DHT (the hormone inhibited by finasteride). In men affected by the PFS, the level of Androstanediol Glucuronide is not restored to previous finasteride levels. The result of the blood test hormone in these patients is generally below the scale or a very low result. It’s unnatural for adult men to have low levels of this molecule. Only individuals who are born with intersex characteristics (hermaphrodites) have low levels of this hormone. It is essentially a masculinizing hormone and may have an effect on sexuality… Women present low levels of Androstanediol glucoronide naturally, since they produce little testosterone. Women who have high levels of this hormone, show reproductive problems (polycystic ovary), excess body hair and a more masculine appearance.

—Andrologica Blog, April 7, 2018

Two papers in a short period of time showing higher rates of suicide with finasteride. PFS is real—time to re-evaluate its use.

—Statement (via Twitter) in response to a study titled Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride, December 7, 2020

Thanks for citing our work [Dr. Faysal]. 100% agree. Haven’t used this drug in over 7 years of practice except in very rare cases.

—Expanding (via Twitter) on a study published in JAMA Dermatology he co-authored, titled Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride, December 7, 2020

Agreed. Finasteride is phasing out of my practice.

—Statement (via Twitter) in response to a study titled Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride, December 7, 2020

Post-finasteride syndrome.

—Response (via Twitter) to medical student Rainy Horowitz’s question: What sex-med topics do you think urology residents would most benefit learning about?: June 21, 2022

[F]inasteride is associated with common adverse health effects in women with long-term treatment for androgenetic alopecia, such as irregular menstrual cycle, aromatase disorder, high cholesterol, heavy menstrual bleeding and induced DNA damage. Long-term-treatment follow-up revealed that (5 mg/day) effects on hair growth are sustained in most women. Finally, the study recommended that finasteride should not be administrated as treatment for androgenetic alopecia in women.

—Prolonged use of finasteride-induced gonadal sex steroids alterations, DNA damage and menstrual bleeding in women: Bioscience Reports, February 2020

[A]pproximately 30 million young men, worldwide, would be prescribed finasteride or dutasteride to treat male pattern hair loss. Even if the incidence of persistent sexual adverse events is 3% to 5%, which may be viewed as a small number, approximately 900,000 to 1.5 million men would suffer persistent sexual and psychiatric adverse events. By no means this would be considered a small number and should not be dismissed or ignored.

—Post-finasteride syndrome: a surmountable challenge for clinicians: Fertility and Sterility, January 2020

You don’t have to be a genius to realize that, when you’re taking away the most potent form of testosterone, and you’re affecting, for example, ejaculate volume, clearly something is changing around the prostate area. Then, when people are coming back and saying they have libido issues, those are relevant.

—How Avodart and Proscar Affect Libido: Prostate Cancer Research Institute, May 3, 2021

Healthcare Professionals should carefully monitor patients during treatment with finasteride for psychiatric symptoms (including anxiety, depression and suicidal ideation). If a patient treated with 1 mg finasteride develops psychiatric symptoms, treatment should be stopped.

—Direct Healthcare Professional Communication letter, October 4, 2018

Even if you take just a little finasteride, it can actually drop your DHT so low that men become impotent. That’s a very common thing. I have patients who come in to see me for sexual problems. Usually it’s ED. Then they have no ejaculate. They also have problems with sex drive. So that’s all gone in many men, just because of finasteride. And that’s huge. You have to choose between hair and sex drive and your personality and your marriage or your partnership… I’ve tried giving testosterone to patients who are on finasteride at the same time. And I have to use huge amounts of testosterone to overcome this drug. And it’s not worth it…. We stopped prescribing finasteride because the risk is just too high.

—BioBalance Healthcast: The Ugly Truth About Finasteride, June 7, 2021

[T]here has been a Red Hand Letter for this drug since 2018. Every patient must be thoroughly informed about its side effects. Finasteride is not one of my first recommendations due to its possible known side effects. If a patient absolutely wants to take finasteride, he must sign a form acknowledging that he has been informed about the side effects and is willing to accept them.

—This Hair-Loss Drug Has Powerful Effects: Men’s Health Germany, June 2021

Pharmacological treatments, including finasteride and oral contraceptives, that inhibit 5α-RI, which results in a blood and brain allopregnanolone decrease also affect subunit expression of GABA_A receptor and are associated with mood symptoms and suicide and are part of post-finasteride syndrome.

—Allopregnanolone, the Neuromodulator Turned Therapeutic Agent: Thank You, Next? Frontiers in Endocrinology, May 2020

Reggie told me that sometimes he got confused for no reason and he felt tired all the time. Plus, his muscles and joints ached… It seemed the finasteride was the culprit.

—He Became Depressed and His Sex Drive Disappeared. What Was the Cause? Discover, October 2020

[T]here is no known treatment for lifelong PFS. Perhaps worst of all, despite that fact that it is the minority of men who are so drastically affected, there is no way to predict who will or won’t suffer the aftermath of taking finasteride. However, PFS is now so prevalent that it has its own foundation, the Post-Finasteride Syndrome Foundation, where you can acquire a great deal of sobering information, enough to make you wonder why anyone would take the drug to begin with. We believe the warnings about finasteride are justified.

—BPH? No Fun. Balding? Yuck. But Nobody Warned Me about Finasteride! SperlingProstateCenter.com, Aug. 30, 2018

[E]very day I receive more and more emails from young men whose lives have been changed by finasteride. Maybe you think I’m exaggerating. I didn’t believe it either, until 10 years ago, when I started seeing more men with PFS… I advise you once again to never use [finasteride] to treat hair loss. Although nobody knows how many men it impacts, its effects are devastating.

—What is Post-Finasteride Syndrome? VigoraClinic.com, April 30, 2020

For the first time, we demonstrate a tissue-specific methylation pattern of SRD5A2 promoter in PFS patients [which] could represent an important mechanism of neuroactive steroid levels and behavioral disturbances previously described in PFS… The SRD5A2 promoter was more frequently methylated in the CSF of PFS patients compared to controls (56.3 versus 7.7%).

—Altered methylation pattern of the SRD5A2 gene in cerebrospinal fluid of post-finasteride patients: a pilot study: Endocrine Connections, July, 2019

People kill themselves after taking [finasteride]…I had a colleague who took his own life 15 years ago, so I know it happens—and so many people with the same symptoms can’t be wrong. People take their own lives because of the effects of the drug, but also because they can’t get through to anyone and they are not believed.

—The Drug that Banishes Baldness Can Ruin a Man’s Love Life: Daily Mail, July 22, 2019

[T]hese data indicate the urgent need for high-quality clinical trials, with long-term follow up, specifically addressing sexual function and mood disorders. In addition, it is imperative to study in detail the molecular mechanisms that cause this condition, trying to identify a possible genetic predisposition, in order to limit the burden of PFS. Finally, therapeutic strategies, [such as] neuroactive steroid treatment, able to relieve or to cure this condition are also urgently needed.

—Post-finasteride syndrome: An emerging clinical problem: Neurobiology of Stress, May 2020

I have hundreds of [PFS] patients. They have low libido. They have flat emotions. They see a woman, they say intellectually, ‘I know I am supposed to be interested in you. But I am actually not interested in you’. They have muted orgasms, reduced volume of ejaculate, reduced penile sensation… If it is 1.4 percent [of finasteride patients who experience persistent sexual dysfunction] and there are several million people on this product, you’re looking at 300,000 men rendered impotent by a hair-loss drug. Their only crime in life is to take an FDA-approved drug.

—Hair Loss Drug Propecia Carries Risk of Losing Something Else: NBC News, March 10, 2017

Stopping finasteride treatment can cause post-finasteride syndrome. This may result in side effects such as memory problems or sexual dysfunction (problems that affect the desire for or ability to have sex). Post-finasteride syndrome wasn’t reported in clinical studies, but it has been reported since the drug was approved. Side effects thought to be caused by post-finasteride syndrome can be mild or serious. Although some of these side effects may go away with time, others may be permanent.

—Medical News Today, July 26, 2021

Definitely see this. “Post-finasteride syndrome.” At least 5-6 patients per year find their way to #UCLA_Andrology. Normal T and gonadotropins on lab evaluation. Can take a year to improve.

—Statement (via Twitter) in response to Jagan Kansal, MD’s tweet, “Thoughts on propecia in young guys causing decreased libido, possibly permanent?” November 6, 2020

There are feared side effects [from finasteride] that include sexual dysfunction in men, some of which can be very serious. And it must be mentioned that there are cases in which these functions are irreversibly impaired, which means there is no recovery after discontinuation of use.

—Segment on German network WDR’s Tricks of the Beauty Industry, June 30, 2021

Maybe not atypical, but anxiety/panic due to finasteride.

—Response (via Twitter) to query by Harrison Kalodimos, MD: “What are some atypical medication side effects that you have seen in practice and look out for now on a regular basis?” April 1, 2021

Seen this far too often to doubt that it’s real. Post-finasteride syndrome is a legit thing. For those who argue that there is no data to support this—As the saying goes, the absence of evidence is not the evidence of absence.

—Statement (via Twitter) in response to Jagan Kansal, MD’s tweet, “Thoughts on propecia in young guys causing decreased libido, possibly permanent?” November 6, 2020

Finasteride is poison. there. I said it.

—Statement (via Twitter) in response to a study titled Sexual Dysfunction in Men Taking Systemic Dermatologic Medication: A systematic review, June 6, 2019

I added finasteride to my 2021 list of Drugs to Avoid.

—Reaction to French medical journal Prescrire’s annual update of drugs to avoid, March 18, 2021

@MariaUloko discusses #postfinasteridesyndrome and #pssd. All healthcare providers should learn about these conditions as finasteride/SSRIs are commonly prescribed.

—Statement (via Twitter), July 27, 2021

[PFS] appears to occur in sensitive individuals, even if exposed to small doses and for short periods, and symptoms can persist for long periods. Based on currently available data, the use of 5α-reductase inhibitors in patients with a history of depression, sexual dysfunction or infertility must be carefully and individually evaluated.

—Post-Finasteride Syndrome Exists!! TagMedicina.it, May 5, 2020

Using finasteride for hair loss is like shooting at sparrows with cannons. The drug.…blocks not only the super hormone but also other hormones that affect thinking and psyche, mood and emotions. Discontinuation of the drug should actually make the hormones work again.…but apparently, something breaks down in some men, in the prostate, in the brain, in the whole organism.

—I Didn’t Want to Go Bald. A Pill the Doctor Gave Me Destroyed My Life (English translation): Die Zeit, Feb. 22, 2018

Depression and suicidal behavior are all very serious side effects caused by finasteride, and this is absolutely unacceptable for a lifestyle drug… Rationally, one cannot advocate for this medicine or justify the fact it’s still on the market. Actually, it should be banned from the market, because it works weakly, it only works as long as you take it and it can have a lot of unwanted serious effects that are intolerable for a lifestyle drug.

—Markthceck (SWR TV) Lifestyle Drug Finasteride: Dead pants instead of a bald head? May 21, 2019

Do not take finasteride for hair loss…Do not take finasteride for any purpose…For many years, Public Citizen’s Health Research Group has classified both [Proscar and Propecia] as Do Not Use because their benefits do not outweigh their adverse effects.

—Updated Review of the Hair Loss and Prostate Drug Finasteride: Worst Pills, Best Pills, January 2020

The use of Finasteride (Proscar) for the prevention of cancer is limited since it only prevents the harmless type of prostate cancer (the SKY Stage.) Proscar can hardly be categorized as “safe” because it can cause breast augmentation, reduced libido andimpotence.

—Statement (via Twitter) in response to study titled Long-Term Effects of Finasteride on Prostate Cancer Mortality, January 29, 2019

Propecia was approved in 1997 as a solution to slow male pattern baldness. Finasteride is not only poorly effective, but it can lead to infertility. As we stated in 2006, we advise against a cosmetic product with potential endocrine side effects. Propecia should have never been approved, and its authorization should be revoked as soon as possible.

—Finasteride-induced Infertility (English translation): Der Arzneimittelbrief (The Drug Letter), November 2013

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.

—Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride: PeerJ, March 9, 2017

I have personally seen in my practice otherwise completely healthy young men who come in for ED and the only medication they had taken was finasteride for hair loss.  PFS is real.

—Response (via Twitter) to Rachel S. Rubin, MD, vis-a-vis the clinical study titled Post-finasteride syndrome: An emerging clinical problem, January 2, 2020

Propecia…diminishes dihydrotestosterone levels and suppresses libido in about 10 percent of men but is much more profound in younger guys… Try stopping and using minoxidil instead for hair preservation.

—5 Common Medications That Can Cause Erectile Dysfunction: MedShadow, June 9, 2019

By reducing DHT so drastically, effects can occur in the genital tissues and in the brain. This can lead to numbness in the penis and erectile and libido disorders, which are related to what happens in the brain. These symptoms are very rare, but once you have them, it’s forever.

—Baldness Medication Can Cause Permanent Erection Problems (English translation): De Volkskrant, February 15, 2019

I do not prescribe finasteride or dutasteride for sexually active patients. I have seen some cases of post-finasteride-syndrome that do not revert to anything. In my opinion, these medications are contraindicated in this population.

—Statement (via Twitter) in response to a study titled Sexual Dysfunction in Men Taking Systemic Dermatologic Medication: A systematic review, June 6, 2019

The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent. I think it’s important to be educated about the potential side effects.

—Donald Trump’s hair loss drug tied to anger, depression, and self-harm in new medical study: The Daily Mail, March 21, 2017

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: The Journal of Clinical Endocrinology & Metabolism, July 2018

Blocking 5 alpha-reductase to any degree in the brain is a crapshoot. Theoretically, you are going to block the production of hormones that serve very important behavioral purposes. Essentially, the cells get too much DHT, it puts them in overdrive and it burns them out. But unfortunately, in some men, the damage is hardwired.

—The Medical Mystery Behind America’s Best-Selling Hair-loss Drug: Tonic magazine, Nov. 21, 2016

Fun fact: castrated rats regain erections [with] testosterone supplementation, but LOSE it when co-administered with 5 alpha reductase inhibitor. Finasteride: NOT a benign drug.

—Statement (via Twitter) in response to SWOG Cancer Research Network article titled Finasteride Safe, Long-Term Results Show, May 17, 2018

“[Finasteride’s] potential side effects, especially the long-term side effects of the drug, should be the overriding concerns to both the users and the manufacturer… [Finasteride] has the capability to impair male sexual performance, creating the inability to achieve an erection, decreases libido and has the horrifying potential of causing specific birth defects in a developing male fetus.”

—Supposed Miracle Baldness Cure Creates Serious Health Concerns Among Hair Restoration Professionals: Business Wire, December 24, 1997

Signs of post-finasteride syndrome (PFS) include mood swings, mental fog, depression, anxiety, erectile dysfunction, orgasm and ejaculation dysfunction. [Propecia] is a scary drug and we have no idea who might be affected worse by it. Some men taking Propecia for [male pattern baldness] 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.

—Playing with your sex hormones with Propecia use can play with your sex life: Pelvic Health & Rehabilitation, July 16, 2015

I think [Propecia] is a potentially dangerous drug. Twenty percent of men who take Propecia see their sexual function diminish. I even told my brother-in-law to stop taking it.

—Is This Hair-loss Drug Dangerous? (English version): 66 Minutes, Feb. 3, 2019

Persistent adverse effects development from finasteride in young men include erectile dysfunction, low libido, lack of orgasm and depression. Finasteride use in young males is a potential risk for their sexual health. Physicians treating male pattern hair loss should discuss with patients the potential risk of adverse events with finasteride. We propose that the Dermatologist Society remove from their guidelines “the utilization of finasteride for male pattern hair loss.”

—Sexual and Nonsexual Problems after Finasteride Used for Hair Loss in Young Men: American Society for Men’s Health, 2014

According to Bernard Begaud…“This drug should never have been marketed for cosmetic purposes.” But now that it is available, it’s up to those concerned to decide whether or not to take this medication, or to stop taking it. They need to be better informed.

—Should We Fear Hair-loss Medications? Le Figaro, March 3, 2019

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.

—Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia: PLOS ONE, June 24, 2014

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.

—Are Hair-Loss Drugs Safe? Men’s Journal: September 2015

A group of Italian researchers gave finasteride to rats and noticed that the number of androgen receptors in their brains went up. Moreover, the effects persisted long after the drug had been discontinued.…[T]hey then called in men with PFS, took skin from the penis and found that the density of androgen receptors in men with PFS was about twice that of those without. Now, remember the idea of the testosterone bell curve and damping effects (little testosterone, little growth, more testosterone, more growth, even more testosterone, reduced growth)? I think this is what we are seeing here. With a greater concentration of receptors, the organ becomes more sensitive to testosterone and at a certain point, paradoxically, that sensitivity may shut down.

—The Virility Paradox: The Vast Influence of Testosterone on Our Bodies, Minds, and the World We Live In: February 2018

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.

—The Wonderhair Pill, May 2016. VRT-TV, Belgium

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).

—A pharmacogenetic survey of androgen receptor (CAG)n and (GGN)n polymorphisms in patients experiencing long term side effects after finasteride discontinuation: International Journal of Biological Markers, Dec. 9, 2014

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.

—Patients treated for male pattern hair with finasteride show, after discontinuation of the drug, altered levels of neuroactive steroids in cerebrospinal fluid and plasma: Journal of Steroid Biochemistry and Molecular Biology, February 2015

To date there are no predictive factors for the risk of development of post-finasteride syndrome and no known treatment for the disorder. For the time being, as a general rule: Refrain from prescribing oral finasteride to a patient with a personal history of depression, sexual dysfunction, or fertility problems.

—The Difficult Hair Loss Patient: Guide to Successful Management of Alopecia and Related Conditions: August 2015

A review of 17 randomized controlled trials (including more than 17,000 patients) demonstrated a nearly twofold increase in sexual, ejaculatory and orgasmic dysfunction in young men using Propecia for male pattern hair loss. At the same time, a recent study demonstrated changes in the levels of certain steroids in cerebrospinal fluid of men taking finasteride for hair loss. These steroids have been shown to influence brain function, and their presence may help explain the profound psychological changes such as depression and suicidality that have been associated with finasteride use. This research should cause us to think more carefully about this commonly encountered medication.

—Potential side effects of the drug Trump reportedly takes for hair loss: The Washington Post, Feb. 3, 2017

Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS). Aim: To determine whether (CAG)n-rs4045402 and (GGN)n-rs3138869 polymorphisms in the androgen receptor (AR) gene are implicated in PFS. Conclusion: This study showed that short and/or long (CAG)n and (GGN)n repeats had different frequencies according to symptoms reported by patients with PFS, likely reflecting the vast array of genes modulated by the AR [and] a U-curvilinear profile of (CAG)n repeats for skin dryness symptoms, where the two extremes exhibited a worse condition than medium repeats.

—Androgen Receptor (AR) Gene (CAG)n and (GGN)n Length Polymorphisms and Symptoms in Young Males With Long-Lasting Adverse Effects After Finasteride Use Against Androgenic Alopecia: Journal of Sexual Medicine, November 2016

Sexual dysfunction and suicidal ideation that appears to result from [finasteride] are important adverse effects. Patients should be informed of these risks, so that they can weigh the benefits of harms against treatment.

—Finasteride 1 mg in Alopecia: Sexual Dysfunction, Suicidal Ideation: Prescrire, October 2016

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.”

—Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride: American Journal of Men’s Health, June 13, 2014

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.

—A Clinical Overview of Finasteride and Its Potential Causative Links to Long-term Side-effects: The Medical Independent, Jan. 22, 2015

The effects in the brain of finasteride…have been poorly explored. Therefore, the effects of a subchronic treatment of finasteride.…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.

—Effects of Subchronic Finasteride Treatment and Withdrawal on Neuroactive Steroid Levels and Their Receptors in the Male Rat Brain: Neuroendocrinology, Dec. 9, 2015

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.

—Post-Finasteride Syndrome Therapy, MatthewBruhin.com, 2015

In my own practice, I see probably a half-dozen patients a year who come in with the observation—Hey, I was feeling fine, I went on [Propecia], and after that, I noticed these changes in my sexual health.  It’s always been a question in my mind: Was this a lingering drug effect, or are there other factors coming into play?

—Hair Loss Drug ‘Under Fire’ For Sexual Side-Effects: CBS 2 News Chicago, May 11, 2011

[Finasteride therapy] is a modification of the hormonal mechanism, which raises the question of reversibility. Does stopping treatment mean the physiological mechanism of testosterone secretion is reset? I can’t answer. We probably don’t have the precise data we’d need to answer that.

—Santé report on the suicide of PFS patient Romain Mathieu: France 5 News, Nov. 24, 2016

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.

—An observational retrospective evaluation of 79 young men with long‐term adverse effects after use of finasteride against androgenetic alopecia: Androlog, Jan. 13, 2016

[O]ur results showed that [finasteride] treatment affected the expression of a number of accumbal proteins involved in key functional processes, such as regulation of GABAergic neurotransmission, as well as steroid and pyrimidine metabolism. These findings may prove crucial to understanding the neurochemical mechanisms of FIN’s neuropsychiatric side effects.

—Exploring the neural mechanisms of finasteride: a proteomic analysis in the nucleus accumbens, Psychoneuroendocrinology, October 2016

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.

—The Wonderhair Pill: VRT-TV, May 2016