The post-finasteride syndrome: clinical manifestation of drug-induced epigenetics due to endocrine disruption.

Finasteride treatment impairs biosynthesis and function of neurosteroids, which are critical regulators of central (CNS) as well as peripheral nervous system functions and modulate a host of neurotransmitter receptors, such as gamma amino butyric acid receptors. Thus, finasteride-induced neuroendocrine disruption of biosynthesis of critical signaling molecules results in pathophysiological states, which contribute to inhibition of biochemical pathways responsible for a host of physiological functions, ranging from sexual activity, mood, and cognition. In addition, finasteride-induced epigenetic changes in gene expression, including upregulation of androgen receptors (AR), increased histone acetylation, and methylation results in undesirable biological outcomes such as impairment of dopaminergic signaling and modulation of other neurotransmitter receptors, may be the underlying mechanism causing persistent or permanent adverse effects, manifested in anxiety, depression, and suicidal ideation.... The medical community has an obligation not to turn a blind eye on this rare yet debilitating condition in young men.

Traish, A.M. Curr Sex Health Rep (2018) 10: 88. https://doi.org/10.1007/s11930-018-0161-6 [Curr Sex Health Rep]