Men under the age of 40 who use finasteride for alopecia are at risk for suicide if they develop persistent sexual adverse effects and insomnia.
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 the age of 40 who use finasteride for alopecia are at risk for suicide if they develop persistent sexual adverse effects and insomnia.
—Finasteride and Suicide: A Postmarketing Case Series: Dermatology, January 14, 2020
[A]t least 17 countries…have warned…of the potential for depression, sexual side effects, or both.
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.
Two subjects—eight percent—committed suicide during or after the study.
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
FDA is concerned that use of finasteride by pediatric patients may pose long-term safety risks.
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
Even if the incidence of persistent sexual adverse events is 3% to 5%… approximately 900,000 to 1.5 million men would suffer persistent sexual and psychiatric adverse events.
[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
We wouldn’t recommend that any man take [finasteride], especially not young men.
We are certainly very cautious, because we see the side effects. We wouldn’t recommend that any man take [finasteride], 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? Puls, SRF-TV, May 7, 2018
For the first time, we demonstrate a tissue-specific methylation pattern of SRD5A2 promoter in PFS patients.
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]…and so many people with the same symptoms can’t be wrong.
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.
[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
Their only crime in life is to take an FDA-approved drug.
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
Finasteride is poison.
Finasteride is poison. there. I said it.
Using finasteride for hair loss is like shooting at sparrows with cannons.
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.
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.
Do not take finasteride for hair loss…Do not take finasteride for any purpose.
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
Proscar can hardly be categorized as ‘safe’ because it can cause breast enlargement, reduced libido and impotence.
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.
Propecia should not have been authorized in the first place, and its approval should be revoked as soon as possible.
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.
Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.
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.
Propecia…suppresses libido in about 10 percent of men but is much more profound in younger guys.
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.
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 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.
The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent.
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
Persistent side effects from finasteride are real.
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. [In] some men, the damage is hardwired.
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
Finasteride: NOT a benign drug.
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.
[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’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
I think [Propecia] is a potentially dangerous drug.
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.
We propose that the Dermatologist Society remove from their guidelines ‘the utilization of finasteride for male pattern hair loss.’
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
This drug should never have been marketed for cosmetic purposes.
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
Some of the effects of androgen inhibition cannot be reversed once local androgen levels are re-established.
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
I would not feel comfortable recommending Propecia to a young, sexually active man.
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
With a greater concentration of receptors, the [penis] becomes more sensitive to testosterone and at a certain point, paradoxically, that sensitivity may shut down.
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.
I don’t think it’s very responsible for dermatologists to use [finasteride] to combat hair loss.
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
This research should cause us to think more carefully about this commonly encountered medication.
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
Sexual dysfunction and suicidal ideation that appears to result from [finasteride] are important adverse effects.
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
Finasteride treatment may have broad consequences for brain function.
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
Does stopping finasteride treatment mean the physiological mechanism of testosterone secretion is reset?
[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
Further studies are necessary to investigate the pathophysiological and biochemical pathways leading to post-finasteride syndrome.
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.
[Finasteride] treatment affected the expression of a number of accumbal proteins.
[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…takes a medication for a specific purpose, but then develops side effects that may be more damaging than its positive effects.
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
[Finasteride] is associated with adverse side effects that could become persistent after therapy discontinuation.
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
Persistent sexual side effects as well as anxious/depressive symptomatology reported even after discontinuation of finasteride.
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
Refrain from prescribing oral finasteride to a patient with a personal history of depression, sexual dysfunction, or fertility problems.
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.
(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.
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
Adverse effects persisted…indicating the possible presence of a ‘post-finasteride syndrome.’
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
Further research is needed on who is susceptible to the persistent, adverse side-effects of finasteride.
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
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 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