Doctors & Researchers Speaking Out

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 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

Michael S. Irwig, MD, Attending Endocrinologist
Beth Israel Deaconess Medical Center

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

Mohit Khera, MD, Director, Laboratory for Andrology Research
Baylor College of Medicine

Health care professionals should…conduct a full evaluation and a…risk-benefit assessment for patients before each prescription of finasteride.

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

Roger S. Ho, MD, Associate Professor of Dermatology
NYU Langone Health

This drug for young men must be taken off the market.

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

Hartmut Porst, MD
Founder, European Institute for Sexual Health

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

Janet Woodcock, MD, Director of the Center for Drug Evaluation and Research
US Food and Drug Administration

Patients and doctors remain largely unaware of the long-term consequences of [finasteride] on the nervous system and mental health.

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

Keshav Narain, MD
South Bay Retina Ophthalmology Clinic, San Jose, CA

Don’t take finasteride.

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

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

Ashley Winter, MD, Urologist
Kaiser Permanente San Diego Urology

This systematic review…supports the conclusion that [finasteride] 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.

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

Ross J. Baldessarini, MD, Professor of Psychiatry
Harvard Medical School

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.

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

Quoc-Dien Trinh, MD, Associate Professor of Surgery
Harvard Medical School

Post finasteride syndrome is so real!

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

Jessica Yih, MD, Urologist
Wexner Medical Center, Ohio State University

Don’t risk your future children for a little hair.

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

Vijayant Govinda Gupta, MD
Govinda Healthcare Medicentre, New Delhi, India

[S]ymptoms can persist for months or years after stopping the drug.

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

Meg Seymour, PhD, Senior Fellow
National Center for Health Research

PFS can start shortly after starting the medication and can possibly last months to years after stopping.

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

Robert Dhir, MD
HTX Urology, Houston, TX

Due to the risk of sexual side effects, clinicians should exercise caution when treating AGA patients with finasteride.

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

Mark S. Nestor, MD, Dermatologist
University of Miami Miller School of Medicine

That little pill messed me up pretty good.

You wipe a drug off the earth… mine is finasteride… Go! That little pill messed me up pretty good.

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

Kenneth Delay, MD
Panhandle Men's Health, Tallahassee, FL

[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.

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

Shelly Gray, PharmD, Shirley & Herb Bridge Endowed Professor
University of Washington School of Pharmacy

Finasteride USERS BEWARE!!!

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

Jared J Wallen, MD
YOU & WEE Urologic Surgery & Wellness, Sarasota, FL

There are currently no satisfactory treatment options for post-finasteride syndrome.

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

Petra Jungmayr, Pharmacist
Esslingen, Germany

It’s unnatural for adult men to have low levels of [Androstanediol glucoronide].

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

Ángel Cunill Castro, MD
Andrology Clinic of Madrid

[T]ime to re-evaluate its use.

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

Faysal A. Yafi, MD, Associate Professor of Urology
University of California, Irvine Medical Center

Haven’t used this drug in over 7 years of practice.

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

Naeem Bhojani, MD, Associate Professor of Urology
University of Montreal

Finasteride is phasing out of my practice.

Bhavik Shah, MD, Advanced Urology
Decatur, GA

[F]inasteride is associated with common adverse health effects in women…such as irregular menstrual cycle, aromatase disorder, high cholesterol, heavy menstrual bleeding and induced DNA damage.

[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

Wedad Saeed Al-Qahtani, Assistant Professor
Naif Arab University for Security Sciences, Riyadh, Saudi Arabia

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

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

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.

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

Mark A. Moyad, MD, Director of Preventive & Alternative Medicine
University of Michigan Department of Urology

We stopped prescribing finasteride because the risk is just too high.

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

Kathy Maupin, MD, St. Louis, MO

Finasteride is not one of my first recommendations due to its possible known side effects.

[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

Désirée Hölscher, MD
Diagnostics Center, Hamburg, Germany

Pharmacological treatments, including finasteride and oral contraceptives, that inhibit 5α-RI…are associated with mood symptoms and suicide.

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 GABAA 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

Graziano Pinna, PhD, Associate Professor
The Psychiatric Institute, University of Illinois at Chicago

It seemed the finasteride was the culprit.

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

Douglas G. Adler, MD, Professor of Medicine
University of Utah School of Medicine

We believe the warnings about finasteride are justified.

[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

Dan Sperling, MD, Radiologist
Medical Director, Sperling Prostate Center

[E]very day I receive more and more emails from young men whose lives have been changed by finasteride.

[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

Eduardo García Cruz, MD, Urologist
Serrate & Ribal Institute of Urology, Barcelona

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

Roberto Melcangi, PhD, Head of Neuroendocrinology, Department of Pharmacological and Biomolecular Sciences
University of Milano

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

David Healy, MD, Professor of Psychiatry
Bangor University

[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

Silvia Diviccaro, PhD, Post-Doctoral Fellow, Department of Pharmacological and Biomolecular Sciences
University of Milano

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

Irwin Goldstein, MD, Clinical Professor of Surgery, University of California at San Diego
Editor-in-Chief, The Journal of Sexual Medicine

Post-finasteride syndrome wasn’t reported in clinical studies, but it has been reported since the drug was approved.

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

Alex Brewer, PharmD, San Diego, CA

At least 5-6 patients per year find their way to #UCLA_Andrology.

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

Sriram V. Eleswarapu, MD
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles

[N]o recovery after discontinuation of use.

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

Julia Maerker-Stroemer, MD
Krohnstiegcenter Dermatology Center, Hamburg, Germany

…anxiety/panic due to finasteride.

Travis Bias, DO
Family Medicine Physician, Oakland, CA

Post-finasteride syndrome is a legit thing.

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

Petar Bajic, MD
Glickman Urological and Kidney Institute, Cleveland Clinic

Finasteride is poison.

Rachel Rubin, MD, Urologist
IntimMedicine Specialists

I added finasteride to my 2021 list…

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

Donald H. Marks, MD
Hospitalist, UAB Medicine, Birmingham, AL

All healthcare providers should learn about these conditions.

@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

Amy Pearlman, MD, Urologic Surgeon
Pearlman MDs, Iowa City, IA

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.

[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

Andrea Militello, MD, Urologist/Andrologist
Department of Urological, Biomedical and Translational Sciences, Federiciana University

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

Michael Zitzmann, MD, Andrology Professor
University of Munster, Germany

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.

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

Wolfgang Becker-Brüser, MD, Publisher
Arznei-Telegramm

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

Michael Carmone, MD, Director, Health Research Group
Public Citizen

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.

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

Mark Scholz, MD, Medical Director
Prostate Oncology Specialists

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.

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

Dietrich von Herrath, MD, Chief Physician
St. Joseph Hospital, Berlin

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.

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

Steven M. Belknap, MD, Research Assistant Professor of Dermatology and Medicine
Northwestern University Feinberg School of Medicine

PFS is real.

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

Jonathan Clavell, MD
Clavel Urology, Houston, TX

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

Jesse Mills, MD
UCLA Urology Clinic

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

Marcel Waldinger (1955-2019), MD, PhD, Professor, Department of Pharmacology
Drexel University College of Medicine

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.

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

Gustavo M. Paul, MD
Curitiba Clinical Hospital

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

Landon W. Trost, MD, Head of Andrology
The Mayo Clinic

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

Shalendar Bhasin, MD, Professor of Medicine
Boston University School of Medicine

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

Alan Jacobs, MD, Neuroendocrinologist

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.

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

Alex Tatem, MD, Fellow in Andrology, Male Fertility and Microsurgery
Baylor College of Medicine

[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

L. Lee Bosley, MD (1931-2016), Founder
Bosley, Inc.

[M]any doctors don’t understand or even recognize PFS as a real disease and these patients will suffer alone.

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

Seth D. Cohen, MD, Urologist
Department of Urology, NYU Grossman School of Medicine

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.

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

François Desgrandchamps, MD, PhD, Chief of Urology
St. Louis Hospital, Paris

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

Kim M. Drasa, MD, Professor of Urology
Central Polyclinic, Tirana, Albania

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

Bernard Bégaud, MD, Professor of Pharmacology
University of Bordeaux, Bordeaux, France

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

Carla Di Loreto, PhD, Experimental and Clinical Medical Sciences
University of Udine, Italy

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

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

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.

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

Charles J. Ryan, MD, Distinguished Professor of Clinical Medicine and Urology
University of California, San Francisco

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

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

Daniel Marchalik, MD, Urologist
MedStar Washington Hospital Center

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

Bruno Toussaint, MD, Editorial Director
Prescrire

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

Silvia Giatti, PhD, Pharmacological and Biomolecular Sciences
University of Milano

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

François Haab, MD, Urologic Surgeon
Tenon Hospital, Paris

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.

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

Carlo Trombetta, MD, Head of Department of Urology
University of Trieste, Italy

[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

Alessio Soggiu, PhD
University of Milano

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

Dirk Michielsen, MD, Professor of Urology
Ziekenhuis University, Brussels

[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

Erika Cecchin, PhD, Researcher in Clinical and Experimental Pharmacology
National Cancer Institute, Milan

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

Donatella Caruso, PhD, Professor of Pharmacology and Biology
University of Milano

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.

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

Ralph M Trüeb, MD, Proefssor of Dermatology
Center for Dermatology and Hair Diseases, Zürich

(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

Sabina Cauci, PhD, Medical and Biological Sciences
University of Udine, Italy

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

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

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

Andrew Rynne, MD
Clane General Hospital, Kildare, Ireland

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

Matthew Bruhin, PhD
Bruhin & Associates Psychotherapists, San Diego, California