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Post-finasteride syndrome: An emerging clinical problem.

Silvia Diviccaro1, Roberto Cosimo Melcangi1, Silvia Giatti1

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5 alpha-reductase (5α-R) inhibitors like finasteride can cause persistent sexual and mood side effects, known as post-finasteride syndrome (PFS). Further research is needed to understand the molecular mechanisms behind these adverse events.

Keywords:
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Area of Science:

  • Pharmacology
  • Endocrinology
  • Men's Health

Background:

  • Adverse events are common in pharmacological treatments.
  • 5 alpha-reductase (5α-R) inhibitors (finasteride, dutasteride) are used for benign prostatic hyperplasia and androgenetic alopecia (AGA).
  • While generally well-tolerated, these drugs are associated with sexual dysfunction and mood alterations.

Purpose of the Study:

  • To review adverse events associated with 5 alpha-reductase (5α-R) inhibitors.
  • To discuss the emerging issue of persistent side effects, termed post-finasteride syndrome (PFS), in AGA patients.
  • To highlight the need for further research into the mechanisms and genetic factors underlying PFS.

Main Methods:

  • Review of existing literature and case reports on 5 alpha-reductase (5α-R) inhibitor side effects.
  • Analysis of reported symptoms characterizing post-finasteride syndrome (PFS).
  • Examination of regulatory actions taken by health agencies regarding finasteride labeling.

Main Results:

  • 5 alpha-reductase (5α-R) inhibitors can cause sexual dysfunction (low libido, erectile dysfunction) and mood alterations.
  • Persistent side effects, including sexual, mood, and cognitive complaints, can occur even after drug withdrawal (PFS).
  • Regulatory agencies have updated drug labels to include persistent side effects, based primarily on patient self-reporting.

Conclusions:

  • Post-finasteride syndrome (PFS) represents a significant and emerging clinical problem.
  • The molecular mechanisms and genetic determinants of PFS remain poorly understood.
  • Further clinical studies and research in animal models are crucial for elucidating PFS.