Ischemic Stroke in a Young Adult Male During Finasteride Therapy

Finasteride, a 5-alpha-reductase inhibitor widely prescribed for androgenetic alopecia, is generally considered safe, with most reported adverse effects being sexual or neuropsychiatric in nature. However, recent literature data have raised concerns regarding rare thrombotic complications. The mechanistic basis and clinical relevance of this association remain unclear, particularly in young individuals without traditional risk factors. We report a case of ischemic stroke with left internal carotid artery multilevel stenosis and capsulo-thalamic infarction in a 20-year-old previously healthy male taking finasteride 1 mg daily for androgenetic alopecia. Comprehensive evaluation revealed heterozygous Factor V Leiden mutation, MTHFR compound heterozygosity, PAI-1 4G allele carriage, and ACE D allele polymorphism. Cardioembolic evaluation was unremarkable, and autoimmune testing was negative. Finasteride was discontinued, and the patient was treated with antiplatelet therapy and rehabilitation, with partial neurological recovery. This case highlights ischemic stroke occurring in the setting of a likely intracranial steno-occlusive arteriopathy, with concurrent finasteride exposure as a possible compounding factor. While causality cannot be definitively established, clinicians should remain vigilant when prescribing finasteride to individuals with prothrombotic predispositions. Further observational studies are needed to clarify absolute risk.