Persistent Sexual and Psychological Symptoms After Finasteride Discontinuation: A Cross-Sectional Observational Study

Background: Persistent sexual and psychological symptoms after finasteride discontinuation have been reported; however, factors associated with symptom severity remain insufficiently characterized. Methods: This cross-sectional study included 129 adult men with prior finasteride exposure for male pattern hair loss or benign prostatic hyperplasia. Sexual function, depressive symptoms, and anxiety were assessed using the International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Associations between clinical variables (age, treatment duration, cumulative exposure, and indication) and symptom severity were evaluated using univariate and multivariable regression analyses. Results: The median treatment duration was 24 months (IQR: 12.5-36), and the median time from discontinuation to evaluation was 8 months (IQR: 1-17). Erectile function remained stable over time (mean IIEF: 15.2 ± 0.46 at baseline vs. 15.4 ± 0.47 at 6 months). Depressive symptoms decreased from 12.4 ± 0.41 to 9.1 ± 0.41, and anxiety scores from 3.29 ± 0.23 to 2.54 ± 0.20 over the same period, without normalization in most patients. In multivariable analyses, higher cumulative exposure and older age were independently associated with lower IIEF scores and higher PHQ-9 and GAD-7 scores. Conclusions: In this symptomatic cohort, greater cumulative finasteride exposure and older age were associated with more severe sexual and psychological symptoms after treatment discontinuation. These findings highlight the need for prospective studies to better define risk factors and long-term outcomes.