Post-Finasteride Syndrome: Current Views and Where do we Stand? (Ghadah I Alhetheli et al)

Author(s): Ghadah I Alhetheli1*, Fahad Hamoud Alrashidi2 and Saleh H Alhammad3

Introduction: Androgenetic alopecia is the most frequent cause of hair loss worldwide, affecting around 70% of males and 40% of females. Since the approval of finasteride for androgenetic alopecia, several studies have reported various psychological and sexual side effects. In 2012, the food and drug organization made changes to the drug insert stating the possibility of persistent side effects, or what is known as post-finasteride syndrome. There is still not much known about the rate of these side effects and the causal relationship. Methods: A literature search was performed using the Pubmed and Google Scholar databases that included studies conducted from 1995 to 2020. Results: There were 47 identified articles in Pubmed, while 152 articles were identified using Google Scholar. Duplicates were removed, leaving a total of 185 articles. Following a second, thorough screening of the titles and abstracts, only 62 full-text articles were reviewed. Of those, 35 articles were chosen to be included. Conclusion: Based on the existing literature, the medical community believes that these patterns of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. The medical community must define and characterize the pathophysiological mechanisms underlying PFS, and more attention should be devoted to patient education and counseling as well as to developing novel management modalities. Further highquality clinical studies are needed to evaluate the potential neuropsychiatric side effects of finasteride in humans and to establish whether finasteride has any exact causal relationship with suicidal ideation and other reported side effects.



Any idea what they are talking about here? I just skimmed through the article and didn’t really find anything.

Good sense. Saudis are very rich. If only they could participate in PFS research


Everyone is doing meta-analysis on the same, limited set of studies.

We need more actual research, not summaries of summaries of observational studies.


Yes, and what we really need is more research about treatments. What treatments are most effective, according to clinical trials?


ditto for pssd. for experimental, genetic and clinical studies, the problem is money
these reviews are better than nothing if they get the attention of more people and the media


New studies are definitely needed, but seeing a meta-analysis that concludes PFS is physiological and not psychological is still a win in my book.


We need more actual research, not summaries of summaries of observational studies.

Agreed. Although I also agree with @BibFortuna that concluding PFS is physiological and not psychological is another step in the right direction for acceptance and awareness. But we do need more basic science at this point about the driving mechanisms involved. That needs to be our highest priority as a patient community.

Yes, and what we really need is more research about treatments. What treatments are most effective, according to clinical trials?

Unfortunately this isn’t really possible with current scientific understanding. Without understanding what the mechanisms driving the disease are, there is no way to recreate it in an animal model to effectively test treatments with any sort of accuracy.

We need basic understanding first before we get too far ahead of ourselves. One step at a time in the right direction.


How can a study like this on PFS start it’s second paragraph by stating:

“ Finasteride, an inhibitor (5α-R), was approved for the treatment of AGA in 1997. [6] Over the years, finasteride has been well tolerated and has a relatively good safety profile with rare and reversible side effects, such as decreased sexual libido and ejaculatory volume, specifically when prescribed in a dose of 5 mg for cases of Benign Prostatic Hyperplasia (BPH).”

I though we were all beyond that already.


I don’t know if this is entirely true. Of course more research is important for developing new treatments, but there are existing methods of treatment. Dr. Goldstein claims “In general, our multidisciplinary management algorithm has significantly helped more than 2/3 of patients improve life quality.”

Now I know some people on this website might disagree with that, but comments on a message board should not be given the same weight as a clinical trial.

That’s not a clinical trial though. Clinical trials occur when researchers have an understanding of a disease, hypothesise what might be able to treat it (with some accuracy), then test it in a clinical setting.

Unfortunately Goldstein is just throwing shit at a wall in his private practice to see what sticks. I also have reservations about the validity of that claim considering many patients who have seen Goldstein have reported back that it did nothing/little to improve their symptoms. “Improving life quality” is a very subjective phrase and there’s nothing scientific about it - it gives no indication of exactly what improved and by how much.

It’s also inaccurate to say there are existing methods of treatment. If that were the case, they would be at least somewhat effective across all patients, not have varying degrees of success in select groups.

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I didn’t say it was a clinical trial, I said there should be clinical trials to test the efficacy of treatments out there that have seen some success. He also has patients, some of whom have posted on this forum, who have recovered. At least one of his patients that I know of has even had a child after PFs and his treatments.

“I also have reservations about the validity of that claim considering many patients who have seen Goldstein have reported back that it did nothing/little to improve their symptoms.”

Again, forum posts do not carry the weight of a clinical trial, and you should stop acting like they do. You’re acting like a clinical trial has already been carried out and it failed, because of posts that you read here, but that isn’t so.

That is awesome, was he able to un-silence androgen receptors and reverse tissue loss? Cause I could use a hit of that and I know some others on here could too.

Depending on where the ultrasound was looking at, I had no tissue loss or mild tissue loss. He also said that getting my DHT up will prevent any tissue damage. I had plenty of other PFS symptoms though including extreme insomnia, which I have never had before, neuropathy, penile shrinkage, penile insensitivity, ED, anxiety, and more. I attribute the lack of tissue damage to the fact that I caught it early, and booked an appointment with him the same week that I crashed. But who knows. He also said my testicles were normal despite low LH and low FSH, which is unusual.

But the reversibility of the damage is something that has been discussed here before: Interview: Dr. Goldstein - Penile tissue changes reversible (via androgens)

And there are people here who have had success after seeing Goldstein: My story and RECOVERY :)

dumdumdum saw him and no longer has mental side effects and can maintain an erection as long as it is stimulated.

The former host of the PFS global support network was one of his patients and he quickly started to feel much better after seeing Goldstein:

I mentioned to Goldstein that I had listened to this podcast, and he said that the host, Amir, has since had a second child with his wife, well after he crashed from PFS.

I’ve just gone through and had to delete multiple posts from multiple users in this thread that are a breach of our terms of service:

I apologise for derailing this thread in the first place, but its purpose was not to debate the merits of research vs self-experimentation. A debate which has been had ad-nauseum throughout this forum over 15 years with very little to show for it. At this point our organisational goals are clear, and this isn’t the place to debate them.