Post-Finasteride syndrome (Dermatologist commentary, 04/2020)

https://www.ncbi.nlm.nih.gov/pubmed/32317131

Abstract

Finasteride is a 5α-reductase enzyme inhibitor that has been approved for the treatment of male androgenic alopecia since 1997. Over time, it has been considered a safe and well-tolerated drug with rare and reversible side effects. Recently there have been reports of adverse drug-related reactions that persisted for at least three months after discontinuation of this drug, and the term post-finasteride syndrome arose. It includes persistent sexual, neuropsychiatric, and physical symptoms. Studies to date cannot refute or confirm this syndrome as a nosological entity. If it actually exists, it seems to occur in susceptible people, even if exposed to small doses and for short periods, and symptoms may 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 should be carefully and individually assessed.

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This is a weird comment to me. There are studies which have provided both confirmatory and unsupportive evidence but the sentence makes it seem like there is no evidence to support either view.

The recommendation is definitely an improvement over what dermatologists have said but it assumes those are the main risk factors for PFS and it can occur in individuals with otherwise prior good health. We can consider this incremental progress.

It’s largely what you would expect from people whose interests are opposite ours. I take it as a positive that they felt the need to address the issue of PFS in the first place. It’s better than being ignored. And while they try their best to highlight the limitations of the current literature of PFS and the evidence suggesting that the drug is safe, they cannot outright dismiss PFS anymore. And this will only get more difficult as more evidence comes out.

The good thing is, we know we are right. And over time it will be proven. Now, the amount of time it takes do that is the tricky part.

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I hope this gets repeated often and the word for this is spread, because I’m pretty certain if my GP had known Finasteride to be risky with people with a history of depression then he sure as hell wouldn’t have prescribed it to me. He was well aware of my depression history and one of the main reasons I got the prescription was that I said I didn’t want to deal with going bald on top of my depression.

I so badly wish I had read the warning signs on the internet before believing in the safety of this medicine. The most tragically comic thing about all of it is that my therapy actually is going so incredibly well and now my only reason to be depressed is my erectile dysfunction.

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I have never regretted anything more in my entire life.

Back when I took it, I remember getting to my truck after I walked out of the doctors office. I looked at the label on the side of the bottle and it said, “May cause some sexual side effects”. There was nothing about permanent irreversible damage. I called that same doctor back 2 1/2 months later when I crashed and told her that it had caused the sexual side effects and asked her how long this should last. She seemed confused that I was even telling her this but said that it should go away within a couple of days. The ignorance of the doctors who prescribe this crap and what it can do is appalling.

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Any drug is poison.

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In the future, the measurement of dopamine and serotonin levels in individuals with PFS may elucidate many issues, since the pathways of these neurotransmitters can be altered in neurosteroidogenesis disorders, which in itself would affect sexual behavior in these patients.[44]

“The possibility that epigenetic mechanisms may influence the occurrence of PFS is also discussed, as it appears to affect a limited number of individuals exposed to the drug.44 Giatti et al. even raised the hypothesis that PFS has mechanisms in common with post-selective serotonin reuptake inhibitor syndrome, given the wide range of similar symptoms in the two clinical entities.”

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How will testicular shrinkage and sagging be explained?