What are your theories on the cause of brainfog?
I’ve heard various things, from “the way the male brain reacts to estrogen” to the result of “any sudden hormonal change”
There is no theory or mystery, it’s due to Finasteride’s inhibition of neurosteroids, particularly Allopregnanolone.
Do a search for “Allopregnanolone”. Review the sticky posts in this section, as well as:
That’s true only if you are still taking finasteride. If, on the other hand, you are not taking finasteride, the production of Allopregnanolone is not inhibited anymore, and at this point there is really no agreement on this forum of what causes brain fog: maybe a hormonal imbalance, or maybe some persistent effect caused by finasteride. Personally, I’m more inclined to think that it’s a hormonal imbalance, for the simple fact that brain fog is also experienced by men and women who never took a 5AR inhibitor (or a SSRI, or accutane, etc…) but who have other hormonal problems. I successfully treat it with pregnenolone (currently, 400 mg transdermal pregnenolone per day, but I was taking more when I started).
In time, brain fog tends to clear up for many as they are no longer taking Finasteride/inhibiting neurosteroids.
Personally it took 1-2 years off drug before this started to improve, and the cloudiness/hazy thought processes began to get clearer. It obviously takes the brain time to repair any damage that may have occurred on the drug.
There are many (myself included) for which brain fog has never cleared up. So it’s definitely a persistent side effect for a large number PFS sufferers.
Personally I think the problem neurosteroid related. It could be a neurosteroid or hormonal imbalance, but it might also be that e.g. the GABA receptors (or something in that pathway) have been permanently affected by the finasteride usage. I base my opinion on the fact that finasteride has a known affect on GABA related hormones (Allopregnanolone), and that some members have successfully treated PFS using GHB / Xyrem which are GABA agonists targeting the GABA receptors.
My brainfog only started after I quit - figure that one out!
I think its quite possible that the ‘damage’ is in fact inflammation caused by inhibiting these neurosteroids, along with other variables. Pro-inflammatory cytokines acting upon the brain are one of three things that already exist in the literature which can cause our symptoms, along with low levels of testosterone and psychiatric problems. (I know, Mew, you had some similar-ish ideas back in 2009).
What type of damage can the brain repair? (I thought brain damage was irreversible…)
Furthermore, if that was the case, how do you explain that there are people who get brain fog only months after quitting?
If brain fog is caused by the mechanism of action of propecia, how do you explain that so many people who never took propecia suffer of brain fog? Don’t get me wrong: propecia causes brain fog, but I think that it causes it indirectly, by leading to a hormonal profile that brings brain fog. For example, Dr Goldstein once told me that he has several female patients with brain fog (they never took propecia). He didn’t talk about any “brain inflammation”; he noticed, however, that most have low progesterone.
I meant “brain damage” in the sense of whatever Finasteride does when inhibiting neurosteroids, can take time to repair… ie, myelination, neural plasticity, or other normal metabolic processes that are dependent on Allopregnanolone synthesis.
I cannot speak for those people, I can only speak for my own situation. In my case the depression I experienced towards end of 11 months of usage cleared up within a few weeks of quitting, as has been documented to occur in other case reports:
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HOWEVER – the “brain fog” (foggy thinking, slow thought processes, impaired memory recall, slurring of speech, feeling “drunk”/“just woken up”/out of it all the time etc) took 1-2 years before it began improving somewhat.
As for why someone might experience “brain fog” many months after discontinuation, I have no idea other than it might relate to hormonal imbalances post-drug (ie, drop in Testosterone etc).
Everyone has their own definition of “brain fog”, so it’s hard to know exactly what people are referring to. I’m referring to a specific neurological condition which arises by inhibiting 5-alpha reductase.
That said, I’m not really interested in arguing about anecdotal cases who never took Finasteride, since 1) I don’t believe everything I read on the Internet, 2) they never took a 5AR inhibitor, and 3) I’m interested in why Finasteride/5ARIs caused these issues specifically in those who took them.
Progesterone is a precursor to Allopregnanolone (Progesterone --> Dihydroprogesterone --> Allopregnanolone)… therefore perhaps low Progesterone contributed to low Allopregnanolone levels in select individuals. Or, perhaps they were taking natural 5 alpha reductase inhibitors via supplements or diet? Who knows.
Unfortunately there’s no commercial tests available to tests for allopregnanolone levels, only in research labs. Testing for this might reveal insight into wether 5AR or 3a-HSD enzyme activity has been persistently affected post-drug.
Have you discussed this with any of the researcher’s you’ve been in contact with? Perhaps measurements of Allopregnanolone could be the subject of a future study?
Also, since Allopregnanolone (just like DHT) is a paracrine hormone (i.e. it is both produced and acting locally in parts of the body), one should ideally measure Allopregnanolone locally in different parts of the body where it’s relevant. Of course measuring the systemic Allopregnanolone level is better than nothing, but it does not reveal any local imbalances. For example a low Allopregnanolone level in one part of the brain could be compensated by a high level elsewhere, so the systemic level would appear to be fine even though there is a lack of Allopregnanolone in a local part of the brain.
Contacting a research institute like NIH and describing our stories quickly via email would help get research done. If each person took some time like I did, we’d make progress. A single doctor doesn’t likely have the resources to get this figured out alone.
Imagine all the new cases of Alzheimer’s… I bet many older guys are taking Avodart for their prostate issues and their fog is blamed on age when in fact they can be experiencing the same fog as us.
I’m gonna get my mineral and amino acid levels checked to see if any precursors can be worsening my fog.
Exactly. I felt this drug was basically harmless from the beginning, because it had been used for many years by older men, but these older men’s symptoms of brain fog were difficult to diagnose because of advancing age. In hindsight, that wasn’t very smart of me, but who outside of the medical community could have imagined brain effects from this poison?