Which are the 20% of the most important studies IYO (Pareto principle)?

Hey, guys,
The topic of PFS is still quite new to me. It will take weeks, if not months, to read all the studies listed on the Foundation’s website.
So I would like to know, what do you think are the 20% of studies, after the Pareto Principle, which contain 80% of the most important information?

PS: Please, you can also include studies that are not PFS specific but that provide a broad understanding of the 5ar enzyme or epigenetics.

Don’t assume this is the best list. I tried to include a varied mix from different lines and categories of PFS research:

Studies showing biological abnormalities in PFS patients:

The “AR overexpression” pilot study:

C. D. Loreto, F. L. Marra, G. Mazzon, E. Belgrano, C. Trombetta, and S. Cauci, “Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia,” PLoS ONE , vol. 9, no. 6, p. e100237, Jun. 2014, doi: 10.1371/journal.pone.0100237.


The larger of the “neurosteroid deficiency” studies:

R. C. Melcangi et al. , “NEUROACTIVE STEROID LEVELS AND PSYCHIATRIC AND ANDROLOGICAL FEATURES IN POST-FINASTERIDE PATIENTS.,” The Journal of Steroid Biochemistry and Molecular Biology , doi: 10.1016/j.jsbmb.2017.04.003.


Methylation of 5-alpha reductase II gene pilot study:

R. C. Melcangi et al. , “Altered methylation pattern of the SRD5A2 gene in the cerebrospinal fluid of post-finasteride patients: a pilot study,” Endocrine Connections , vol. 8, no. 8, pp. 1118–1125, Aug. 2019, doi: 10.1530/EC-19-0199.


Abnormal fMRI findings, but authors associated this with depression. Also, I have heard there were significant differences in a few androgen-responsive genes, but these are listed in an appendix that I can’t access:

S. Basaria et al. , “Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss,J Clin Endocrinol Metab , vol. 101, no. 12, pp. 4669–4680, Dec. 2016, doi: 10.1210/jc.2016-2726.


Literature describing symptoms of PFS:

M. S. Irwig, “Persistent sexual side effects of finasteride: could they be permanent?,” J Sex Med , vol. 9, no. 11, pp. 2927–2932, Nov. 2012, doi: 10.1111/j.1743-6109.2012.02846.x.

A. M. Traish, J. Hassani, A. T. Guay, M. Zitzmann, and M. L. Hansen, “Adverse Side Effects of 5α‐Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients,” The Journal of Sexual Medicine , vol. 8, no. 3, pp. 872–884, Mar. 2011, doi: 10.1111/j.1743-6109.2010.02157.x.


A literature review:

J. K. Than, K. Rodriguez, and M. Khera, “Post-finasteride Syndrome: A Review of Current Literature,” Curr Sex Health Rep , vol. 10, no. 3, pp. 152–157, Sep. 2018, doi: 10.1007/s11930-018-0163-4.

A review of the quality of finasteride’s clinical studies:

S. M. Belknap et al. , “Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis,” JAMA Dermatol , Apr. 2015, doi: 10.1001/jamadermatol.2015.36.


Learning Materials:

A good beginner’s book on molecular biology if you don’t already have a basic background in biology and chemistry. Contains lots of descriptive cartoons, but it brushes upon the simplest concepts of many mo-bio topics:

Molecular Biology (made simple and fun), 4th edition


A good primer on molecular biology IMO, if you have a basic background in biology and chemistry:

Essential Cell Biology, 4th edition

I’ve never read a proper book on epigenetics, but @axolotl seems fond of this one. I think it provides a history of epigenetics, as well as scientific explanations :

The Epigenetics Revolution: (How Modern Biology Is Rewriting Our Understanding of Genetics, Disease, and Inheritance,) 1st Edition


Anything from Melcangi or Traish. I give articles by them to all my doctors.


Yes Melcangi and Traish are the most advanced researchers right now. See also Irwig’s studies (including a new paper this year, “Finasteride and Suicide: a Postmarketing Case Series”). The Kiguradze et al study in PeerJ is worth a look. And see the review by Zakhem et al in JAAD (authors are in the Dermatology department at NYU Medical School).

I have compiled a bibliography here: https://finasteride.network

These articles are all in the bibliography, with links to abstracts.

If you want to explore other papers, you could focus on the ones with the books icons which are review articles.