What Is Post-Finasteride Syndrome, and Is It Permanent

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Finasteride is a medication that's commonly prescribed at a low dose for male-pattern baldness under the brand name Propecia. It's also prescribed at a higher dose for benign prostatic hyperplasia (BPH) under the brand name Proscar.

For most people, finasteride is well tolerated. But in rare cases, it can cause mental and physical side effects that persist even after the medication is stopped. This is known as post-finasteride syndrome. But what exactly is post-finasteride syndrome? And how do you know if you have it?

Is post-finasteride syndrome real, and who's most likely to experience it?

Post-finasteride syndrome (PFS) is a term that refers to physical, mental, and sexual side effects that last for at least 3 months after you stop taking finasteride.

But PFS is a controversial topic for several reasons:

• The first reports of PFS started 15 years after finasteride was initially FDA approved.

• Most PFS cases are self-reported, instead of being diagnosed by a healthcare professional.

• So far, clinical studies haven't been able to definitively connect persistent sexual side effects with finasteride.

• There's some evidence that PFS may be related to what's known as a "nocebo effect." This is when expecting something negative to happen makes it more likely to occur. One study found that about 44% of people reported sexual side effects from finasteride if they were told in advance they were likely to happen. Only about 15% of people reported these side effects if they weren't given this information.

Despite this controversy, PFS is a very real condition for the people who experience it. And both researchers and advocacy groups are pushing for the medical community to formally recognize PFS and make sure people are aware of it before taking finasteride.

It's unclear who may be at higher risk for developing PFS. It's more commonly reported by people taking finasteride for hair loss. But this is likely because the overall age group is typically younger than those taking it for BPH. And PFS may be more likely if you take finasteride for more than 7 to 12 months.

Researchers also believe epigenetics could be involved. Epigenetics is the study of how our cells regulate gene activity in response to things like medications or environmental changes. These changes aren't the same for everyone. So it's possible that some people may be more prone to genetic changes that lead to PFS when they take finasteride.

Some reports also suggest that people with certain mental health conditions may be at higher risk for PFS. But experts are still working to understand what causes PFS. So risk factors may change as we learn more about this condition.

Symptoms of post-finasteride syndrome

The criteria for a PFS diagnosis includes prior treatment with finasteride along with sexual problems that persist for at least 3 months after treatment is stopped. This may include:

• Loss of sex drive

• Erectile dysfunction

• Reduced ability to orgasm

The following must also be confirmed:

• No evidence of sexual issues prior to taking finasteride

• No other medical conditions that could cause these symptoms

• No other current or prior medication or substance use that could cause these symptoms

Other symptoms may appear as part of PFS, but they aren't considered part of a PFS diagnosis. This includes physical side effects, such as:

• Gynecomastia - breast development in males

• Changes in the amount or consistency of semen

• Shrinking, pain, or numbness of the penis or testicles

• Peyronie's disease - an abnormal curve of the penis

• Muscle pain or weakness

• Joint pain

• Dry skin

• Chronic fatigue

It can also include mental health side effects, such as:

• Memory issues

• Changes in emotional expression

• Slow thinking

• Depression

• Anxiety

• Thoughts of suicide or self-harm

If you experience PFS symptoms, it's a good idea to report them to the FDA's MedWatch program. These reports can help researchers and healthcare professionals better understand how often PFS occurs and learn more about it.

Is post-finasteride syndrome permanent?

Several people report that their PFS symptoms improve over time. But for others, PFS may persist or worsen. Since we don't know for sure what causes PFS, it's difficult to know if it's a permanent condition or one that can be managed with medications and/or therapy.

Talk to your healthcare team about PFS before you take finasteride to assess your risk. And be sure to let them know if you experience any side effects after you stop taking it, especially if you're having thoughts of self-harm. They can help determine the cause and the best course of treatment.

Treatment for post-finasteride syndrome

There isn't a known cure or treatment for PFS at this time. But medications, physical therapy, and counseling may help improve some symptoms. It's also possible that your symptoms will improve over time.

The best way to manage PFS is to speak to a healthcare professional. They can review your medical history and develop a treatment plan based on your personal needs.

Support and advocacy groups can also be helpful. These resources can connect you with others who have PFS. Be sure to check out the Post-Finasteride Syndrome Foundation. This nonprofit organization offers resources and support. They also focus on research and raising awareness about PFS.

Are other medications linked to post-finasteride syndrome?

Yes, dutasteride (Avodart) and saw palmetto (an herbal supplement) work in a similar way as finasteride. So it's possible that PFS may occur after taking either of these medications, too.

A condition similar to PFS has also been reported by people taking selective serotonin reuptake inhibitors (SSRIs). These include antidepressants such as sertraline (Zoloft) and fluoxetine (Prozac). It's referred to as post-SSRI sexual dysfunction (PSDD). People experiencing PSDD may experience long-term sexual side effects after stopping their medication.

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