Lasting, multi-system dysfunctions

Original investigations

Basaria S, Jasuja R, Huang G, et al. Characteristics of men who report persistent sexual symptoms after finasteride use for hair loss. J Clin Endocrinol Metab. 2016;101(12):4669-4680. doi:10.1210/jc.2016-2726 | PubMed

Borgo F, Macandog AD, Diviccaro S, et al. Alterations of gut microbiota composition in post-finasteride patients: a pilot study. J Endocrinol Invest. 2020 Sep 19. doi:10.1007/s40618-020-01424-0 | PubMed | PMC full text

Cauci S, Chiriacò G, Cecchin E, et al. Androgen receptor (AR) gene (CAG)n and (GGN)n length polymorphisms and symptoms in young males with long-lasting adverse effects after finasteride use against androgenic alopecia. Sex Med. 2017 Mar;5(1):e61-e71. doi:10.1016/j.esxm.2016.11.001 | PubMed | PMC full text

Cecchin E, De Mattia E, Mazzon G, Cauci S, Trombetta C, Toffoli G. A pharmacogenetic survey of androgen receptor (CAG)n and (GGN)n polymorphisms in patients experiencing long term side effects after finasteride discontinuation. Int J Biol Markers. 2014;29(4):e310–e316. doi:10.5301/jbm.5000095 | PubMed

Di Loreto C, La Marra F, Mazzon G, Belgrano E, Trombetta C, Cauci S. 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. 2014;9(6):e100237. doi:10.1371/journal.pone.0100237 | PubMed

Howell S, Song W, Pastuszak A, Khera M. Differential gene expression in post-finasteride syndrome patients. J Sex Med. 2021 Sep;18(9):1479–1490. doi:10.1016/j.jsxm.2021.05.009 | PubMed

Irwig MS. Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 2014;150(12):1361-1363. doi:10.1001/jamadermatol.2014.1830 | PubMed

Khera M, Than JK, Anaissie J, et al. Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia. Transl Androl Urol. 2020;9(3):1201-1209. doi:10.21037/tau.2020.03.21 | PubMed

Melcangi RC, Casarini L, Marino M, et al. Altered methylation pattern of the SRD5A2 gene in the cerebrospinal fluid of post-finasteride patients: a pilot study. Endocr Connect. 2019;8(8):1118-1125. doi:10.1530/EC-19-0199 | PubMed

Melcangi RC, Santi D, Spezzano R, et al. Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients. J Steroid Biochem Mol Biol. 2017;171:229-235. doi:10.1016/j.jsbmb.2017.04.003 | PubMed

Case reports & series

[Abstract] Carlisle M, Uloko M, Yee A, Goldstein S, Goldstein I. Vascular, neurologic and hormonal abnormalities in men with persistent sexual dysfunction after discontinuation of finasteride. J Urol. 2022 May 1;207(5S):e620–621. doi:10.1097/JU.0000000000002592.07

Garreton AS, Valzacchi GR, Layus O. Post-finasteride syndrome: about 2 cases and review of the literature. Andrology-Open Access. 2016;5(2):170. doi:10.4172/2472-1212.1000170 | Journal site

Gupta AK, Sharma N, Shukla P. Atypical post-finasteride syndrome: a pharmacological riddle. Indian J Pharmacol. 2016;48(3):316–317. doi:10.4103/0253-7613.182898 | PubMed | PMC full text

Irwig MS. Decreased alcohol consumption among former male users of finasteride with persistent sexual side effects: a preliminary report. Alcohol Clin Exp Res. 2013;37(11):1823-1826. doi:10.1111/acer.12177 | PubMed

Irwig MS. Persistent sexual side effects of finasteride: Could they be permanent? J Sex Med. 2012 Nov;9(11):2927-32. doi:10.1111/j.1743-6109.2012.02846.x | PubMed

Irwig MS, Kolukula S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med. 2011;8(6):1747-1753. doi:10.1111/j.1743-6109.2011.02255.x | PubMed

Lehmann P. [Post-finasteride-syndrome after prescription of 1 mg finasteride-tablet as a treatment for androgenetic hair loss]. Akt Dermatol. 2020. German; abstract in English. doi:10.1055/a-1023-3102

Li X, Guo Y, Lu Y, et al. Case report: a study of the clinical characteristics and genetic variants of post-finasteride syndrome patients. Transl Androl Urol. 2022 Oct. doi:10.21037/tau-22-92PubMed | PMC full text

Melcangi RC, Caruso D, Abbiati F, et al. Neuroactive steroid levels are modified in cerebrospinal fluid and plasma of post-finasteride patients showing persistent sexual side effects and anxious/depressive symptomatology. J Sex Med. 2013;10(10):2598-2603. doi:10.1111/jsm.12269 | PubMed

Motofei IG, Rowland DL, Georgescu SR, et al. Post-finasteride adverse effects in male androgenic alopecia: a case report of vitiligo. Skin Pharmacol Physiol. 2017;30(1):42-45. doi:10.1159/000455972 | PubMed

Trüeb RM, Régnier A, Dutra Rezende H, Gavazzoni Dias MFR. Post-finasteride syndrome: an induced delusional disorder with the potential of a mass psychogenic illness? Skin Appendage Disord. 2019;5(5):320-326. doi:10.1159/000497362 | PubMed

Epidemiology, pharmacovigilance & surveys

Ali AK, Heran BS, Etminan M. Persistent sexual dysfunction and suicidal ideation in young men treated with low-dose finasteride: a pharmacovigilance study. Pharmacotherapy. 2015;35(7):687-695. doi:10.1002/phar.1612 | PubMed

Diviccaro S, Melcangi RC, Giatti S. Post-finasteride syndrome: an emerging clinical problem. Neurobiol Stress. 2019;12:100209. doi:10.1016/j.ynstr.2019.100209 | PubMed

[Abstract] Fiuk J, Butcher M, Kohler T, McVary K. 133 Female post-finasteride syndrome: It’s not just a man’s world. Journal Sex Med. 2016 May 1;13(5, Suppl 1):S62-S63. doi:10.1016/j.jsxm.2016.02.139

Ganzer CA, Jacobs AR. Emotional consequences of finasteride: fool’s gold. Am J Mens Health. 2018;12(1):90–95. doi:10.1177/1557988316631624 | PubMed

Ganzer CA, Jacobs AR, Iqbal F. Persistent sexual, emotional, and cognitive impairment post-finasteride: a survey of men reporting symptoms. Am J Mens Health. 2015;9(3):222-228. doi:10.1177/1557988314538445 | PubMed

Guo M, Heran B, Flannigan R, Kezouh A, Etminan M. Persistent sexual dysfunction with finasteride 1 mg taken for hair loss. Pharmacotherapy. 2016;36(11):1180-1184. doi:10.1002/phar.1837 | PubMed

Healy D, Le Noury J, Mangin D. Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med. 2018;29(3-4):125-134. doi:10.3233/JRS-180744 | PubMed

Hogan C, Le Noury J, Healy D, Mangin D. One hundred and twenty cases of enduring sexual dysfunction following treatment. Int J Risk Saf Med. 2014;26(2):109-116. doi:10.3233/JRS-140617 | PubMed

Kiguradze T, Temps WH, Yarnold PR, et al. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017;5:e3020. doi:10.7717/peerj.3020 | PubMed

Nguyen DD, Herzog P, Cone EB, et al. Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: a pharmacovigilance analysis of VigiBase. J Am Acad Dermatol. 2022 Mar 26. doi:10.1016/j.jaad.2022.03.037 • PubMed

Schifano N, Capogrosso P, Boeri L, et al. Are finasteride-related penile curvature/Peyronie’s disease adverse event reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases. Int J Impot Res. 2022. doi:10.1038/s41443-022-00568-2 | PubMed

Walf AA, Kaurejo S, Frye CA. Research brief: self-reports of a constellation of persistent antiandrogenic, estrogenic, physical, and psychological effects of finasteride usage among men. Am J Mens Health. 2018;12(4):900-906. doi:10.1177/1557988317750989 | PubMed

Legal matters

Lehmann P. [Post-finasteride-syndrome after prescription of 1 mg finasteride-tablet as a treatment for androgenetic hair loss]. Akt Dermatol. 2020. German. doi:10.1055/a-1023-3102

Low P, Li KD, Hakam N, et al. 5-alpha reductase inhibitor related litigation: a legal database review. Andrology. 2021. doi:10.1111/andr.13145 • PubMed


Chislett B, Chen D, Perera ML, Chung E, Bolton D, Qu LG. 5-alpha reductase inhibitors use in prostatic disease and beyond. Transl Androl Urol. 2023. doi:10.21037/tau-22-690PubMedPMC full text

Frye CA, DaCosta D, Lembo VF, Walf AA. Advances in knowledge of androgens: how intentional and accidental neurosteroid changes inform us of their action and role. Curr Sex Health Rep. 2020;12:209–220. doi:10.1007/s11930-020-00276-2

Giatti S, Diviccaro S, Panzica G, Melcangi RC. Post-finasteride syndrome and post-SSRI sexual dysfunction: two sides of the same coin? Endocrine. 2018;61(2):180-193. doi:10.1007/s12020-018-1593-5 | PubMed

Hui EX, Huang X, Oon HH. Review of dermatologic medications and impact on male fertility, sexual dysfunction and teratogenicity. Andrology. 2022 Oct. doi:10.1111/andr.13236 • PubMed

Irwig MS. Persistent sexual and nonsexual adverse effects of finasteride in younger men. Sex Med Rev. 2014;2(1):24-35. doi:10.1002/smrj.19 | PubMed

Kaur KK, Allahbadia G, Singh M. Post-finasteride syndrome – When will we get the courage to fight the dictating pharma industry – despite awareness of “sexual, neurological and metabolic side effects in young men for over a decade.” Arch Urol. 2020. doi:10.22259/2638-5228.0301003

Kuhl H, Wiegratz I. Das post-Finasterid-Syndrom. Gynäkologische Endokrinologie. 2017;15:153–163. doi:10.1007/s10304-017-0126-2

Maksym RB, Kajdy A, Rabijewski M. Post-finasteride syndrome – Does it really exist? Aging Male. 2019;22(4):250–259. doi:10.1080/13685538.2018.1548589 | PubMed

Mervis JS, Borda LJ, Miteva M. “Post-finasteride syndrome”: What to tell our female patients? Br J Dermatol. 2018;179(3):785-786. doi:10.1111/bjd.16658 | PubMed

Pereira AFJR, Coelho TOA. Post-finasteride syndrome. Anais Brasileiros de Dermatologia. 25 March 2020. doi:10.1016/j.abd.2020.02.001 | PubMed

Saengmearnuparp T, Lojanapiwat B, Chattipakorn N, Chattipakorn S. The connection of 5-alpha reductase inhibitors to the development of depression. Biomed Pharmacother. 2021 Aug 31;143:112100. doi:10.1016/j.biopha.2021.112100 | PubMed | Full text

Than JK, Rodriguez K, Khera M. Post-finasteride syndrome: a review of current literature. Curr Sex Health Rep. 2018;10:152-157. doi:10.1007/s11930-018-0163-4

Traish AM. Post-finasteride syndrome: a surmountable challenge for clinicians. Fertil Steril. 2020;113(1):21-50. doi:10.1016/j.fertnstert.2019.11.030 | PubMed

Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med. 2011;8(3):872-884. doi:10.1111/j.1743-6109.2010.02157.x | PubMed

Zakhem GA, Goldberg JE, Motosko CC, Cohen BE, Ho RS. Sexual dysfunction in men taking systemic dermatologic medication: a systematic review. J Am Acad Dermatol. 2019;81(1):163-172. doi:10.1016/j.jaad.2019.03.043 | PubMed


Epstein ES. Post-finasteride syndrome (PFS) update: point/counterpoint. Hair Transplant Forum International [Not peer-reviewed]. 2016 January;26(1):1-6. doi:10.33589/26.1.0001

Goldstein I. An old problem with a new cause-5 alpha reductase inhibitors and persistent sexual dysfunction. J Sex Med. 2011;8(7):1829–1831. doi:10.1111/j.1743-6109.2011.02368.x | PubMed

Gray SL, Semla TP. Post-finasteride syndrome. BMJ. 2019;366:l5047. doi:10.1136/bmj.l5047 | PubMed

Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med. 2021 Oct 26. doi:10.3233/JRS-210023 | PubMed

Irwig MS. How routine pharmacovigilance failed to identify finasteride’s persistent sexual side effects. Andrology. 2021 Oct 28. doi:10.1111/andr.13122 | PubMed

Rezende HD, Dias MFRG, Trüeb RM. A comment on the post-finasteride syndrome. Int J Trichology. 2018;10(6):255-261. doi:10.4103/ijt.ijt_61_18 | PubMedPMC full text

Singh MK, Avram M. Persistent sexual dysfunction and depression in finasteride users for male pattern hair loss: a serious concern or red herring? J Clin Aesthet Dermatol. 2014;7(12):51-55. PubMed | PMC full text

Trüeb RM, Luu NC, Gavazzoni Dias MFR, Dutra Rezende H. How to deal with the issues of fertility, malignancies, and the postfinasteride syndrome while prescribing finasteride for male pattern hair loss. Skin Appendage Disord. 2022 May. doi:10.1159/000520493 • PubMed

Animal studies

Diviccaro S, Giatti S, Borgo F, et al. Treatment of male rats with finasteride, an inhibitor of 5alpha-reductase enzyme, induces long-lasting effects on depressive-like behavior, hippocampal neurogenesis, neuroinflammation and gut microbiota composition. Psychoneuroendocrinology. 2019;99:206-215. doi:10.1016/j.psyneuen.2018.09.021 | PubMed

Oztekin CV, Gur S, Abdulkadir NA, et al. Incomplete recovery of erectile function in rat after discontinuation of dual 5-alpha reductase inhibitor therapy. J Sex Med. 2012;9(7):1773–1781. doi:10.1111/j.1743-6109.2012.02759.x | PubMed

Oztekin CV, Yilmaz-Oral D, Kaya-Sezginer E, et al. Beneficial effects of human umbilical cord blood mononuclear cells on persistent erectile dysfunction after treatment of 5-alpha reductase inhibitor in rats. J Sex Med. 2021 May. doi:10.1016/j.jsxm.2021.02.005 • PubMed

Sung HH, Yu J, Kang SJ, et al. Persistent erectile dysfunction after discontinuation of 5-alpha reductase inhibitor therapy in rats depending on the duration of treatment. World J Mens Health. 2019;37(2):240–248. doi:10.5534/wjmh.180082 | PubMed