Doctors expressing concerns about adverse effects of finasteride

Following are excerpts of articles, videos and tweets of doctors expressing concerns about harms of finasteride. (There are other doctors who consider the drug “safe and well-tolerated.”)

Articles & presentations

Ophthalmologist in the San Francisco Bay Area (USA)

I am writing to increase awareness regarding finasteride, a medication with several under-recognized and under-reported adverse effects.

Patients and doctors remain largely unaware of the long term consequences of this drug on the nervous system and mental health. Unfortunately, some of the side effects of finasteride are more serious and persistent than the original condition it is intended to treat. Neurotoxicity is likely more common than reports would suggest.

In my San Jose, California ophthalmology clinic, we encountered a surprising association between finasteride use and presence of optic neuropathy or retinopathy…

It is especially important that physicians recognize the potential for this drug to impact optic nerve function. This is a medication that patients may conceal or leave off their lists of medications since it is marketed separately via the internet directly to patients. We have made it a point now to ask every patient about finasteride use.

Excerpt from: Keshav Narain, MD. A Letter regarding Finasteride. Website of South Bay Retina, an ophthalmology clinic.

Sexual medicine specialist in San Diego, CA (USA)

5-alpha reductase is not only used to convert testosterone to dihydrotestosterone. 5-alpha reductase converts androstenedione to dihydroandrostenedione; progesterone to dihydroprogesterone; [and numerous other biochemical conversions]. Every one of those events is blocked by finasteride. Every one of these agents goes to make neurosteroids that are participating in the patient’s thinking, decision-making, executive function. We are voluntarily making people block all these things with the hope that they’re going to shrink their prostate or grow some hair. It’s ridiculous.

With Hims and Keeps and Roman, the number of patients getting on these crazy drugs is exponentially increasing, despite all the evidence and all the discussions. There are dozens of PFS articles out now. The statement that “Oh this doesn’t really exist,” that’s just nonsense.

Dr. Irwin Goldstein, Director of San Diego Sexual Medicine, in the Q&A portion of a webinar held by the Sexual Medicine Society of North America (SMSNA) on 27 Jul 2021. Webinar description | Full video (link goes to Goldstein comment at 54:33)

Traumatic brain injury specialist in Encino, CA (USA)

In comparing PFS patients symptoms with those of veterans and civilians who sustained a traumatic brain injury, their complaints were nearly identical and when you compare the results of their laboratory bio-marker panel of neurosteroids and neuroactive steroids, their deficits (insufficiencies and deficiencies) were identical.

Mark Gordon, MD, Millenium Health Centers: Post-Finasteride Syndrome (PFS): A Surmountable Challenge for Clinicians and a Newfound Hope for Patients

Continuing Medical Education: Age Management

Symptoms included sexual and neurologic disorders, including decreased or complete loss of sex drive, erectile dysfunction, impotence, chronic anxiety, depression, and an altered gut microbiome. Many patients claim these symptoms are permanent. Etiologies of PFS include changes in penile vascular architecture, interference, and reduction of the neurosteroid that influences GABA, the calming neurotransmitter production, allopregnanolone. We discuss finasteride in detail, the symptoms of PFS, along with recommended laboratory studies and a remedial program.

From William Clearfield, DO. Session on Post Finasteride Syndrome at 2021 CME conference of Age Management Medicine Group.

Lifestyle recommendations from Cornell male fertility center

Do not use finasteride (Propecia, Proscar) for hair loss. There is accumulating evidence that it negatively impacts male fertility…

Men’s Health and Fertility Lifestyle Information, Weill Cornell Center for Male Reproductive Medicine & Microsurgery. Director: Marc Goldstein, MD