Advice from peers on taking finasteride for hair loss

The points below are based on firsthand experience of long-term adverse effects after taking finasteride, corroborated by adverse event reports to FDA and published medical literature. See also: Persistent adverse effects of finasteride.
This information only applies to finasteride for hair loss, not for other indications such as prostate conditions.

Key points

  1. Men have a wide variety of experiences with finasteride, from not having any adverse effects to reporting immediate, severe adverse effects which may be permanent.
  2. Recent research in a top dermatology journal reports that some men experience irreversible sexual adverse effects from finasteride (that is, sexual dysfunction remains indefinitely after stopping the drug).
  3. Therefore, taking finasteride is a gamble, and losing the gamble could have severe, life-changing consequences. Beyond loss of sexual function and sexual desire, men have reported neuropsychiatric, cognitive and physical symptoms as well as sleep problems. We will refer to these symptoms as a post-drug syndrome.
  4. There is no way to assess your risk of getting a post-drug syndrome.
  5. There is no effective treatment for the post-drug syndrome.
  6. Men have reported a post-drug syndrome after taking as little as one pill of finasteride.
  7. If you have a diagnosis of, or predisposition to, depression, bipolar disorder, an anxiety disorder or obsessive-compulsive disorder, you may be at higher risk of a post-drug syndrome.1
  8. If you have previously taken any of the following, you may be at higher risk of a post-drug syndrome: SSRI/SNRI antidepressants, finasteride, dutasteride, saw palmetto or Accutane/isotretinoin.
  9. There is no published evidence that that taking finasteride at a lower dose or lower frequency would reduce risk of a post-drug syndrome.
  10. The only certain way to avoid the risk of adverse effects of finasteride is not to take it.
  11. If you decide to take finasteride, stopping and restarting the drug could increase your risk of a post-drug syndrome.
  12. Research suggests that longer duration on finasteride increases the risk of developing erectile dysfunction that continues after stopping the drug (see Kiguradze et al., 2017).

1 This does not mean the syndrome has a psychological origin; rather, that those with psychiatric diagnoses or predispositions may be more susceptible to psychological and other adverse effects of the drug. See research on psychological adverse events here.

Propecia (finasteride 1mg) patient information

Propecia is the brand name of finasteride for androgenetic alopecia, or hair loss. This is an excerpt from the label:

Adverse effects of Propecia (finasteride)

References

Belknap SM, Aslam I, Kiguradze T, et al. Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis. JAMA Dermatol. 2015;151(6):600-606. doi:10.1001/jamadermatol.2015.36 | PubMed

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.2018.09.021PubMed

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

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

Kiguradze T, Temps WH, Yarnold PR, Cashy J, Brannigan RE, Nardone B, Micali G, West DP, Belknap SM. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017;5:e3020. doi:10.7717/peerj.3020 | PubMed

See more papers on persistent adverse effects of finasteride and ‘post-finasteride syndrome’.