5-alpha syndrome (post-finasteride syndrome)

See also: Research: effects on sexuality & fertility • History of researchDescription of 5-alpha syndrome

💊 indicates pharma ties / conflict of interest

Textbook chapter

Fierro MC, Yafi FA, Reisman Y. Post-Finasteride Syndrome. In: Reisman Y, Lowenstein L, Tripodi F, eds. Textbook of Rare Sexual Medicine Conditions. Cham: Springer; 2022: 65–79. doi:10.1007/978-3-030-98263-8_6

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. doi:10.1210/jc.2016-2726PubMed

Borgo F, Macandog AD, Diviccaro S, et al. Alterations of gut microbiota composition in post-finasteride patients: a pilot study. J Endocrinol Invest. 2020. doi:10.1007/s40618-020-01424-0 • PubMedPMC 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. doi:10.1016/j.esxm.2016.11.001PubMedPMC 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. 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. 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. doi:10.1016/j.jsxm.2021.05.009PubMed

Ihentuge CJ, Csoka AB. Epigenetic effects of finasteride on dopaminergic signaling pathways: a potential contributor to post-finasteride syndrome [Abstract presented at American Physiology Summit 2024]. Physiology. 2024. doi:10.1152/physiol.2024.39.S1.1269

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. 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. 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. doi:10.1016/j.jsbmb.2017.04.003 • PubMed

Case reports & series

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 [Abstract]. 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. doi:10.4172/2472-1212.1000170 • Via journal site

Gupta AK, Sharma N, Shukla P. Atypical post-finasteride syndrome: a pharmacological riddle. Indian J Pharmacol. 2016. doi:10.4103/0253-7613.182898 • PubMedPMC full text

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. 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. doi:10.3233/JRS-140617 • PubMed

Irwig MS. Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1830 • PubMed

Irwig MS. Decreased alcohol consumption among former male users of finasteride with persistent sexual side effects: a preliminary report. Alcohol Clin Exp Res. 2013. doi:10.1111/acer.12177 • PubMed

Irwig MS. Persistent sexual side effects of finasteride: Could they be permanent? J Sex Med. 2012. 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. 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

Höfner K. [Medical duty to warn in the case of post-finasteride syndrome]. Akt Urol. 2021. doi:10.1055/a-1257-8330

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. doi:10.21037/tau-22-92 • PubMedPMC 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. 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. doi:10.1159/000455972PubMed

Peters KM, Stachelek JA, Zwaans BMM. NM 094 | Post-retinoid, post-finasteride and post-SSRI syndromes: patient evaluation and initial treatment. Poster presented at: SUFU 2024 Winter Meeting (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction); February 20–24, 2024; Fort Lauderdale, FL. Abstract (p. 303 of program) • Tweet with poster image

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. doi:10.1159/000497362 • PubMed

Wesley D, Bronsther R. (135) Post-finasteride syndrome: a case presentation and discussion. Journal of the Academy of Consultation-Liaison Psychiatry. 2022;63(Suppl 2):S179. doi:10.1016/j.jaclp.2022.10.137 • PDF via conference site

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. doi:10.1002/phar.1612 • PubMed

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

Fiuk J, Butcher M, Kohler T, McVary K 💊 [COIs]. 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. 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. 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. doi:10.1002/phar.1837 • PubMed

Gupta MA, Vujcic B, Gupta AK. Finasteride use is associated with higher odds of obstructive sleep apnea: results from the US Food and Drug Administration Adverse Events Reporting System. Skinmed. 2020 May 1;18(3):146-150. Via journal site • PubMed [Proposes obstructive sleep apnea may have a mediating role in symptoms of post-finasteride syndrome]

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. 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. doi:10.3233/JRS-140617 • PubMed

Irwig MS, Sanz J, Lin D, Tan N, Dommasch E. Beliefs and counseling practices among dermatologists regarding sexual and other adverse effects of finasteride. Int J Impot Res. 2023. doi:10.1038/s41443-023-00750-0 • PubMed • Online access via Springer Nature

Kiguradze T, Temps WH, Yarnold PR, et al. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017. doi:10.7717/peerj.3020 • 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. 2023. 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. doi:10.1177/1557988317750989PubMed

Reviews

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

Escamilla-Cruz M, Magaña M, Escandón-Perez S, Bello-Chavolla OY. Use of 5-alpha reductase inhibitors in dermatology: a narrative review. Dermatol Ther (Heidelb). 2023. doi:10.1007/s13555-023-00974-4 • PubMed

Fertig RM, Gamret AC, Darwin E, Gaudi S. Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: a comprehensive review. Dermatol Online J. 2017. Journal site • PubMed

Fertig R, Shapiro J 💊 [COIs], Bergfeld W 💊 [COIs], Tosti A 💊 [COIs]. Investigation of the plausibility of 5-alpha-reductase inhibitor syndrome. Skin Appendage Disord. 2017;2(3-4):120-129. doi:10.1159/000450617 | PubMed

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. doi:10.1007/s11930-020-00276-2

Giatti S, Diviccaro S, Cioffi L, Cosimo Melcangi R. Post-finasteride syndrome and post-SSRI sexual dysfunction: two clinical conditions apparently distant, but very close. Front Neuroendocrinol. 2023. doi:10.1016/j.yfrne.2023.101114PubMed

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

Gül M, Fode M, Urkmez A, et al. A clinical guide to rare male sexual disorders. Nat Rev Urol. 2023. doi:10.1038/s41585-023-00803-5 • 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. doi:10.3233/JRS-210023PubMed

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

Irwig MS. Persistent sexual and nonsexual adverse effects of finasteride in younger men. Sex Med Rev. 2014. 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

Kelly Y, Blanco A, Tosti A 💊 [COIs]. Androgenetic alopecia: an update of treatment options. Drugs. 2016. doi:10.1007/s40265-016-0629-5PubMed

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

Leliefeld HHJ, Debruyne FMJ & Reisman Y. The post-finasteride syndrome: possible etiological mechanisms and symptoms. Int J Impot Res. 2023. doi:10.1038/s41443-023-00759-5PubMed

Maksym RB, Kajdy A, Rabijewski M. Post-finasteride syndrome – Does it really exist? Aging Male. 2019. 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. 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.2020.02.001PubMed

Saengmearnuparp T, Lojanapiwat B, Chattipakorn N, Chattipakorn S. The connection of 5-alpha reductase inhibitors to the development of depression. Biomed Pharmacother. 2021. doi:10.1016/j.biopha.2021.112100PubMedFull text

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

Traish AM. Post-finasteride syndrome: a surmountable challenge for clinicians. Fertil Steril. 2020. 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. doi:10.1111/j.1743-6109.2010.02157.x • PubMed

Walton NL, Antonoudiou P, Maguire JL. Neurosteroid influence on affective tone. Neurosci Biobehav Rev. 2023. doi:10.1016/j.neubiorev.2023.105327PubMed

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. doi:10.1016/j.jaad.2019.03.043 • PubMed

Commentary

Cakir OO, Serefoglu EC. Post-finasteride syndrome: an underestimated phenomenon. Urol Androl Open J. 2017. doi:10.17140/UAOJ-1-e002

Carson CC. Post-finasteride syndrome: real or myth? Trends in Urology & Men’s Health. 2024. doi:10.1002/tre.972

Epstein ES. Post-finasteride syndrome (PFS) update: point/counterpoint. Hair Transplant Forum International [Not peer-reviewed]. 2016. 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. doi:10.1111/j.1743-6109.2011.02368.x • PubMed

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

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

💊 Perelman MA [details in post on X]. Comment on “The post-finasteride syndrome: possible etiological mechanisms and symptoms”. Int J Impot Res. 2024. doi:10.1038/s41443-024-00886-7

Rezende HD, Dias MFRG, Trüeb RM. A comment on the post-finasteride syndrome. Int J Trichology. 2018. doi:10.4103/ijt.ijt_61_18 • PubMed • PMC 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. PubMedPMC full text

Trüeb RM. Discriminating in favour of or against men with increased risk of finasteride-related side effects? Exp Dermatol. 2017. doi:10.1111/exd.13155 • PubMed

Trüeb RM. Psychiatric comorbidity related to the therapy of male androgenetic alopecia independent of the 5-alpha reductase pathway. Skin Appendage Disord. 2022. doi:10.1159/000518750 • 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. doi:10.1159/000520493 • PubMed

Animal studies

See also: Research review: Alterations to penile and prostatic tissue associated with finasteride and dutasteride treatment

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. doi:10.1016/j.psyneuen.2018.09.021PubMed

Diviccaro S, Herian M, Cioffi L, et al. Exploring rat corpus cavernosum alterations induced by finasteride treatment and withdrawal. Andrology. 2023. doi:10.1111/andr.13515 • 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. 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. 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. doi:10.5534/wjmh.180082 • PubMed

See also: History of lawsuits

Collier R. Propecia lawsuits: the lasting effects of delayed drug warnings. CMAJ. 2013. doi:10.1503/cmaj.109-4488 • PubMed

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

Höfner K. [Medical duty to warn in the case of post-finasteride syndrome]. Akt Urol. 2021. doi:10.1055/a-1257-8330

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

Nguyen DD, Fellouah M, Nguyen AV, et al. Litigation associated with 5-alpha-reductase-inhibitor use: a Canadian legal database review. Can J Urol. 2023. Via journal site • PubMed