Case reports & series

Some case reports appear in more than one category. Selected smaller case series have been included. Additional case series may be found in related bibliographies linked below.

5-alpha syndrome (post-finasteride syndrome)

Carlisle M, Uloko M, Yee A, Goldstein S, Goldstein I. MP38-07 Vascular, neurologic and hormonal abnormalities in men with persistent sexual dysfunction after discontinuation of finasteride. J Urol. 2022. 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

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

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 • PubMed • 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. 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 vitiligoSkin Pharmacol Physiol. 2017. doi:10.1159/000455972PubMed [Sexual dysfunction and depressive symptoms also reported]

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 illnessSkin Appendage Disord. 2019. doi:10.1159/000497362 • PubMed

See also: Research on 5-alpha syndrome (post-finasteride syndrome) and online reports of long-term dysfunctions

Dermatology

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Al Hammadi A, Asai Y, Patt ML, Sasseville D. Erythema annulare centrifugum secondary to treatment with finasteride. J Drugs Dermatol. 2007. Journal site• PubMed

Famenini S, Gharavi NM, Beynet DP. Finasteride associated melasma in a Caucasian male. J Drugs Dermatol. 2014. Journal site • PubMed

Gupta AK, Sharma N, Shukla P. Atypical post-finasteride syndrome: a pharmacological riddle. Indian J Pharmacol. 2016. doi:10.4103/0253-7613.182898 • PubMed • PMC full text [Generalized itching, burning micturition, abdominal discomfort, and seborrhea]

Jia H, Ran L. Maculopapular drug eruption caused by finasteride: a case report. Clin Cosmet Investig Dermatol. 2023. doi:10.2147/CCID.S426747 • PubMed • PMC full text

Lear JT, Byrne JP. Finasteride-related cutaneous vasculitisPostgraduate Medical Journal 1996. doi:10.1136/pgmj.72.844.127-a • PubMed • PMC full text

Magdaleno-Tapial J, Valenzuela-Oñate C, García-Legaz-Martínez M, et al. Angioedema-like contact dermatitis caused by mesotherapy with dutasteride. Contact Dermatitis. 2020. doi:10.1111/cod.13585 • PubMed

Melo DF, Saceda-Corralo D, Tosti A 💊 [COIs], et al. Frontal edema due to mesotherapy for androgenetic alopecia: a case series. Dermatol Ther. 2022. doi:10.1111/dth.15247 • PubMed

Moreno-Fernandez A, Mira Laguarda JM, Ruiz-Hornillos FJ, Rubio Sotes M. Urticarial rush due to finasteride. Allergy. 2010. doi:10.1111/j.1398-9995.2009.02165.x • PubMed

Motofei IG, Rowland DL, Georgescu SR, et al. Post-finasteride adverse effects in male androgenic alopecia: a case report of vitiligoSkin Pharmacol Physiol. 2017. doi:10.1159/000455972 • PubMed

Muddebihal A, Khurana A, Kulhari A, Ahuja A. Psoriasiform drug eruption to finasteride: uncommon side effect of a commonly used drug. Int J Trichology. 2022. doi:10.4103/ijt.ijt_42_21 • PubMed • PMC full text

Oyama N, Kaneko F. Solitary fixed drug eruption caused by finasteride. J Am Acad Dermatol. 2009. doi:10.1016/j.jaad.2008.07.037 • PubMed

Reguero Del Cura L, De Quintana Sancho A, Rubio Lombraña M, López Sundh AE, González López MA. Two cases of paradoxical nonscarring alopecia after mesotherapy with dutasteride. Skin Appendage Disord. 2022. doi:10.1159/000518043 • PubMed

Tresch S, Cozzio A, Kamarashev J, et al. T cell-mediated acute localized exanthematous pustulosis caused by finasteride. J Allergy Clin Immunol. 2012. doi:10.1016/j.jaci.2011.07.033 • PubMed

Photosensitivity

Espasandín-Arias M, García-Rodiño S, Suárez-Peñaranda JM, Rodríguez-Granados MT. Photosensitivity associated with dutasteride therapy. J Dtsch Dermatol Ges. 2020. doi:10.1111/ddg.14062 • PubMed

Santo Domingo D, Stevenson ML, Auerbach J, Lerman J. Finasteride-induced pseudoporphyriaArch Dermatol. 2011. doi:10.1001/archdermatol.2011.144 • PubMed

Yamada T. Photosensitivity reaction induced by finasteride. J Gen Fam Med. 2021. doi:10.1002/jgf2.510 • PubMed • PMC full text

Saw palmetto

Gammoudi R, Ameur K, Ouni B, et al. Fixed drug eruption to Serenoa repens: First case report and consideration of the use of herbal medicine. Dermatol Ther. 2020. doi:10.1111/dth.14247 • PubMed

Sinclair RD, Mallari RS, Tate B. Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Australas J Dermatol. 2002. doi:10.1046/j.1440-0960.2002.00620.x • PubMed

See also: Research: adverse effects on skin

Endocrinology

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Carlin BI, Seftel AD, Resnick MI, Findlay J. Finasteride induced gynecomastiaJ Urol. 1997 Aug;158(2):547. PubMed

Farkas HS, Jee YH, Szymczuk V, Leschek EW. Persistent gynecomastia due to short-term low-dose finasteride for androgenetic alopecia. JCEM Case Rep. 2024. doi:10.1210/jcemcr/luae050 • PubMed • PMC full text

Ferrando J, Grimalt R, Alsina M, Bulla F, Manasievska E. Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride. Arch Dermatol. 2002. doi:10.1001/archderm.138.4.543 • PubMed

Mansouri P, Farshi S, Safar F. Finasteride-induced gynecomastiaIndian J Dermatol Venereol Leprol. 2009. doi:10.4103/0378-6323.51273 • PubMed

Miller JA, Pramanik B, Gilhooly P. Waxing and waning gynecomastia: an indication of noncompliant use of prescribed medication. South Med J. 1999. PubMed

Ramot Y, Czarnowicki T, Zlotogorski A. Finasteride induced gynecomastia: case report and review of the literature. Int J Trichology. 2009. doi:10.4103/0974-7753.51930 • PubMed

Schmutz JL, Barbaud A, Trechot P. Gynécomastie et finastéride (Propecia): 4 nouveaux cas [Gynecomastia and finasteride (Propecia): 4 new cases]. Ann Dermatol Venereol. 2004. French. doi:10.1016/s0151-9638(04)93684-8 • PubMed

Volpi R, Maccarini PA, Boni S, Chiodera P, Coiro V. Case report: finasteride-induced gynecomastia in a 62-year-old man. Am J Med Sci. 1995. doi: 10.1097/00000441-199506000-00005 • PubMed

Wade MS, Sinclair RD. Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day). Australas J Dermatol. 2000 Feb;41(1):55. doi:10.1046/j.1440-0960.2000.00392.x | PubMed

Zaballos P, Rodero J, Vives JM, Magarolas A, Andreu M. Ginecomastia unilateral secundaria al tratamiento con finasterida [Unilateral gynecomastia secondary to treatment with finasteride]. Actas Dermo-Sifiliograficas. 2004 Apr;95(3):199-200. Spanish. Journal site

Zimmerman RL, Fogt F, Cronin D, Lynch R. Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastiaArch Pathol Lab Med. 2000. doi:10.5858/2000-124-0625-CAIAYO • PubMed

See also:
1. Research: effects on liver, pancreas, metabolism, diabetes & kidneys
2. Re: cases of 5-alpha reductase deficiency in Dominican Republic: Hernandez LO, Inchaustegui S, Arguello CN. Los casos de pseudo-hermafroditismo en la Sección de las Salinas, Prov. de Barahona [Cases of pseudohermaphroditism in the Section of Las Salinas, Barahona Province]. Revista Médica Dominicana. 1951;6(2):114–136. Spanish. View more research on 5-alpha reductase deficiency.

Hematology

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Al-Harbi TM, Kagan J, Tarnopolsky MA. Finasteride-induced myalgia and hyperCKemiaJ Clin Neuromuscul Dis. 2008. doi:10.1097/CND.0b013e3181873cca • PubMed

Kouriefs C, Betambeau N, Rowbotham C, Coyne K, Rowley M, Jones CR. Finasteride-induced thrombocytopeniaBJU Int. 2002. doi:10.1046/j.1464-410x.2002.02851.x • PubMed

Smith VM, Cockshoot D. A serious side effect of a potentially widely used cosmetic product. Clin Exp Dermatol. 2015. doi:10.1111/ced.12570 • PubMed [Rhabdomyolysis]

Hepatology & gastroenterology

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Lin YH, Perng CL, Lin HJ, Chang FY. Acute pancreatitis possibly related to finasteride. J Clin Gastroenterol. 2001. doi:10.1097/00004836-200103000-00027PubMed

Martínez de Guzmán M, Martínez-Crespo JJ. Hepatitis por finasterida [Finasteride-induced hepatitis]. Farm Hosp. 2006. Spanish. doi:10.1016/s1130-6343(06)74011-9 • PubMed

Yance S, Montes P. Hepatotoxicidad por tamsulosina / dutasterida: reporte de un caso probable [Hepatotoxicity by tamsulosin / dutasteride: report of a probable case]. Rev Gastroenterol Peru. 2023. Spanish. doi:10.47892/rgp.2023.433.1544 • English translation (PDF) • PubMed

See also: Research: effects on liver, pancreas, metabolism, diabetes & kidneys

Musculoskeletal system

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Al-Harbi TM, Kagan J, Tarnopolsky MA. Finasteride-induced myalgia and hyperCKemiaJ Clin Neuromuscul Dis. 2008. doi:10.1097/CND.0b013e3181873cca • PubMed

Haan J, Hollander JM, van Duinen SG, Saxena PR, Wintzen AR. Reversible severe myopathy during treatment with finasteride. Muscle Nerve. 1997. DOI • PubMed

Persey M, Payne L, Webley M. Finasteride: a steroid-unsparing drug? Rheumatology (Oxford). 1999. doi:10.1093/rheumatology/38.3.285PubMed [Polymyalgia rheumatica and eczema]

Ryu HJ, Kwon DY. Reversible myopathy and ophthalmoparesis after low-dose finasteride administration for androgenic alopecia. Dermatol Surg. 2014. doi:10.1111/dsu.12458 • PubMed

Smith VM, Cockshoot D. A serious side effect of a potentially widely used cosmetic product. Clin Exp Dermatol. 2015. doi:10.1111/ced.12570 • PubMed [Rhabdomyolysis]

See also: Research: effects on musculoskeletal system and Musculoskeletal adverse events

Neurology

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Al-Harbi TM, Kagan J, Tarnopolsky MA. Finasteride-induced myalgia and hyperCKemiaJ Clin Neuromuscul Dis. 2008. doi:10.1097/CND.0b013e3181873cca • PubMed

Choi BK, Cheon K, Cho BH, Jung JW, Lee KY. Cerebral venous sinus thrombosis associated with dutasteride use. Yonsei Med J. 2020. doi:10.3349/ymj.2020.61.6.553 • PubMed • PMC full text

Gaddameedi SR, Khan MA, Arty F, et al. An unusual case of thalamic stroke in a young adult with patent foramen ovale and finasteride use. Cureus. 2024. doi:10.7759/cureus.60300 • PubMed • PMC full text

Haan J, Hollander JM, van Duinen SG, Saxena PR, Wintzen AR. Reversible severe myopathy during treatment with finasteride. Muscle Nerve. 1997. DOI • PubMed

Kang DW, Jeong HG, Kim HR, et al. Finasteride induced cerebral venous thrombosisJournal of the Korean Neurological Association. 2015. PDF at ResearchGate

Prajapati J, et al. Finasteride-induced CVST: rare drug to cause CVT used for alopecia. J Stroke Med. 2019 Jun;2(1):62-63. doi:10.1177/2516608519860317

Pugnaghi M, Monti G, Biagini G, Meletti S. Temporal lobe epilepsy exacerbation during pharmacological inhibition of endogenous neurosteroid synthesis. BMJ Case Rep. 2013. doi:10.1136/bcr-2012-008204 • PubMed • PMC full text

Tsuji Y, Nakayama T, Bono K, Kitamura M, Imafuku I. [Two cases of stroke associated with the use of finasteride, an approved drug for male-pattern hair loss in Japan]. Rinsho Shinkeigaku. 2014. Japanese. doi:10.5692/clinicalneurol.54.423 • PubMed

See also: Research on vascular system & stroke

Ophthalmology

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Intraoperative floppy iris syndrome

Issa SA, Dagres E. Intraoperative floppy iris syndrome and finasteride intake. J Cataract Refect Surg. 2007. doi:10.1016/j.jcrs.2007.07.025 • PubMed

Wong AC, Mak ST. Finasteride-associated cataract and intraoperative floppy-iris syndromeJ Cataract Refract Surg. 2011. doi:10.1016/j.jcrs.2011.04.013 • PubMed

Yeu E, Grostern R. Saw palmetto and intraoperative floppy-iris syndromeJ Cataract Refract Surg. 2007. doi:10.1016/j.jcrs.2006.12.032 • PubMed

Macular conditions

Lombardo R, Loraschi A, Lecchini S, Cosentino M. Finasteride-associated central serious [sic] chorioretinopathyDrug Safety. 2008. doi:10.2165/00002018-200831100-00098

Shin YK, Lee GW, Kang SW, Kim SJ, Kim AY. Macular abnormalities associated with 5α-reductase inhibitor. JAMA Ophthalmol. 2020. doi:10.1001/jamaophthalmol.2020.1279 • PubMed

Other conditions

Chou SY, Kao SC, Hsu WM. Propecia-associated bilateral cataractClin Exp Ophthalmol. 2004. doi:10.1046/j.1442-9071.2004.00770.x • PubMed

Lee JW, Lee HJ. Reversible visual loss caused by combination therapy of alfuzosin and finasteride in a patient with uveitic glaucoma. Cutan Ocul Toxicol. 2013. doi:10.3109/15569527.2012.733788

Ratra D, Lakshmipathy B, Ratra V. Finasteride-associated central retinal vein occlusionClin Exp Optom. 2024. doi:10.1080/08164622.2024.2349557 • PubMed

Ryu HJ, Kwon DY. Reversible myopathy and ophthalmoparesis after low-dose finasteride administration for androgenic alopecia. Dermatol Surg. 2014. doi:10.1111/dsu.12458 • PubMed

See also: Research: adverse effects on eyes & visual function

Pathology

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Zimmerman RL, Fogt F, Cronin D, Lynch R. Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia. Arch Pathol Lab Med. 2000. doi:10.5858/2000-124-0625-CAIAYO • PubMed

Pediatrics & reproductive medicine

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AlSaad D, Lee BH, Al-Obaidly S. Finasteride use during pregnancy and early neonatal outcome: a case report. Int J Clin Pharm. 2018. doi:10.1007/s11096-018-0661-5 • PubMed

BinJadeed HF, Alajlan A. Pregnancy and neonatal outcome with maternal exposure to finasteride: case series. Journal of Dermatology and Dermatologic Surgery. 2021. doi:10.4103/jdds.jdds_33_21

Ibarra Vilar P, Marín Pérez A, Hernández Peñalver AI, et al. Genitales ambiguos tras toma de finasteride [Ambiguous genitalia after taking finasteride] [Abstract]. Presented at: XXVII Reunión de la Sociedad Ginecológica Murciana: Laparoscopia ginecológica. March 4, 2017; Hospital Comarcal del Noroeste, Caravaca de la Cruz, Spain. Spanish. Content warning: includes a sensitive image of a fetus. Abstract (Spanish) • English translation

Lechuga Sancho AM, Hernández Serrano R, González Casado I, Gracia Bouthelier R. Recién nacido con extrofia vesical y posible exposición intrauterina a finasterida [Newborn with bladder exstrophy associated with finasteride exposure]. An Pediatr (Barc). 2004 Nov;61(5):451-3. doi:10.1016/s1695-4033(04)78429-5 • PubMed • Unofficial translation

Levy B, Teplitsky S, Kalaitzoglou E, Kahler S, Matheny JP, Saltzman AF. “Exogenous” 5 alpha reductase deficiency: a case report. Urology. 2023. doi:10.1016/j.urology.2023.05.001 • PubMed

Sallout BI, Al Wadi KA. Aphalangia possibly linked to unintended use of finasteride during early pregnancy. Ann Saudi Med. 2009. doi:10.4103/0256-4947.51805 • PubMed • PMC full text

See also: Research on teratogenicity (birth abnormalities)

Pharmacovigilance & drug safety

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Irwig MS. Finasteride and suicide: a postmarketing case series. Dermatology. 2020. doi:10.1159/000505151 • PubMed

See also: Disability and deaths in men who used finasteride

Psychiatry

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Altomare G, Capella GL. Depression circumstantially related to the administration of finasteride for androgenetic alopecia. J Dermatol. 2002. doi:10.1111/j.1346-8138.2002.tb00200.x • PubMed

Harth W, Linse R. Body dysmorphic disorder and life-style drugs. Overview and case report with finasteride. Int J Clin Pharmacol Ther. 2001. doi:10.5414/cpp39284 • 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 illnessSkin 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 • Poster via conference site

See also: Research: adverse effects on brain, mind & behavior

Rheumatology

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Persey M, Payne L, Webley M. Finasteride: a steroid-unsparing drug? Rheumatology (Oxford). 1999. doi:10.1093/rheumatology/38.3.285PubMed [Polymyalgia rheumatica and eczema]

Urology & andrology

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AlSaad D, Lee BH, Al-Obaidly S. Finasteride use during pregnancy and early neonatal outcome: a case report. Int J Clin Pharm. 2018. doi:10.1007/s11096-018-0661-5 • PubMed

Berthold D, Lhermitte B, Uffer M, Doerfler A. Finasteride-related Leydig cell tumour: report of a case and literature review. Andrologia. 2012. doi:10.1111/j.1439-0272.2011.01214.x • PubMed

Chiba K, Yamaguchi K, Li F, Ando M, Fujisawa M. Finasteride-associated male infertilityFertil Steril. 2011. doi:10.1016/j.fertnstert.2010.12.001 • PubMed

Collodel G, Scapigliati G, Moretti E. Spermatozoa and chronic treatment with finasteride: a TEM and FISH study. Arch Androl. 2007. doi:10.1080/01485010701426471 • PubMed

Fouda AM, Bazeed AM. Hematuria and hematospermia associated with the use of finasteride for the treatment of androgenic alopecia: a case report. Drug Saf Case Rep. 2017. doi:10.1007/s40800-017-0059-7PubMed • PMC full text

Glina S, Neves PA, Saade R, Netto NR Jr, Soares JB, Galuppo AG. Finasteride-associated male infertilityRev Hosp Clin Fac Med Sao Paulo. 2004. doi:10.1590/s0041-87812004000400009 • PubMed

Ibarra Vilar P, Marín Pérez A, Hernández Peñalver AI, et al. Genitales ambiguos tras toma de finasteride [Ambiguous genitalia after taking finasteride] [Abstract]. Presented at: XXVII Reunión de la Sociedad Ginecológica Murciana: Laparoscopia ginecológica. March 4, 2017; Hospital Comarcal del Noroeste, Caravaca de la Cruz, Spain. Spanish. Content warning: includes a sensitive image of a fetus. Abstract (Spanish) • English translation

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

Lechuga Sancho AM, Hernández Serrano R, González Casado I, Gracia Bouthelier R. Recién nacido con extrofia vesical y posible exposición intrauterina a finasterida [Newborn with bladder exstrophy associated with finasteride exposure]. An Pediatr (Barc). 2004 Nov;61(5):451-3. doi:10.1016/s1695-4033(04)78429-5 • PubMed • Unofficial translation

Liu KE, Binsaleh S, Lo KC, Jarvi K. Propecia-induced spermatogenic failure: a report of two cases. Fertil Steril. 2008. doi:10.1016/j.fertnstert.2007.08.026 • PubMed

Ricci G, Martinelli M, Luppi S, et al. Finasteride and fertility: case report and review of the literature. J Drugs Dermatol. 2012. doi:10.1111/dth.12069 • PubMed

Şalvarci A, Istanbulluoğlu O. Secondary infertility due to use of low-dose finasteride. Int Urol Nephrol. 2013. doi:10.1007/s11255-012-0315-9 • PubMed

Tu HY, Zini A. Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil Steril. 2011. doi:10.1016/j.fertnstert.2010.12.061 • PubMed

Wu C, Forbes E, Jarvi KA. Clomiphene citrate rescue of spermatogenesis in men with infertility while remaining on finasteride: a case report. Can Urol Assoc J. 2017. doi:10.5489/cuaj.4191PubMed • PMC full text

Yamada Y, Fujiwara H, Somiya S, et al. [Delay in high-grade metastatic prostate cancer progression by dutasteride: a case report]. Hinyokika Kiyo. 2018. Japanese. doi:10.14989/ActaUrolJap_64_4_187PubMed [Possible barrier to diagnosis of prostate cancer]

See also: Research on 5-alpha syndrome (post-finasteride syndrome); research on genitourinary system, sexual function & fertility; and adverse effects on reproductive anatomy & sexual function