Publications

Published: 3 March 2016
Updated:  29 April 2016

Post-Finasteride Syndrome

 

Prescriber Update 37(1): 8-9
March 2016

Key Messages

  • Post-Finasteride Syndrome can occur in some men who have taken finasteride.
  • Symptoms (sexual, physical, and mental and neurological) often persist after the patient has stopped taking finasteride.
  • Patients should be informed of the risks of taking finasteride prior to treatment initiation.
  • The symptoms associated with Post-Finasteride Syndrome should be discussed with patients prior to treatment.


Post-Finasteride Syndrome (PFS) was recently added to the US National Institutes of Health (NIH) list of genetic and rare diseases1,2*. Finasteride is a 5-alpha reductase type II enzyme inhibitor used to treat hair loss (eg, Propecia, Profal and ReGen) or enlarged prostate (eg, Proscar, Finasteride Rex and Fintral).

PFS includes sexual, physical, and mental and neurological symptoms in patients who have taken finasteride (Table 1). Symptoms often persist after the patient has stopped taking finasteride.

Table 1: Reported symptoms of Post-Finasteride Syndrome1

Sexual Symptoms Physical Symptoms Mental and Neurological Symptoms
Decreased or complete loss of sex drive Female-like breast development and enlargement Severe memory/recall impairment
Erectile dysfunction, impotence Chronic fatigue, listlessness Slowed thought processes
Loss of morning and spontaneous erections Muscle atrophy, weakness Impaired problem solving, decreased comprehension
Sexual anhedonia, loss of pleasurable orgasm Decreased oil and sebum production Depression
Decreased semen volume and force Chronically dry, thinning of skin Anxiety
Penile shrinkage and numbness Melasma Suicidal ideation
Peyronie’s disease Tinnitus Emotional flatness and anhedonia
Scrotal shrinkage and numbness Increased fat deposition, obesity and elevated body mass index Insomnia
  Decrease in body temperature  
  Reduced HDL cholesterol, raised fasting glucose and triglycerides  
  Attempted suicide  
  Completed suicide  


Importantly, some patients can experience suicidal ideation and depression after stopping finasteride treatment. Patients and their families should be advised about these symptoms and to seek medical advice as soon as possible if they occur.

Unfortunately, PFS is a condition with no known cure and few, if any, effective treatments.

Further information about PFS can be found on the Post-Finasteride Syndrome Foundation website (www.pfsfoundation.org/).

To date, the Centre for Adverse Reactions Monitoring (CARM) has received 10 reports associating finasteride use with at least one of the symptoms of PFS listed in Table 1. Age, when reported, ranged from 22 to 81 years of age. Only three patients reported that they had recovered at the time of the report.

Please report any adverse events, including those associated with PFS, to CARM (https://nzphvc.otago.ac.nz/).

References
  1. Post-Finasteride Syndrome Foundation. 2015. Global Public Health Advisory – US National Institutes of Health Recognises Post-Finasteride Syndrome. URL: us5.campaign-archive2.com/?u=644fb8b633594fee188a85091&id=9cea0753a4&e=5459eb9419 (accessed 6 October 2015).
  2. National Institutes of Health Genetic and Rare Diseases Information Center. 2015. Adverse events of 5-alpha-reductase inhibitors. URL:  http://rarediseases.info.nih.gov/gard/12407/post-finasteride-syndrome/resources/1 (accessed 28 April 2016).

* The sentence above has been changed to more accurately reflect action taken by the US NIH with respect to PFS.