Published: 3 March 2016
Updated: 29 April 2016

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Post-Finasteride Syndrome

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

Post-Finasteride Syndrome (PFS) was recently added to the US National Institutes of Health (NIH) list of genetic and rare diseases^1,2*. 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.