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Gynäkologische Endokrinologie

, Volume 15, Issue 2, pp 153–163 | Cite as

Das Post-Finasterid-Syndrom

  • Herbert Kuhl
  • Inka Wiegratz
Arzneimitteltherapie
  • 336 Downloads

Zusammenfassung

Das Post-Finasterid-Syndrom (PFS) beschreibt eine langfristige Störung der Sexualfunktion sowie psychische und kognitive Veränderungen, die während oder nach der Behandlung einer androgenetischen Alopezie (AGA) mit 1 mg Finasterid pro Tag bzw. während oder nach der Therapie einer benignen Prostatahyperplasie (BPH) mit 5 mg/Tag auftreten und nach Absetzen persistieren. Die günstige Wirkung von Finasterid auf AGA und BPH beruht auf einem starken Abfall der 5α-Dihydrotestosteron(DHT)-Konzentration aufgrund einer irreversiblen Blockade der 5α-Reduktase in den Sexualorganen, dem Gehirn, der Haut und vielen anderen Organen und Geweben. Dadurch wird die Umwandlung von Testosteron in das 2,5-mal stärkere Androgen DHT gehemmt. Zu den persistierenden Nebenwirkungen zählen sexuelle Dysfunktionen, Depression, Angst und kognitive Störungen, welche die Lebensqualität beeinträchtigen. Die psychischen und mentalen Nebenwirkungen gehen von der 5α-Reduktase-Blockade im zentralen Nervensystem aus, die zu einem lokalen Abfall von DHT und anderen 3α,5α-reduzierten neuroaktiven Steroiden, z. B. Allopregnanolon, führt. Die Ätiologie der irreversiblen Veränderungen ist nicht geklärt. Möglicherweise spielen dabei epigenetische Prozesse eine Rolle. Zufriedenstellende Therapieoptionen stehen bisher nicht zur Verfügung.

Schlüsselwörter

5α-Reduktase-Hemmer Dihydrotestosteron Sexuelle Dysfunktion Depression Kognitive Störungen 

Post-finasteride syndrome

Abstract

Post-finasteride syndrome (PFS) describes a long-term disorder of sexual function, mental and cognitive alterations, which occur during and persist after treatment of androgenetic alopecia (AGA) with 1 mg/day finasteride or following treatment of benign prostatic hyperplasia (BPH) with 5 mg/day finasteride. The favorable effect of finasteride on AGA and BPH is due to a severe reduction in the concentration of 5α‑dihydrotestosterone (DHT) resulting from an irreversible blockade of 5α‑reductase in the sex organs, the brain, the skin, and many other organs and tissues. This inhibits the transformation of testosterone to the 2.5 times more potent androgen DHT. The persisting side effects include sexual dysfunction, depression, anxiety and cognitive disorders, which impair the quality of life. The mental and psychological side effects are derived from the blockade of 5α‑reductase in the central nervous system, which leads to a local reduction of DHT and other 3α,5α-reduced neuroactive steroids, including allopregnanolone. The etiology of the irreversible alterations is unknown. Epigenetic processes possibly play a role. Satisfactory therapy options are not currently available.

Keywords

5α-reductase inhibitors Dihydrotestosterone Sexual dysfunction, physiological Depression Cognitive disorders 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H. Kuhl und I. Wiegratz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.AschaffenburgDeutschland
  2. 2.VivaNeo Kinderwunschzentrum WiesbadenWiesbadenDeutschland
  3. 3.VivaNeo Kinderwunschpraxis FrankfurtFrankfurt am MainDeutschland

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