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The post-finasteride syndrome: possible etiological mechanisms and symptoms

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A Comment to this article was published on 12 April 2024

Abstract

Finasteride and dutasteride, synthetic 5α-reductase inhibitors (5ARIs) are recommended in many guidelines for the treatment of benign prostatic hyperplasia/lower urinary tract symptoms and alopecia despite a variety of side effects like sexual, neurological, psychiatric, endocrinological, metabolic and ophthalmological dysfunctions and the increased incidence of high grade prostate cancer. The sexual side effects are common during the use of the drug but in a small subgroup of patients, they can persist after stopping the drug. This so-called post-finasteride syndrome has serious implications for the quality of life without a clear etiology or therapy. Three types of 5α-reductases are present in many organs in- and outside the brain where they can be blocked by the two 5ARIs. There is increasing evidence that 5ARIs not only inhibit the conversion of testosterone to 5α-dihydrotestosterone (DHT) in the prostate and the scalp but also in many other tissues. The lipophilic 5ARIs can pass the blood-brain barrier and might block many other neurosteroids in the brain with changes in the neurochemistry and impaired neurogenesis. Further research and therapeutic innovations are urgently needed that might cure or relieve these side effects. More awareness is needed for physicians to outweigh these health risks against the benefits of 5ARIs.

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Authors and Affiliations

  1. Andros Clinics The Netherlands, Wilhelminapark 12, 3581 NC, Utrecht, The Netherlands

    Herman H. J. Leliefeld

  2. Andros Clinics The Netherlands, Mr. E.N. van Kleffenstraat 5, 6842 CV, Arnhem, The Netherlands

    Frans M. J. Debruyne

  3. Flare-Health, Oosteinderweg 348, 1432 BE, Aalsmeer, The Netherlands

    Yakov Reisman

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  1. Herman H. J. Leliefeld
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HL corresponding author, confirms that the two other contributing authors (2 and 3) played an important role in the final result of the manuscript, with revisions and approval of the final version. They agreed to be accountable for all aspects of the work.

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Leliefeld, H.H.J., Debruyne, F.M.J. & Reisman, Y. The post-finasteride syndrome: possible etiological mechanisms and symptoms. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00759-5

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