Post-Finasteride Syndrome (PFS) – Symptoms, Causes & Treatment

Post-finasteride syndrome (PFS)^[1] may develop in men who have taken finasteride, a medicine used to treat male pattern baldness (androgenetic alopecia) and an enlarged prostate. Finasteride is sold under the brand names Propecia^[2] and Proscar^[3], or simply sold as generic finasteride.

Finasteride works by preventing the conversion of testosterone into dihydrotestosterone (DHT), a hormone that’s suggested to cause both conditions. Symptoms range from mood changes, sexual dysfunction and neurological and physical symptoms.

It’s important to note that PFS is very rare, with approximately 1000 men suffering from the condition worldwide. Millions of men have had great success by taking finasteride, reporting no ongoing side effects after their treatment has ended.

There isn’t yet a definite cure for post-finasteride syndrome, but the symptoms can be managed. In fact, several men have experienced a partial improvement^[4], although there haven't been any documented cases of PFS patients fully regaining their health.

However, a small number of individuals with post-finasteride syndrome have described feeling 80%, 90%, or even 99% improved over a span of one to five years.

Symptoms

Post-finasteride syndrome happens when people who've taken finasteride experience lasting side effects even after stopping the medication. Symptoms may include:

• Sexual problems, like erectile dysfunction, decreased libido (sex drive), reduced sensation in the genital area, and difficulty achieving an orgasm
• Physical issues, such as fatigue, muscle weakness and joint pain
• Mental health changes like feeling depressed, anxious, or having trouble concentrating
• Appearance changes such as weight gain, and changes in skin and hair texture
• Neurological symptoms like tingling, tremors or coordination problems

Not everyone who takes finasteride gets PFS, and not all doctors agree on its causes. If you think you have PFS, it's important to see a doctor for proper evaluation and support. Treatment options can vary depending on your symptoms.

Causes

Post-finasteride syndrome is a complex and controversial condition, and its exact cause is not fully understood. However, there are several theories proposed by researchers and healthcare professionals.

Hormone disruption

Finasteride stops a chemical process in the body that changes testosterone into another hormone called dihydrotestosterone (DHT).

Some experts think that this change in hormone levels, especially in DHT and testosterone, might disrupt how the body's nerve and hormone systems work together, which could cause symptoms of PFS.

Genetic factors

Some people might be more likely to get PFS because of their genes. Genes can affect how bodies process and react to medications like finasteride.

Brain and nervous system effects

There's a chance that finasteride might directly affect the brain and nerves, changing how certain chemicals work in these areas. These changes could be linked to the thinking and mood problems that people with PFS report.

Other factors

Factors such as age, underlying health conditions, simultaneous medication use, and the dosage of finasteride may contribute to the development and severity of PFS symptoms.

Diagnosis

Diagnosing post-finasteride syndrome^[5] involves a comprehensive assessment by a healthcare provider. It begins by looking at the symptoms, which commonly include sexual dysfunction, cognitive difficulties, mood changes, and physical symptoms like fatigue.

A thorough medical history, including medication use, particularly finasteride, is essential, alongside a physical examination in order to rule out other potential causes.

Blood tests may be requested to look at hormone levels and other relevant markers. Psychological assessments are also performed to evaluate cognitive function and mood.

You may be referred for consultations with specialists such as urologists, endocrinologists, neurologists or psychiatrists.

However, given the lack of diagnostic criteria available for PFS, diagnosis relies on clinical judgement and the exclusion of alternative explanations.

Treatment

Treatment for post-finasteride syndrome focuses on managing symptoms and improving quality of life, although there is no definitive cure. Since PFS symptoms can vary widely among individuals, treatments may be tailored to address symptoms and their severity.

Symptom management

Medications or therapies may be prescribed to relieve specific symptoms. For example, medications for erectile dysfunction or depression may be prescribed if these symptoms are present.

Hormone therapy

Some individuals with PFS may benefit from hormone replacement therapy (HRT)^[6] to restore hormonal balance. However, hormone replacement therapy should be approached cautiously and under the guidance of a healthcare professional, as it may not be suitable for everyone and can carry risks.

Cognitive and behavioural therapy

Therapy techniques can help individuals cope with cognitive difficulties, mood changes, and other psychological symptoms associated with PFS. Cognitive-behavioural therapy (CBT) or counselling may be beneficial.

Lifestyle changes

Making lifestyle changes such as adopting a healthy diet, engaging in regular exercise, practising stress-reduction techniques and getting enough sleep can contribute to overall well-being and may help to manage some symptoms.

Support groups

Support groups or online communities may provide valuable support and resources for those struggling with PFS. Connecting with others who are experiencing similar challenges can offer emotional support and practical advice.

Research and clinical trials

Since PFS is still not fully understood, participating in research studies or clinical trials investigating potential treatments may be an option for some individuals.