Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss

Basaria, Shehzad; Jasuja, Ravi; Huang, Grace; Wharton, Whitney; Pan, Hong; Pencina, Karol M.; Li, Zhuoying; Travison, Thomas G.; Bhawan, Jag; Gonthier, Renaud; Labrie, Fernand; Dury, Alain Y.; Serra, Carlo; Papazian, Allen; O’Leary, Michael P.; Amr, Sami S.; Storer, Thomas W.; Stern, Emily; Bhasin, Shalender

doi:10.1210/jc.2016-2726

Cited by 58 publications

(48 citation statements)

References 39 publications

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“…Finally, there has been a preliminary report of abnormal function in brain areas linked to sexual arousal in fMRI scans of PFS patients viewing erotic stimuli [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases

Healy

Noury

Mangin

2018

JRS

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OBJECTIVE:To investigate clinical reports of post-SSRI sexual dysfunction (PSSD), post-finasteride syndrome (PFS) and enduring sexual dysfunction following isotretinoin.METHODS:Data from RxISK.org, a global adverse event reporting website, have been used to establish the clinical features, demographic details and clinical trajectories of syndromes of persistent sexual difficulties following three superficially different treatment modalities.RESULTSWe report on 300 cases of enduring sexual dysfunction from 37 countries following 14 different drugs comprised of serotonin reuptake inhibiting antidepressants, 5α-reductase inhibitors and isotretinoin. While reports of certain issues were unique to the antidepressants, such as the onset of premature ejaculation and persistent genital arousal disorder (PGAD), there was also a significant overlap in symptom profile between the drug groups, with common features including genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. Secondary consequences included relationship breakdown and impaired quality of life.CONCLUSIONSThese data point to a legacy syndrome or syndromes comprising a range of disturbances to sexual function. More detailed studies will require developments in coding systems that recognise the condition(s). Further exploration of these tardive sexual syndromes may yield greater understanding of tardive syndromes in general.

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“…Finally, there has been a preliminary report of abnormal function in brain areas linked to sexual arousal in fMRI scans of PFS patients viewing erotic stimuli [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases

Healy

Noury

Mangin

2018

JRS

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“…Recently, Basaria et al didn't find evidence of sequence variation in AR, SRD5A1, or SRD5A2 genes, or of significant alterations in expression of AR-dependent genes in the skin, but they can't exclude the possibility of variations in other genes, like epigenetic effects, or in the gene expression levels in other tissues or specific brain regions involved in regulation of mood and sexual function. Therefore, symptomatic finasteride users are unlikely to benefit from treatment with testosterone, DHT, or any other androgen because these patients didn't show evidence of androgen deficiency, persistent SRD5A inhibition or androgen insensitivity [48]. In our experience, both patients reported adverse effects attributable to the use of finasteride, being both cases very similar between them, except for the fact that one of them only needed one pill of finasteride 1 mg to experience its adverse effects and, after the withdrawal of the drug, its persistence and progression, warning about a possible time and/or dose independent characteristic of the syndrome.…”

Section: Discussionmentioning

confidence: 99%

Post-Finasteride Syndrome: About 2 Cases and Review of the Literature

Alej¹,

Garreton²,

Valzacchi³

et al. 2016

Andrology (Los Angel)

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Introduction: Finasteride is widely used in the treatment of benign prostatic hyperplasia and androgenetic alopecia. Persistent sexual adverse events in patients that withdraw the drug was poorly studied. Materials and methods: case report study of two clinical cases of post-finasteride syndrome. Case 1: 27 year old male who, after 7 months of finasteride 1mg/day intake for androgenetic alopecia, began with erectile dysfunction, low libido, hypospermia, muscular hipotrophy and penile shrinking, in a persistent and progressive way although withdrawal of the drug. He was also evaluated by a psychiatrist. Case 2: 23 year old male that after the intake of 1 pill of finasteride 1mg for androgenetic alopecia began with erectile dysfunction, low libido, hypospermia, less intense orgasms, asthenia, muscle pain and penile shrinking, in a persistent and progressive way although withdrawal of the drug. He is under psychiatric evaluation. Results: Case 1: Hormonal profiles were normal, with a dihydrotestosterone of 192 pg/ml and the penile ultrasound showed an hyperechogenicity at the distal portion of the right corpus cavernosum. The genetic determination of the CAG triplets of the androgen receptor gene showed a value of 24 repetitions. Treatment with Tadalafil and vacuum therapy was effective, although not complete, but he didn't benefit from the 3 month application of Andractim®, with a posterior benefit from the application of HCG 6000 UI/week associated with Anastrozole 2mg/week, with normal hormonal controls. Case 2: penile Doppler and hormonal profiles were normal. Treatment with Tadalafil was effective, although not complete. There was no adherence to other treatments. Conclusion: post-finasteride syndrome is a little known entity with an unknown physiopathology, and is currently under study. Awareness should be promoted about the existence of this syndrome in order to give the best assistance to these patients until we have a better comprehension of this entity.

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“…5-ARIs can also significantly decrease sperm count and mobility; however, this effect is insufficient to reduce fertility in men with normal semen prior to treatment. The above side effects are generally less common among men treated with lower doses of 5-ARIs for male-pattern baldness (240). Psychotropic drugs also have profound negative effects on male fertility and include antidepressants, antipsychotics and recreational drugs, such as opioids and cannabis.…”

Section: Drug-induced Male Infertility and Sperm Abnormalitiesmentioning

confidence: 99%

“…This may be attributed to a central action of elevated serotonin on the hypothalamus, moderate elevation of PRL and possibly a direct action on smooth muscle cells. One should consider that ejaculatory dysfunction is also prevalent among untreated men with depression as well (240).…”

Section: Drug-induced Male Infertility and Sperm Abnormalitiesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

Diamanti-Kandarakis

Duntas

Kanakis

et al. 2019

European Journal of Endocrinology

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In the currently overwhelming era of polypharmacy, the balance of the dynamic and delicate endocrine system can easily be disturbed by interfering pharmaceutical agents like medications. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the feedback axis, on hormonal transport, binding and signaling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can interfere with the hormonal assays, leading to erroneous laboratory results that disorientate clinicians from the right diagnosis. The purpose of this review is to cover a contemporary topic, the drug-induced endocrinopathies, which was presented in the monothematic annual Combo Endo Course 2018. This challenging part of endocrinology is constantly expanding particularly during the last decade, with the new oncological therapeutic agents, targeting novel molecular pathways in the process of malignancies. In this new context of drug-induced endocrine disease, clinicians should be aware that drugs can cause endocrine abnormalities via different mechanisms and mimic a variety of clinical scenarios. Therefore, it is extremely important for clinicians not only to promptly recognize drug-induced hormonal and metabolic abnormalities, but also to address the therapeutic issues for timely intervention.

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Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss

Cited by 58 publications

References 39 publications

Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases

Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases

Post-Finasteride Syndrome: About 2 Cases and Review of the Literature

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

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