Post-finasteride syndrome

Gray, Shelly L.; Semla, Todd P.

doi:10.1136/bmj.l5047

Cited by 19 publications

(18 citation statements)

References 13 publications

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“…Several studies have substantiated that FIN increases the risk for depressive symptoms in a subset of vulnerable patients [16,17,18]. In addition, several patients have reported that these psychological complications can persist even after FIN discontinuation [18,19,20,21,22,23], prompting some authors to coin the term “post-finasteride syndrome” (PFS) to define this condition. Altogether, this emerging evidence has led several national agencies to issue warnings about the potential for depression and other psychological sequelae [22,23].…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of PFS and other psychological complications of FIN remain unclear, in view of selection bias in many published clinical studies and high nocebo effect, as well as suboptimal safety information [22,23]. A full characterization of the behavioral effects of FIN is particularly important, given that preliminary reports have indicated that FIN may also have therapeutic properties for several neuropsychiatric conditions characterized by poor impulse control and excessive externalizing manifestations, including Tourette’s syndrome and pathological gambling [2,24,25].…”

Section: Introductionmentioning

confidence: 99%

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The Steroidogenesis Inhibitor Finasteride Reduces the Response to Both Stressful and Rewarding Stimuli

et al. 2019

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Finasteride (FIN) is the prototypical inhibitor of steroid 5α-reductase (5αR), the enzyme that catalyzes the rate-limiting step of the conversion of progesterone and testosterone into their main neuroactive metabolites. FIN is clinically approved for the treatment of benign prostatic hyperplasia and male baldness; while often well-tolerated, FIN has also been shown to cause or exacerbate psychological problems in vulnerable subjects. Evidence on the psychological effects of FIN, however, remains controversial, in view of inconsistent clinical reports. Here, we tested the effects of FIN in a battery of tests aimed at capturing complementary aspects of mood regulation and stress reactivity in rats. FIN reduced exploratory, incentive, prosocial, and risk-taking behavior; furthermore, it decreased stress coping, as revealed by increased immobility in the forced-swim test (FST). This last effect was also observed in female and orchiectomized male rats, suggesting that the mechanism of action of FIN does not primarily reflect changes in gonadal steroids. The effects of FIN on FST responses were associated with a dramatic decrease in corticotropin release hormone (CRH) mRNA and adrenocorticotropic hormone (ACTH) levels. These results suggest that FIN impairs stress reactivity and reduces behavioral activation and impulsive behavior by altering the function of the hypothalamus–pituitary–adrenal (HPA) axis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Steroidogenesis Inhibitor Finasteride Reduces the Response to Both Stressful and Rewarding Stimuli

et al. 2019

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“…Men on finasteride should be counselled about the possibility of these adverse effects and warned that unwanted symptoms can persist after treatment discontinuation, the origin of which remains unclear. Patients should be referred to psychology services for relevant therapeutic interventions 99 …”

Section: Post‐finasteride Syndrome and Anabolic Androgensmentioning

confidence: 99%

Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism

Jayasena

Anderson

Llahana

et al. 2021

Clinical Endocrinology

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Male hypogonadism (MH) is a common endocrine disorder. However, uncertainties and variations in its diagnosis and management exist. There are several current guidelines on testosterone replacement therapy that have been driven predominantly by single disciplines. The Society for Endocrinology commissioned this new guideline to provide all care providers with a multidisciplinary approach to treating patients with MH. This guideline has been compiled using expertise from endocrine (medical and nursing), primary care, clinical biochemistry, urology and reproductive medicine practices. These guidelines also provide a patient perspective to help clinicians best manage MH.

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“…Kaplan et al [104] reported that a chronic treatment (5 years) with dutasteride induces a higher incidence of erectile dysfunction and gynecomastia than finasteride. Cases of persistent sexual dysfunction have been recently reported after the discontinuation of finasteride [32,60,97,99,100,129,131,134,141,147,149,166,170]. Irwig and Kolukula [99], using the Arizona Sexual Experience Scale (ASEX) validated questionnaire, interviewed 71 healthy male (21-46 years) finasteride-users, finding a high incidence of sexual dysfunction (Tables 6 and 7).…”

Section: -Arimentioning

confidence: 99%

“…Gur et al [30] report instead that the true prevalence of sexual side effects with 5-ARI treatment is currently unknown. (D) There have been recent reports of persistent sexual dysfunction after discontinuation of finasteride treatment [32,56,60,97,99,100,129,131,134,141,147,149,166,170,237]. Several authors have considered gynecomastia as a sexual dysfunction.…”

Section: Dutasteride (A) (B) (C) Finasteride (A) (B) (C) (D)mentioning

confidence: 99%

Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors

Torre

Palleria

Tamanini

et al. 2021

Uro

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This is a critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. In this narrative review, we analyzed data from the literature related to the development of sexual dysfunctions during the treatment of BPH or LUTS. Both α-blockers and 5-alpha reductase inhibitors (5-ARIs) can induce erectile dysfunction, ejaculatory disorders and a reduction in sexual desire. The sexual side effect profile of these drugs is different. Among the α-blockers, silodosin appears to have the highest incidence of ejaculatory disorders. Persistent sexual side effects after the discontinuation of finasteride have been recently reported; however, further studies are needed to clarify the true incidence and the significance of this finding. However, most of the published studies are affected by a weak methodology and other important limitations, with only a few RCTs available. Therefore, it is desirable that future studies will include validated tools to assess and diagnose the sexual dysfunction induced by these medications, especially for ejaculation and sexual desire disorders.

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Post-finasteride syndrome

Abstract: Efforts to explain persistent symptoms are undermined by poor long term data on harms

Cited by 19 publications

References 13 publications

The Steroidogenesis Inhibitor Finasteride Reduces the Response to Both Stressful and Rewarding Stimuli

The Steroidogenesis Inhibitor Finasteride Reduces the Response to Both Stressful and Rewarding Stimuli

Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism

Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors

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