First time posting on the forum. my urologist recently decided to up my dosage of finasteride from a compounded 0.5 mg 2x per week to 5 mg daily in relation to a PSA rise to 4.5 and after 2 months i am beginning to feel symptoms of depression , low energy and a worsening of erectile dysfunction , depressive symptoms are what concern me the most. My brief history: 63 years old been on TRT under the care of an endocrinologist for 12 years , blood work 2-3 times per year,all are usually pretty normal with T hovering around 1000 consistently , MRI results were negative and PSA had come back down to 3.5 but URO wants to see if we can shrink the Prostate down a little.will go back to him for a followup in 1 month .From exerience i can say my PSA has all ways fluctuated depending in my DHT levels.Running out of options to avoid the big C but defiantly not a fan of this high dose finasteride
I’m sorry about your issues with high PSA and the side effects of reducing it. Finasteride absolutely crushes DHT levels, and the side effects you’re experiencing with finasteride are classic symptoms of low DHT.
It’s a decision for you and your doctor to make, but I’d definitely be concerned about crushed DHT and all that it brings. And I’d hate for you to then have doctor try to get you on antidepressants when the root cause is low DHT. The other concern is that some men never recover from having taken finastetide even after stopping it; it’s called finasteride syndrome. I’d rather not live with depression and no libido than high PSA, and would personally take the risk of prostate c over a life in depression. But again this is a very personal decision to make.
Maybe get your doctor to order DHT labs and then your doctor will see what the finasteride is doing to you and its side effects, and have a serious talk with them about your symptoms. Many general practitioners know little about endocrinology/hormones, so take that into consideration when discussing with them.
My thinking is that you and your endocrinologist need to reduce your TRT dosing, so that your T levels are closer to 400-550 at trough. If injections are once every 2 weeks, a common but bad practice of many endocrinologists, move to once a week injections. With lowered T levels your T conversion to DHT will be lowered without the need for finasteride; you’ll have more normal DHT and estrogen levels, and subsequently reduced PSA levels. And you’ll probably feel much better. I’m surprised your endocrinologist thinks T levels of 1000 are ok. If you’re going to a TRT clinic rather than an insurance aporoved endocrinologist that would explain it. 1000 is definitely high, redlining it…not normal unless you’re a 20 year old (and even then quite high).
Good luck!
I’m going to preface my response with this so we can all be more informed. There’s good information in here, though I do not know if it has been disputed… this isn’t a topic I frequent.
For conciseness, I’ll restate what you said:
Your PSA going down from 4.5 to 3.5 (I believe the range you want is 1-3)… Was the drop to 3.5 before or during finasteride intervention?
For reference: if it were over 10, there is a 50% chance of prostate cancer, according to google.
If my understanding is correct, your provider wants to shrink your prostate down by further blocking DHT in hopes your prostate will eventually shrink. Google says it typically takes 3-6 months for this to happen, under the assumption that high DHT levels are what caused your enlarged prostate - which we don’t know. Again, there are some gripes with the claim that high DHT leads to prostate enlargement, so we don’t know how valid those concerns are.
Has your urologist lowered your test dose alongside finasteride treatment? It seems a logical approach that if high DHT were the problem, reducing the drug providing your DHT could be a good resolution.
RE Depressive symptoms…
Are you just feeling blue, or are there suicidal thoughts?
For legal reasons, you probably shouldn’t answer directly if it’s the latter of these, but you SHOULD absolutely talk to your provider if this is the case.
If it’s the former, do you think you could just deal with the depressive symptoms for the next couple months until treatment is over?