Post Finasteride Syndrome

Pharma
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Efficacy and safety of Finasteride (5 alpha-reductase inhibitor) monotherapy in patients with benign prostatic hyperplasia: A critical review of the literature

RESULTS:

Overall 12 original articles were included and critically evaluated. Sample sizes of patient actively treated with finasteride varied from 13 to 1524 cases analyzed in a single study. Follow-up after treatments ranged from 3 to 54 months. The effect of finasteride in reducing prostate volume (PV) was moderate (standardized mean difference (SMD) effect between 0.5 to 0.8 for all trials evaluable) while the effect on IPSS score and Qmax was considered significant (SMD in the 0.2 to 0.5 variation range). No severe AEs and/or psychiatric disorders were retrieved among the studies. Sexual health dysfunctions were significantly influenced by finasteride therapy when compared with placebo treated patients.

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis - PubMed

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.

CONCLUSIONS AND RELEVANCE:

Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

Skip to 17:20 to hear what this famous endocrinologist has to say about the side effects.

Hell even Joe Rogan experienced sides:

Finasteride has been added to the ‘list of drugs to avoid in 2021’ by a French Medical Journal

Translation from the Journal ‘Drugs to be Avoided for Better Care 2021 Report’

‘Finasteride 1mg, a 5-alpha-reductase inhibitor, has a very high efficacy in modest androgenic alopecia in men: it increases hair density only slightly on the top of the head (by about 10%), and only for the duration of the treatment. It exposes particular sexual disorders (e.g., sexual dysfunction in erection and ejaculation, decreased libido), depression, suicidal ideation and cancer of the breast. When a drug is the chosen option, local minoxidil used with care is less dangerous.’

(Finasteride is on page 6 of the journal)

The journal is called Prescrire, a medical journal that ‘addresses developments in diseases, medications, and in medical techniques and technologies’ and ‘contains no advertising’.

According to their website their ‘editors are healthcare professionals, specially trained in Prescrire’s editorial methods and free from conflicts of interest. Exacting quality control procedures are applied to all editorial content.’

internet is full of doctors talking about PFS.

View: https://twitter.com/i/web/status/1324770761731657734

“Definitely seen this a lot and believe it’s real. Anecdotally feel symptoms are worse the younger they started on finasteride. Clomid has helped on a few pts with lower T / FSH/LH levels…”

View: https://twitter.com/i/web/status/1333240440003420160

“And I’m 100% certain this effects older guys as well…it’s just more obvious in the younger guys who typically have no co-morbidities.”

View: https://twitter.com/i/web/status/1327387622688354305

“Post finasteride syndrome is so real! Hundreds of patients coming to #sandiegosexualmedicine with this. Often have low t. Make sure to check dht also! Some recommend andractim, available in Europe (and online). Shockwave therapy for ED. Can take years to get better for some!”

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People also need to understand 5ari’s do much more than just reducing DHT. Many important neurosteroidal processes are also being disrupted;

All of the following are disrupted due to fina:

The following reactions are known to be catalyzed by 5α-reductase:[9]

Advances in Knowledge of Androgens: How Intentional and Accidental Neurosteroid Changes Inform Us of Their Action and Role

Synthesis of neurosteroids requires 5ɑ-R. As such, finasteride alters neurosteroid levels and can have robust effects clearly related to the adverse effects of finasteride that have been reported in men in the short term and long term following cessation of its use.

Good article:

Mechanisms of finasteride

So let’s discuss what the drug, finasteride, does in the first place.

Finasteride is a 5-alpha reductase inhibitor and this blocks the conversion of testosterone to DHT. What few people know is that there are 5β-R and 3 types of 5α-R enzymes and that they’re not only involved in the conversion of testosterone to DHT, but also in the:

  • synthesis of bile (5β-R specifically), which is essential for the digestion of fat and absorption of fat-soluble vitamins. Bile also acts as an anti-bacterial and anti-microbial substance which keeps the gut clean and prevents SIBO and SIFO.
  • conversion of:
    • androstenedione → 5α-androstanedione
    • progesterone → α-dihydroprogesterone (a very important neuroactive steroid and precursor to allopregnanolone)
    • deoxycorticosterone → dihydrodeoxycorticosterone (DHDOC)
    • cortisol → 5α-dihydrocortisol (for the deactivation of cortisol)
    • aldosterone → 5α-dihydroaldosterone, which increases the excretion of salt, the opposite of aldosterone

Many of the benefits of testosterone, such as enhanced insulin sensitivity, reduced catabolism, higher dopamine, increased thyroid hormone production, are mediated by DHT, and blocking DHT production prevents those effects/benefits.

PFS isn’t fun. It scrambles your hormones, libido and cognition all over the place, right into the gutters, and leaves you feeling like an empty dysfunctional husk. Additional side effects of finasteride include:

  • dry skin or thinning of the skin, weight gain, elevated glucose and lipids and worsening of insulin sensitivity (R).
  • insomnia, obstructive sleep apnea (R), panic attacks, brain fog, suicidal idealization, slow cognition, anhedonia (a sign of elevated serotonin and low dopamine)
  • diminished libido, erectile dysfunction, ejaculatory complaints, penile discomfort, loss of scrotal sensitivity, scrotal discomfort, loss of pubic hair, increased sperm density and gyno (R).
  • involuntary muscle spasms, loss of muscle tone, increased body weight (R).
  • kidney disease. DHT is highly protective to the kidney and an elevated estrogen:androgen ratio is destructive to the kidney (R).
  • accumulation of fat in the liver and the progression of fatty liver (causes NAFLD) (R). Cortisol antagonist can help reverse some of these effects, which just indicate that 5-AR can prevent fatty liver by deactivating cortisol.
  • reduced muscle mass gains even while on testosterone (R).
  • alteration in the gut microbiota, which can lead to digestive issues, skin issues, mental issues, etc. (R)
  • neuroinflammation (R). Neurosteroids such as 5α-DHP and allopregnanolone stimulate neurogenesis, neuronal survival, neuronal differentiation, synaptogenesis, glial differentiation, myelin formation, synaptic function, and synaptic plasticity (R). In addition, under pathological conditions, neuroactive steroids exert neuroprotective actions, promoting neuronal survival and re-myelination and decreasing neuroinflammation.
  • anti-androgenic actions (R). Due to the structural similarity of finasteride to DHT, it is postulated that finasteride could bind to the androgen receptor. It turns out that finasteride happens to be a potent anti-androgen, independent of lowering DHT.
  • Osteoporosis (R)
  • Adrenal insuffeciency (R). “A putative mechanism is that elevated bile acids inhibit inactivation of cortisol in liver by 5α-reductases type 1 and type 2 and 5β-reductase, resulting in compensatory downregulation of the hypothalamic-pituitary-adrenal axis and adrenocortical atrophy.“
  • Excess cortisol (R). DHT is needed to shut down the HPA axis, so blocking it increases cortisol. 5AR is also needed to deactivate cortisol, so without enough 5AR, someone can be in a hyperstressed state all the time.
  • Messes with bile synthesis and excretion, creating toxic bile acids and cholestasis (R). “Due to the failure to synthesize primary bile acids in the AKR1D1 deficiency and the production instead of a spectrum of highly cholestatic and hepatotoxic 3-oxo-Δ4 bile acids[3], bile flow is impaired, leading to cholestasis. Since bile acids are essential for micellar solubilization of lipids, fat and fat-soluble vitamin deficiency occurs quite often.”

Hormonal and neurotransmitter alterations due to finasteride

A low DHT state can lead to low dopamine (R), high estrogen (R), high prolactin (due to reduced dopamine), high cortisol (due to reduced clearance) (R), elevated serotonin (due to elevated estrogen and lower dopamine) and hypothyroidism (R).

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Not lower than baseline. Just lower than the first month or so while I was on finasteride. That first month or so on it, the libido was uncomfortably high.

My position is that as long as one has a sufficient level of androgens they will very likely be fine. Testosterone seems to be enough for the vast majority of guys (after puberty of course). If a guy has low T and uses finasteride, I could see that causing an issue of not enough androgens, and from that low T symptoms.

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Keep caution, finasteride is not something to take lightly.

Wish it was that simple, sadly it’s much more insidious and complex. That said many seem to tolerate it or are able to live with the side effects. (check video with endocrinologist, he thinks around 75% of men will experience side effects)

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Will do. It is something I keep in mind. So far, I am doing well on it. I know about 5 guys including myself that use it or dutasteride. One stopped when he noticed side effects (about 2 weeks in). According to him they went away after a few weeks.

I may do an experiment were I go off for a few weeks and see if there is any differences.

Is that the one with Tomas O’Connor? I’ve watched some of his videos in the past. Overall pretty good, but at the same time he does have some weird takes.

I have a tough time believing that number. The studies have it somewhere around 2-5% (while taking it) depending on the study, but several studies show the placebo having nearly the same percent of sexual side effects as finasteride.

I also think it’s important to keep in mind finasteride is prescribed to millions of guys (and yes, millions). With those numbers there is going to be some that get side effects. I am convinced some do get side effects from finasteride. I just don’t really see a case for years long side effects after taking it. I read a story on PFS’s website of a guy who took it for a few days and claimed he got PFS for years after. I just don’t buy that case. He may have had those things occur, but I believe he attributed it to finasteride in error.

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Ditto.

This is correct from what I have read too.

As with any medication that affects ones hormones, there are bound to be some outliers with issues. The amount is small. I’m sure some do get severe sides from which a collective of users could come together and coin PFS.

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Even Merck acknowledges it’s higher than 5% now and FDA regularly updates the side effect profile of finasteride.

New adverse event added to Propecia label on 15 Jun 2021:

Hematospermia (blood in semen)

And there has been a meta analysis of all the data and studies, I’ll repost it;

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.

CONCLUSIONS AND RELEVANCE:

Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

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It’s much, much more common than you think hence respected endocrinologists warning for it.

Hell even purely anecdotally speaking we can see from various polls on the internet the amount of people experiencing side effects is around 50%;

https://www.hairrestorationnetwork.com/topic/53353-official-thread-have-you-experienced-side-effects-from-finasteride-poll/page/2/

555 people voted, 55% experienced sides

183 people voted, 54% experienced sides

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You have a hard time understanding the term ‘objective’, I take it?

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If I was one of them, I’d be a lot louder about it than the average guy who doesn’t get negative sides.

I believe the percentage of guys that get sexual sides from 19-nor drugs is way higher compared to finasteride. I am too risk adverse to use those drugs. I believe the risk reward of finasteride is worth it. Meaning I think if a guy wants to keep his hair, it is worth at least doing a trial of the drug to see if it’s for you. It may or may not be.

I’d say if the number was even 10% that get the sexual sides while on it, it would be worth trying. Especially since the studies that are evaluating the drug for efficacy and side effects haven’t found an ongoing case yet. Now those studies are only looking at the thousands, while millions are on it. Perhaps there is a sub 1% chance of ongoing sides, and it just hasn’t been captured yet?

I am okay admitting that I don’t for sure know PFS doesn’t exist. It isn’t something I know. It just hasn’t been captured in an appropriate study environment yet.

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Why are you only selecting a part of my quote, I clearly said anecdotally.

Seems you’re a bit upset when confronted with the reality that 5ari’s are not as safe as you believe they are… Typical.

Anyway keep taking it, most have to learn the hard way.

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I don’t take it. I’m pointing out that through all of your sources, none of them are smoking guns. They include

  • possible explanations for PFS
  • unsettled lawsuits of people claiming they have PFS
  • forums
  • Twitter feeds
  • Joe Rogan
  • a super biased website from a scientist that is practicing bad science (by having an obvious conflict of interest whilst conducting ‘studies’).

I’m not saying it doesn’t exist; I’m saying that whether you say it exists or it doesn’t exist inherently makes it come true for the person claiming either side.

I believe this is a Munchausen’s thing, but what do I know?

Nocebo can be a real bastard sometimes. Good luck with those sexual sides, I have no dog in this fight - just calling out your subpar “sources”.

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My friend, you don’t even use any sources to try and counter any argument I made. The ony argument you made is a logical fallacy by attacking and trying to dismiss the research from the scientist from that finasteride research website.

Also seems you didn’t even read anything I posted. That lawsuit showed Merck has sealed evidence to downplay the risks from propecia. You also ignore the fact Merck has manipulated its studies in the past too.

The forum polls were like I said anecdotal but still give insight in something many dismiss as very rare.

Those twitter posts I quoted are from doctors. Are you a doctor?

What’s wrong with Joe Rogan’s experience? He’s a public figure and I assume most know him, hence me posting it since many think side effects from fina are so rare…

“super biased website from a scientist practicing bad science” The irony, my god. Are you a scientist? Serious tell me your credentials. With all due respect it’s very clear you don’t even know what defines good or bad science.

And you ignore ALL of the other studies and comments form actual doctors I posted. Hmm you may not take it but you seem very biased friend, wonder what your agenda is.

Wish it was just nocebo though but if you actually believe blocking the most androgenic hormone in the body and disrupting multiple neurosteroidal pathways will ONLY affect the state of your hair… I don’t know what to say…

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PFS by the Numbers - The Post-Finasteride Syndrome Foundation (pfsfoundation.org)

I don’t see it but…I also believe its real just not prevalent. I was a user for 10 years and I stopped due to the fact that I couldn’t substantiate the risk for my hair.

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“reported”. Most are not officialy reported, same case with most medication.

Like I said many don’t even know what finasteride does and even then most probably think their lower libido, etc is due to age.

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Another interesting fact, FDA even admits it didn’t knew the long term risks:

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@Andrewgen_Receptors I think actually made some good points about the studies / sources you posted.

Your evidence is evidence, but it’s not high quality evidence. Anecdotal evidence is evidence as well, but it is low quality compared to a randomized control trial.

We have trials that weren’t done by Merck to that are high quality studies (including randomized control studies, the gold standard). These have guys that weren’t taking the drug, took the drug for the study, were asked questions about sexual side effects. There are studies like this with large sample sizes (from the 100s to the 1000s). Varying percentages got sexual side effects while on the drug, as well as placebo. I figure it probably had to do with what they told them during the study, and what questions they asked. But, they didn’t have guys that got the sides well on, that went off and still had them later. Some studies report that the guys that did get sides had them go down in severity even while continuing to take the drug.

What I am trying to say is this is the type of data I’d base my decisions on. The outcomes are what we should expect in real life. It is quality data that can be trusted.

I guess if one case of PFS isn’t found in a randomized control style with sample sizes in the thousands, I just figure it just isn’t worth being worried about.

image

They have 10 year data, showing already balding men had like a 90% chance of having just as good of hair in 10 years of taking finasteride as they did in the beginning. That is fairly long term IMO.

image

This is true from almost all drugs that haven’t been around for 50 years. It’s definitely true for TRT.

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Problem is the “official” studies and data we have is also not high quality evidence.

We actually don’t have any high quality studies. And really seems you people don’t read my posts or just skim over them, already adressed this. A meta anlysis of all the data has been done, I’ll repost it again:

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.

CONCLUSIONS AND RELEVANCE:

Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

We definitely need better, long term studies.

Btw I think “PFS” is closely related to some form of hypogonadism. Many other syndroms are also closely related looking at what symptoms people experience like PSSD (post ssri syndrome, this is officialy medically recognized in europe), PAS (post accutane syndrome),… It seems many medication can cause this chronic androgenic disruption…

Anyway, this thread was made foremost to talk about ways to recover from PFS. I’m more interested in what you guys have to say about that and what you suggest.

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When a scientist runs an organization, and that organization’s sole purpose is to spread information about the dangers of Finasteride, I know enough to understand any scientific articles generated by that scientist, about this subject - are not objective.

I’m not sure how one could qualify a study completed by individuals with conflicts of interest as “good”.

If you read up in this thread, I don’t think PFS is something made up - but I do think that the more people who know about PFS, the more people will claim to have it via nocebo effect. I said it before but I’ll say it again: I’m only calling out your sources and their bias. A PhD does not a smart person make.

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Okay so you stick with your logical fallacy instead of providing any real arguments. And you would have a point if it was only one scientist but I posted multiple studies and doctors talking about the dangers of finasteride and the reality of PFS. (and I can post a ton more from various other respected sources btw but I have a feeling you already made up your mind anyway…)

Lol real nocebo is very rare, imagine anyone experiencing nocebo effects from just reading about possible side effects…