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Current Sexual Health Reports

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01-09-2018 | Male Sexual Dysfunction and Disorders (AW Pastuszak and NK Gupta, Section Editors)

Post-finasteride Syndrome: A Review of Current Literature

Authors: Jeffrey K. Than, Katherine Rodriguez, Mohit Khera

Published in: Current Sexual Health Reports | Issue 3/2018

Abstract

Purpose of Review

A constellation of persistent adverse effects—collectively termed post-finasteride syndrome (PFS)—after 5α-reductase inhibitor treatment for benign prostatic hyperplasia (BPH) and androgenic alopecia (AGA) has recently been described. The severity of these sexual, physical, neurological, and psychiatric side effects raises important concerns regarding the treatment of these conditions, especially given the prevalence of indications for these medications. Here we review the literature exploring the symptoms, proposed mechanisms, and potential disease modulating factors for PFS.

Recent Findings

While the persistent sexual side effects associated with PFS are well documented, research on the physical, neurological, and psychiatric adverse effects is much less ubiquitous. Though the mechanisms leading to PFS have been proposed, a clear treatment plan for these patients has not been established. In the treatment of BPH and AGA with 5α-reductase inhibitors, the risks of PFS should be considered.

Summary

The occurrence of persistent adverse sexual, physical, neurological, and psychiatric side effects after 5α-reductase inhibitor is well supported by the existing data. While additional studies are needed to better evaluate the role of 5α-reductase inhibitors in the manifestation of the symptoms of PFS, the risks of PFS should be critically evaluated when treating patients with BPH or AGA.

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11.••

Basaria S, Jasuja R, Huang G, Wharton W, Pan H, Pencina K, et al. Characteristics of men who report persistent sexual symptoms after finasteride use for hair loss. J Clin Endocrinol Metab. 2016;101(12):4669–80. https://doi.org/10.1210/jc.2016-2726. This study compares PFS patient body composition, fMRI responses, sexual function, mood, cognition, and hormonal levels to those of asymptomatic finasteride users and healthy controls to investigate the pathophysiologic mechanism of PFS CrossRefPubMedPubMedCentral

12.•

Liu L, Zhao S, Li F, Li E, Kang R, Luo L, et al. Effect of 5alpha-reductase inhibitors on sexual function: a meta-analysis and systematic review of randomized controlled trials. J Sex Med. 2016;13(9):1297–310. https://doi.org/10.1016/j.jsxm.2016.07.006. This comprehensive meta-analysis examines changes in sexual function in BPH and AGA patients using 5α-reductase inhibitors CrossRefPubMed

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Kaplan SA, Chung DE, Lee RK, Scofield S, Te AE. A 5-year retrospective analysis of 5alpha-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride. Int J Clin Pract. 2012;66(11):1052–5. https://doi.org/10.1111/j.1742-1241.2012.03010.x.CrossRefPubMed

16.•

Mervis JS, Borda LJ, Miteva M. “Post-finasteride syndrome”: what to tell our female patients? Br J Dermatol. 2018; https://doi.org/10.1111/bjd.16658. This meta-analysis investigates the sexual side effects in female patients using 5α-reductase inhibitors off-label for hair loss

17.

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Traish AM, Haider KS, Doros G, Haider A. Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia. Horm Mol Biol Clin Invest. 2015;23(3):85–96. https://doi.org/10.1515/hmbci-2015-0015. CrossRef

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21.•

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27.

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28.•

Ganzer CA, Jacobs AR. Emotional consequences of finasteride: fool's gold. Am J Mens Health. 2018;12(1):90–5. https://doi.org/10.1177/1557988316631624. This study examines the psychiatric and family history of PFS patients to determine the effect of pre-treatment factors on the course of PFS CrossRefPubMed

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Title: Post-finasteride Syndrome: A Review of Current Literature
Authors: Jeffrey K. Than
Katherine Rodriguez
Mohit Khera
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Sexual Health Reports / Issue 3/2018
Print ISSN: 1548-3584
Electronic ISSN: 1548-3592
DOI: https://doi.org/10.1007/s11930-018-0163-4

At a glance: The STEP trials

Springer Medicine

Post-finasteride Syndrome: A Review of Current Literature

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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