Is Post Finasteride Syndrome Real?

The research community is still uncertain about whether Finasteride side effects can persist long after treatment has been stopped

What is Finasteride?

Finasteride is a prescription drug that is used as a remedy for male pattern balding (androgenic alopecia). It not only stops hair loss but it can even help start new hair growth. It’s best known under the trade name Propecia, but today it’s also available as generic prescription medication. Millions of men have used finasteride for hair loss prevention over the recent two decades, given that pattern baldness is a very common inherited condition that occurs in about 80% of white males and in 50% of men of other ethnicities.

Finasteride is typically used a long-term cure for many years, with a daily oral dose of 1mg, and it takes several months of treatment before the first positive effects become apparent.

Finasteride also is used as a drug against enlarged prostate as well as for prostate cancer prevention. Other uses of finasteride are the treatment of excessive hair growth in women and hormone replacement therapy.

Once you go off the drug is there a post-finasteride syndrome?

When you stop taking finasteride, the medication’s concentration in the body will gradually come down to zero within a few days. The chemical effect finasteride had on DHT production (which is the substance that damages hair follicles and causes hair loss) will wear off and within a couple of months hair loss will resume at about the rate it had before you started taking finasteride.
Some men claim that even as finasteride leaves the body, there are long-term side effects that can linger on for many years — some even claim that they last for life. This problem is called the “post-finasteride syndrome” and the alleged symptoms cited by men who think they suffer from the condition can include:

  • Reduced libido
  • Erectile difficulties and lower semen production
  • Chronic fatigue
  • Muscle aches and cramps
  • Peyronie’s disease
  • Enlarged breast tissue
  • Dry skin
  • Skin rashes
  • Anxiety and depression 
  • Increased body fat and weight gain
  • Insomnia
  • Memory impairment

As you can see, it’s a very comprehensive list of often complex ailments that normally would have more than one specific cause. The research community hasn’t yet reached a conclusion as to whether any of these conditions can be blamed on finasteride, because the drug usually is well tolerated by tens of millions of men and, perhaps more importantly, there isn’t a lot of long-term research on what happens to men after they’ve stopped using finasteride for, say, three or five years.  

A big study by the American National Cancer Institute (NCI) surveyed 19,000 men who took finasteride daily for seven years and the study didn’t find an unusual frequency or severity of side effects. But there aren’t any similar large long-term studies on men who discontinued finasteride. On the other hand, a 2017 meta-review concluded that previous studies on post-finasteride syndrome tended to be of poor quality and often didn’t feature control groups. The few high quality studies there are didn’t find strong evidence for post-finasteride syndrome. 

It’s also difficult to separate the effect of finasteride from other factors, such as for example the process of aging. Men’s sexual abilities typically peak around age 40, which is also the time when male pattern hair loss typically gets started to thin your hairline. Let’s say a man starts taking finasteride at 40 and continues until he’s 50. Regardless of what the effect of finasteride may be, during these ten years and in the decades to follow most men will see a natural decrease in sexual appetite and many start noticing erectile issues. 

It’s almost impossible to clearly figure out how much finasteride contributed to lower sexual abilities and how much is just the effect of aging. This is not intended to discredit the men who claim the syndrome is a real thing, but it shows how uncertain the evidence base is and explains why the scientific community still isn’t clear on the subject.

To be sure though, finasteride can have side effects while you take the drug and it’s important that you are aware of those. So, before you decide to start a finasteride treatment, discuss possible side effects with your doctor. Here’s a list of the most common side effects: 

  • Skin rashes & tingling sensation
  • Swollen face & limbs
  • Weight gain or weight loss
  • Tender breast tissue
  • Stomach aches

There also are more serious but rare side effects that require medical help. If you notice any of the below while taking finasteride, it’s best to see a doctor. 

  • Impotence & erection problems
  • Ejaculation disorder
  • Lower sexual appetite
  • Reduced sperm count

Regarding all the above-mentioned side effects, it’s been observed in clinical trials that if any of these side effects occur, they normally are most intense during the early phase of treatment. They then tend to improve within a couple of months. Moreover, if side effects perhaps throughout the entire treatment period, in most cases they still tend to disappear three to four months after finasteride use is stopped.

If you have been a long-term user of finasteride and have been off it for 3-4 months now but still experience any of the above-described symptoms, it’s important that you see a doctor. Whether it’s post-finasteride syndrome or not, your symptoms need to be treated.   

References:

Fertig, Raymond, et al. “Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome.” Skin Appendage Disorders, vol. 2, no. 3–4, 2016, pp. 120–129, www.ncbi.nlm.nih.gov/pmc/articles/PMC5264352/, 10.1159/000450617. Accessed 28 Jan. 2020.

Finasteride Male Pattern Hair Loss Study Group. “Long-Term (5-Year) Multinational Experience with Finasteride 1 Mg in the Treatment of Men with Androgenetic Alopecia.” European Journal of Dermatology?: EJD, vol. 12, no. 1, 2002, pp. 38–49, www.ncbi.nlm.nih.gov/pubmed/11809594. Accessed 28 Jan. 2020. 

Trueb, RalphMichel, et al. “A Comment on the Post-Finasteride Syndrome.” International Journal of Trichology, vol. 10, no. 6, 2018, p. 255, www.ncbi.nlm.nih.gov/pmc/articles/PMC6369643/, 10.4103/ijt.ijt_61_18. Accessed 228 Jan. 2020.

Adil, Areej, and Marshall Godwin. “The Effectiveness of Treatments for Androgenetic Alopecia: A Systematic Review and Meta-Analysis.” Journal of the American Academy of Dermatology, vol. 77, no. 1, 2017, pp. 136-141.e5, www.ncbi.nlm.nih.gov/pubmed/28396101, 10.1016/j.jaad.2017.02.054. Accessed 28 Jan. 2020.


 

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