The post-finasteride syndrome: possible etiological mechanisms and symptoms.
Herman H J LeliefeldFrans M J DebruyneYakov ReismanPublished in: International journal of impotence research (2023)
Finasteride and dutasteride, synthetic 5α-reductase inhibitors (5ARIs) are recommended in many guidelines for the treatment of benign prostatic hyperplasia/lower urinary tract symptoms and alopecia despite a variety of side effects like sexual, neurological, psychiatric, endocrinological, metabolic and ophthalmological dysfunctions and the increased incidence of high grade prostate cancer. The sexual side effects are common during the use of the drug but in a small subgroup of patients, they can persist after stopping the drug. This so-called post-finasteride syndrome has serious implications for the quality of life without a clear etiology or therapy. Three types of 5α-reductases are present in many organs in- and outside the brain where they can be blocked by the two 5ARIs. There is increasing evidence that 5ARIs not only inhibit the conversion of testosterone to 5α-dihydrotestosterone (DHT) in the prostate and the scalp but also in many other tissues. The lipophilic 5ARIs can pass the blood-brain barrier and might block many other neurosteroids in the brain with changes in the neurochemistry and impaired neurogenesis. Further research and therapeutic innovations are urgently needed that might cure or relieve these side effects. More awareness is needed for physicians to outweigh these health risks against the benefits of 5ARIs.
Keyphrases
- benign prostatic hyperplasia
- lower urinary tract symptoms
- prostate cancer
- high grade
- end stage renal disease
- mental health
- cerebral ischemia
- white matter
- chronic kidney disease
- newly diagnosed
- primary care
- gene expression
- ejection fraction
- case report
- prognostic factors
- radical prostatectomy
- low grade
- peritoneal dialysis
- clinical trial
- stem cells
- randomized controlled trial
- adverse drug
- multiple sclerosis
- subarachnoid hemorrhage
- emergency department
- bone marrow
- drug induced
- mesenchymal stem cells
- smoking cessation
- sleep quality
- physical activity
- brain injury
- clinical practice