Post-Finasteride Syndrome

Simon2015

This is a peer reviewed article by Dr. Andrew Rynne on Post-Finasteride Syndrome.

I have not seen it discussed on this board before. The medical community need to be aware that Finasteride can cause permanent side effects and should not be given out likely.

http://mobile.medicalindependent.ie/page.aspx?contentid=58263

Post-finasteride syndrome is now a recognised condition, affecting as many as 20 per cent of those taking finasteride or who have ever taken this drug for whatever reason — benign prostatic hyperplasia, prostate cancer or male pattern baldness. The sexual side-effects of finasteride may be persistent or permanent.1
The persistent sexual side-effects of finasteride may manifest after varying periods of taking the drug, or not until the drug is discontinued. It is not known why some men are susceptible to the potential adverse affects of finasteride, while others — the majority — are not affected.
Persistent adverse effects of finasteride in younger men include erectile dysfunction, low libido, lack of orgasms and depression. One study has found lower levels of several neurosteroids in this population. Out of the various, persistent side-effects, erectile dysfunction and alcohol consumption issues have been the most studied in animal models. Further research is needed on who is susceptible to the persistent, adverse side-effects of finasteride and on the underlying mechanisms of the medication.2
Fourteen young men have presented with post-finasteride syndrome and in addition to the adverse events reported above, common symptoms have included:

• Nocturnal urinary frequency that does not respond to anti-spasmodic therapy.
• Penile numbness, most particularly in the area of the fraenulum.
• ‘Brain fog’ and difficulty in concentrating.
• Misshapen penis, sometimes described as Peyronie’s disease. In my view, it is more Peyronie’s-like and is probably due to the laying-down of fibrous plaques along the tunica albuginea in a disorganised fashion.
• Severe depression and despair. Research is ongoing but it would now appear that there is a significant increased risk of suicide within this population.3
• Mondor’s disease of the penis, although one cannot be sure if this is finasteride-related.
• Chronic fatigue syndrome and muscular wasting.

Biological mechanism

finasteride is a 5 alpha reductase inhibitor. It prevents the conversion of testosterone into dihydrotestosterone (DHT). Dihydrotestosterone is the active form of testosterone. Testosterone on its own is inactive. Dihydrotestosterone is found in many parts of the body, including the hair follicles, where it plays a causative role in the development of natural male pattern baldness. It is also found in many brain cells, as part of the brain chemistry playing a role in neurotransmission.
It is rare for any medication to permanently interfere with delicate brain function, such as sensitivity to pleasure or desire or thought processes. However, it now appears that finasteride may have this capacity in a subset of men. To a far lesser extent, SSRIs also have this potential, albeit in a less spectacular way.4 Interfering with brain chemistry is something not to be undertaken lightly.
Management and prevention

Unfortunately, on the question of the management or treatment of the syndrome, there is very little to reference. Research is ongoing, thanks mainly to the sterling work of the Post Finasteride Foundation, which was established in 2011.
Until the underlying biological mechanism of the syndrome is understood, it is difficult to see from where a cure will come to help the thousands of men across the world who are suffering from the issues that this disease can cause.
However, there are some ways that doctors might help patients with post-finasteride syndrome:

• A good listening ear. Acknowledge that the disease exists and that it has many and varied presentations, including symptoms like penis disfigurement, genital shrinkage and nocturnal urinary frequency.
• As best you can, try to explain our limited understanding of the syndrome. Never suggest that it is ‘psychological’ or that it is ‘all in your head’.
• Do not refer to a psychiatrist or psychotherapist, as this may be interpreted as your non-acceptance of post-finasteride syndrome as a real entity.
• Do not refer to an endocrinologist as they, of necessity, will be no wiser than you.
• Slightly raise testosterone levels and lower oestrogen levels by the judicious use of testosterone gel and tamoxifen. Here, I use an empirical approach, as I have found that hormonal assay has nothing to offer.
• Treat erectile dysfunction in the usual way, although post-finasteride syndrome erectile dysfunction is often sildenafil- and *********-resistant.

Prevention

Since the treatment of post-finasteride syndrome is all but non-existent, it therefore behoves us as doctors to concentrate on prevention.
Here, the key has to be awareness. If men were being told about the effects of finasteride, then it could be argued that very few, if any of them, would be prepared to run the risk for the sake of temporarily growing some hair on their heads. If men were told that up to 20 per cent of those who take finasteride develop sexual side-effects and that these side-effects may be life-long after discontinuing the drug, then that information alone could stop this condition in its tracks.
At the beginning of this article, post-finasteride syndrome was described as ‘iatrogenic’, or doctor-made, and there is a strong argument to support this.
It can be argued that if it were not for doctors prescribing finasteride for natural male pattern baldness, then there would be no post-finasteride syndrome in young men.
We might still find it in older men being treated with finasteride, but at least fit, healthy young men would be spared the devastation that this condition can beget.
It is true that many young men, desperate to find a solution for their natural balding, are going online and purchasing it from online pharmacies. Thus, you might say, at least in these cases, doctors are exonerated. But that is not quite true. All legal online pharmacies are doctor-dependent and have registered medical practitioners in the background, approving prescriptions for whatever it is the client thinks they need.
In these cases, of course the chances of the client being properly warned of the dangers of finasteride are much reduced, since there is little, if any, interface between doctor and patient with online pharmacies.
At the end of the day, it is up to all medical professionals — including doctors, pharmaceutical manufacturers, governments and regulatory authorities — to prevent post-finasteride syndrome by the simple expedient of making it unavailable.
We need to do this urgently because a cure for this disease may still be a very long way off.

1. Irwig MD et al. Journal of Sexual Medicine. Vol. 9 Issue 11. Pg 2927-2932.
2. Irwig MD. Sex Med Rev 2014: 24-35.
3. Clinical Study of Post-finasteride Syndrome Launched at University of Milano-Bicocca and University of Milano Research Aims to Determine why PFS Patients Develop Neurological and Psychological Dysfunction. JSM Vol. 2 issue 4. February 18, 2014.
4. Journal of Clinical Psychiatry, Vol 59 (Suppl 4), 1998, 48-54.

Research

To help keep yourself updated on developments in research of Post-finasteride syndrome, please see www.pfsfoundation.org.


Case study

Damian is a 29-year-old, single software engineer. He is a non-smoker and light weekend drinker. He takes regular exercise, eats sensibly, looks after his health and is in good physical shape. Three years ago he was prescribed finasteride for his male pattern baldness. He took this drug from May 2009 until September 2011.
While taking it, he noticed no ill effects and it seemed to work very well for him in halting the progress of his balding and even starting the growth of new hair. He was on no other medication.
Having been on the medication for two years and four months, Damian decided he would like to give himself a break and stopped the drug abruptly in September 2011. Within a week of his stopping Proscar, he began to notice some significant symptoms. In the main, these were:

• Difficulty in achieving or sustaining an erection.
• Loss of interest in sexual matters — loss of libido.
• Nocturnal urinary frequency causing sleep deprivation.
• Penile numbness, particularly in an area behind the fraenulum.
• Total loss of sensation during ejaculation — sexual anhedonia.

At first, Damian did not make any connection between these symptoms and his having previously taken finasteride. He had been advised about possible sexual side-effects experienced by less than 1 per cent of men while taking the drug and that these symptoms disappeared on discontinuing it. Nobody, however, had mentioned to him of the possibility of side-effects appearing only after discontinuing this hair-loss medication. Indeed, such a concept ran contrary to most people’s notion of drugs’ side-effects.
It was only after exhaustive online research and on finding a website dedicated to post-finasteride syndrome that it began to dawn on Damian that this was indeed what he had.
During this research, my name came up as someone who might know something about his condition and that is why he contacted and consulted with me.

Definition of post-finasteride syndrome

Post-finasteride syndrome can be defined as: “An iatrogenic disease of brain chemistry brought about by an esoteric response to the 5 alpha reductase inhibitor finasteride and characterised by one or many persistent or permanent sexual, physical and intellectual dysfunctions.”

Simon2015

Compare what Dr Maurice Collins of HRBR has to say about Finasteride side effects to what Dr Andrew Rynne has to say.

Here Dr Rynne calls Finasteride a "dangerous toxic medication".

Both Doctors can't be right ?

his_dudeness

Simon2015 wrote: »

This is a peer reviewed article by Dr. Andrew Rynne on Post-Finasteride Syndrome.

I have not seen it discussed on this board before. The medical community need to be aware that Finasteride can cause permanent side effects and should not be given out likely.

This isn't peer reviewed. It's been submitted to the Medical Independent, which is not a peer reviewed journal
;
These are peer reviewed articles on the topic:
http://www.ncbi.nlm.nih.gov/pubmed/24928450
http://www.ncbi.nlm.nih.gov/pubmed/24717976

and combined only have the opinions of 200 out of te millions of men who have been prescribed finasteride and can only come up with a "possibility" that such a condition exists

Vorsprung

Agree, no-one could reasonably call the Mindo a peer reviewed journal. Strikes me as a bit of a marketing/self promotion piece to be honest. Side effects listed as part of this post-finasteride syndrome are listed in the SPC as recognised side effects. Don't have much experience with the conditions the medication is aimed at treating, but my natural cycnism leads me to conclude that there's a market in it, or it's a great under-recognised iatrogenic condition.

echo beach

Simon2015 wrote: »

Compare what Dr Maurice Collins of HRBR has to say about Finasteride side effects to what Dr Andrew Rynne has to say.

Both Doctors can't be right ?

No, but they can both be wrong. When two people give extreme positions, 'perfectly safe' versus 'extremely dangerous,' then the truth is likely to lie somewhere in between. The question is where?
Finasteride isn't licensed for hair loss in Ireland and there is no evidence that it is being prescribed very much for that indication. The side-effects are known and listed in the Product Information Leaflet and it is up to the patient to decide for themselves if they are willing to risk them. To say, 'you must not take it because I don't think hair loss is something you should worry about' sounds very close to making a decision for somebody else.

Simon2015

echo beach wrote: »

No, but they can both be wrong. When two people give extreme positions, 'perfectly safe' versus 'extremely dangerous,' then the truth is likely to lie somewhere in between. The question is where?

I'd believe the Doctor who has no vested interest in prescribing the drug before I'd believe the Doctor whos business model depends on prescribing the drug to keep his hair loss clinic open.

Dr Andrew Rynne refuses point blank to precribe Finasteride for any reason.

He's practically critical of Doctors who precribe it for hair loss.

Here Dr Rynne calls these Doctors "unethical" for prescribing Finasteride for hair loss.

Skip to 10:34

his_dudeness

Simon2015 wrote: »

I'd believe the Doctor who has no vested interest in prescribing the drug before I'd believe the Doctor whos business model depends on prescribing the drug to keep his hair loss clinic open.

Dr Andrew Rynne refuses point blank to precribe Finasteride for any reason.

He's practically critical of Doctors who precribe it for hair loss.

Here Dr Rynne calls these Doctors "unethical" for prescribing Finasteride for hair loss.

Skip to 10:34

As a doctor who made his living out of mens libido (Dr Rynne has one of the highest case series of vasectomies in Ireland), I'd say he does have a vested interest in men taking drugs that reduce that libido.

Simon2015

his_dudeness wrote: »

As a doctor who made his living out of mens libido (Dr Rynne has one of the highest case series of vasectomies in Ireland), I'd say he does have a vested interest in men taking drugs that reduce that libido.

Its not really a vaild comparison because Dr Rynne has admitted that he has "no treatment" for Post Finasteride Syndronme, so he does not stand to gain financially by speaking out against the use of Finasteride.

his_dudeness

Simon2015 wrote: »

Its not really a vaild comparison because Dr Rynne has admitted that he has "no treatment" for Post Finasteride Syndronme, so he does not stand to gain financially by speaking out against the use of Finasteride.

He may have no treatment, but he loses potential vasectomy customers if men are suffering from impotence and reduced libido from finasteride.

(Admittedly, I'm making an assumption that these men would be less interested in sex and therefore less interested in having a contraceptive procedure done.)

On a side note, does anyone know the rationale for using finasteride for male pattern baldness? I don't fully understand the mechanism.

RoMiLe

his_dudeness wrote: »

On a side note, does anyone know the rationale for using finasteride for male pattern baldness? I don't fully understand the mechanism.

It drastically reduces the amount of DHT (dihydrotestosterone, which is converted from testosterone) in the body. DHT is the hormone that slowly destroys the hair follicles in men that are prone to male pattern baldness.

The problem is this: DHT is one of the most potent male androgens, and inhibiting it is potentially very dangerous. It plays a role in all sexual and secondary sex characteristics (one of which being facial hair growth).

The mechanism by which T is converted to DHT is through an enzyme called 5AR (5 alpha reductase). Finasteride prevents 5AR from working fully, which prevents T conversion. Also, I'm pretty sure 5AR has a few other important roles when it comes to hormones and so forth, but I personally don't even know in-depth how it all works.

An individual who's considering finasteride should know that he's taking a big gamble messing with his hormones just to keep his hair. I personally would not recommend the drug.

Simon2015

A recent study confirms that Finasteride increases the risk of suicide.

http://www.pfsfoundation.org/news/suicidal-ideaton-associated-with-finasteride-use-in-young-men-says-new-study-in-leading-pharmacology-journal/

SOMERSET, N.J., July 23, 2015 – New research in a leading pharmacology journal concludes that young men who take finasteride for hair loss may be at risk of contemplating suicide.
The study, published in the July issue of Pharmacotherapy and titled “Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride,” analyzed 4,910 adverse-event reports involving low-dose finasteride use among men 18 to 45 years old that were submitted to the U.S. Food and Drug Administration between 1998 and 2013.
Researchers found that 11.8% of those reports (577 cases) involved persistent sexual dysfunction (SD) and 7.9% (39 cases) involved suicidal ideation (SI).
“Approximately 60% of the SD events were serious in nature, corresponding to disability (43.5%), required intervention (18.3%), hospitalization (9.9%), life-threatening events (5.5%), and patient death (1.7%),” they report. “Among men who experienced SD and SI, 88% of the SI events were serious (disability [36.7%], hospitalization [20%], life-threatening events [16.7%], and required intervention [13.3%]).”
“Persistent [sexual dysfunction] might be a potential risk of low-dose finasteride for androgenic alopecia therapy in young men, and this risk might contribute to [suicidal ideation],” concludes the study’s lead author, Ayad Ali, a pharmacoepidemiologist in the Global Patient Safety division of Eli Lilly and Company.
“Our findings provide a strong hypothesis for pharmacoepidemiologic studies to further examine this association.”
“This study is further evidence that finasteride most likely plays a role in not only devastating sexual health in a subset of otherwise healthy men, but in some cases leads to suicide,” added PFS Foundation CEO Dr. John Santmann. “It’s critical that health care professionals be aware of the numerous risks when considering finasteride therapy for patients.”
PFS has been reported to occur in men who have taken the prescription drug finasteride to treat hair loss (under the brand name Propecia and generics), or enlarged prostates (Proscar and generics).
Reported symptoms include loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronie’s disease, penile shrinkage, gynecomastia, muscle atrophy, cognitive impairment, insomnia, severely dry skin, and tinnitus. The condition often has a life-altering impact on victims and their families, such as job loss and the breakup of marriages and romantic relationships.
In March 2015, the U.S. National Institutes of Health recognized PFS, adding the condition to its Genetic and Rare Diseases Information Center.
Three months later, a study published in the Journal of the American Medical Association (JAMA), found that, of the 34 clinical trials conducted on finasteride, none adequately reported on sexual side effects.
“People who take or prescribe the drug assume it’s safe, but there is insufficient information to make that judgment,” said the study’s lead author, Steven Belknap, of the Northwestern University Feinberg School of Medicine.
Also in June, a study published in Hormone Molecular Biology and Clinical Investigation showed that finasteride increases the severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia.
“Our findings suggest that finasteride therapy is associated with undesirable and, in some cases, detrimental sexual side effects and reduced quality of life,” said the study’s lead investigator, Abdulmaged M. Traish, professor of urology at Boston University School of Medicine.

his_dudeness

Before you jump the gun, this is from the long form of the paper

Limitations
There are some limitations that merit consideration when interpreting the results. First of all, no causal association can be inferred from these analyses, and the EBGM values are reporting ratios and should not be interpreted as incidence rates or risk ratios since they do not quantify the extent of SD or SI risks. Reporting ratios provide a perspective on adverse event reporting behavior during a time period, which could be due to other artifacts, such as confounding and reporting bias. Especially, voluntary reporting of events could have skewed the reporting frequencies of SD and SI events in the database. Therefore, they should not be viewed in a pharmacology and epidemiology vacuum. Signal detection findings should be interpreted within the context of all other relevant sources of information, including pharmacologic class safety profile, pathophysiology of the event and indication for biological plausibility assessment, and event risk factors

RoMiLe

modsnip. Please read charter- this is a science forum and we ask for peer -reviewed scientific studies only. Blogs don't count.

steddyeddy

From a biochemical point of view it would make no sense that inhibiting DHT synthesis would not have some profound side effects.

arynne

If you had listened as I have listened to dozens of young men explain their post-finasteride symptoms to me, then you too would have been as moved as I was and still am. As each story unfolds you begin to see a pattern emerge. Soon you realize that post-finasteride syndrome has to be a real entity. It can be nothing else. These men are devastated. And it was this sharing of their devastation and feelings of hopelessness that compelled me to speak out against the prescribing of finasteride as a treatment for male pattern balding.

Sorry cynics. It is just that simple -- I have no ulterior motivation, none whatsoever.

Simon2015

New Zealand's Medicine Safety Authority now recognise Post-Finasteride Syndrome. Dr. Andrew Rynne was years ahead of his time when he pointed out how dangerous Finasteride was.

http://medsafe.govt.nz/profs/PUArticles/March2016/PostFinasterideSyndrome.htm

Key Messages

• Post-Finasteride Syndrome is a recently recognised condition that occurs in some men who have taken finasteride.
• Symptoms (sexual, physical, and mental and neurological) often persist after the patient has stopped taking finasteride.
• Patients should be informed of the risks of taking finasteride prior to treatment initiation.
• The symptoms associated with Post-Finasteride Syndrome should be discussed with patients prior to treatment.

Post-Finasteride Syndrome (PFS) is a recently recognised condition that can occur in patients who have taken finasteride1. Finasteride is a 5-alpha reductase type II enzyme inhibitor used to treat hair loss (eg, Propecia, Profal and ReGen) or enlarged prostate (eg, Proscar, Finasteride Rex and Fintral). PFS includes sexual, physical, and mental and neurological symptoms in patients who have taken finasteride (Table 1). Symptoms often persist after the patient has stopped taking finasteride.
Table 1: Reported symptoms of Post-Finasteride Syndrome1
Sexual Symptoms Physical Symptoms Mental and Neurological Symptoms Decreased or complete loss of sex drive Female-like breast development and enlargement Severe memory/recall impairment Erectile dysfunction, impotence Chronic fatigue, listlessness Slowed thought processes Loss of morning and spontaneous erections Muscle atrophy, weakness Impaired problem solving, decreased comprehension Sexual anhedonia, loss of pleasurable orgasm Decreased oil and sebum production Depression Decreased semen volume and force Chronically dry, thinning of skin Anxiety Penile shrinkage and numbness Melasma Suicidal ideation Peyronie’s disease Tinnitus Emotional flatness and anhedonia Scrotal shrinkage and numbness Increased fat deposition, obesity and elevated body mass index Insomnia Decrease in body temperature Reduced HDL cholesterol, raised fasting glucose and triglycerides Attempted suicide Completed suicide
Importantly, some patients can experience suicidal ideation and depression after stopping finasteride treatment. Patients and their families should be advised about these symptoms and to seek medical advice as soon as possible if they occur.
Unfortunately, PFS is a condition with no known cure and few, if any, effective treatments.
Further information about PFS can be found on the Post-Finasteride Syndrome Foundation website (www.pfsfoundation.org/).
To date, the Centre for Adverse Reactions Monitoring (CARM) has received 10 reports associating finasteride use with at least one of the symptoms of PFS listed in Table 1. Age, when reported, ranged from 22 to 81 years of age. Only three patients reported that they had recovered at the time of the report.
Please report any adverse events, including those associated with PFS, to CARM (https://nzphvc.otago.ac.nz/).
References

1. Post-Finasteride Syndrome Foundation. 2015. Global Public Health Advisory – US National Institutes of Health Recognises Post-Finasteride Syndrome. URL: us5.campaign-archive2.com/?u=644fb8b633594fee188a85091&id=9cea0753a4&e=5459eb9419 (accessed 6 October 2015).

wadacrack

I am suffereing from this . Im 3 months post op..

Dont ever take this medication for hair loss . The risks are too great! Now im in for a battle but trying my best to get better!!

Patient11

wadacrack wrote: »

I am suffereing from this . Im 3 months post op..

Dont ever take this medication for hair loss . The risks are too great! Now im in for a battle but trying my best to get better!!

Hi wadacrack did you notice any improvement in your condition ?

wadacrack

Patient11 wrote: »

Hi wadacrack did you notice any improvement in your condition ?

Yes I have improved a bit. Slowly getting better but have a long way to go

Patient11

wadacrack wrote: »

Yes I have improved a bit. Slowly getting better but have a long way to go

This Finasteride poison should be pulled off the market.

You should look at making a complaint against the Doctor who put you on the drug. Finasteride is not even licensed for the treatment of hair loss in Ireland.

‘We Wouldn’t Recommend that Any Man Take’ Finasteride, says Urologist at University Hospital Zurich

http://www.pfsfoundation.org/news/wouldnt-recommend-man-take-finasteride-urologist-university-hospital-zurich-tells-swiss-tv-news-magazine/