https://orcid.org/0000-0002-4395-8871
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J.S. Mervis, L.J. Borda, M. Miteva, ‘Post‐finasteride syndrome’: what to tell our female patients?, British Journal of Dermatology, Volume 179, Issue 3, 1 September 2018, Pages 785–786, https://doi.org/10.1111/bjd.16658
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Funding sources: none.
Conflicts of interest: none to declare.
Dear Editor, Postmarketing surveillance from men using finasteride, a 5‐alpha‐reductase inhibitor, for male pattern hair loss includes reports of various forms of sexual dysfunction, such as decreased libido, erectile and ejaculatory dysfunction and gynaecomastia. Purported mechanisms for these effects include the decreased production of neurosteroids, which may regulate sexual desire and function,1 and impaired testosterone metabolism, leading to relative oestrogen excess.2 Large randomized controlled trials of men on 5‐alpha‐reductase inhibitors for benign prostatic hypertrophy have shown increased sexual dysfunction compared with placebo; however, similar association with male pattern hair loss was not statistically significant.3 Sexual side‐effects have been reported by 43·6% of men informed about these potential effects vs. 15·3% in the uninformed.4 Recently, ‘post‐finasteride syndrome’ (PFS) was introduced as a collective term for not only the array of sexual side‐effects, but also depression, cognitive impairment, fatigue and suicidal ideation, among others, directly related to finasteride use that persist or commence after discontinuation of the drug. The Post‐Finasteride Syndrome Foundation was established and in 2017 the European Medical Agency recommended adding depression and suicidal ideation to the finasteride label.
