The post-finasteride syndrome (PFS) is a symptom complex that is based on the side effects of the drug finasteride. These are persistent neurological, sexual, and physical side effects. Even after stopping the drug, the symptoms sometimes persist for a long time.
What is post-finasteride syndrome?
Post-finasteride syndrome is a physician, media and patient-defined term for side effects of the drug finasteride. Finasteride is a so-called 5-alpha reductase inhibitor, which is used to treat hair loss or benign enlargement of the prostate (BPH). It prevents the conversion of testosterone into the much more potent dihydrotestosterone (DHT). See howsmb for Hyperesthesia Definition and Meaning.
The symptoms of the post-finasteride syndrome occur rarely, although the frequency is not yet clear. It is believed that the number of people suffering from this syndrome has a high number of unreported cases. This could be due to the different severity of the individual symptoms. The effect of finasteride is based on the fact that the effect of the male sex hormone is reduced.
Thus, the typical symptoms of an androgen deficiency can also occur as side effects. It is not known why the symptoms sometimes persist even after the drug has been discontinued. Post-finasteride syndrome was listed in the US National Institutes of Health’s Information Center for Genetic and Rare Disorders in 2015.
The cause of post-finasteride syndrome is the use of the drug finasteride. This drug develops side effects that, in some cases, persist even after its discontinuation. Finasteride is a 5-alpha reductase inhibitor. Steroid 5-alpha reductase is a complex of three isoenzymes responsible for converting testosterone to dihydrotestosterone. Dihydrotestosterone (DHT) is responsible for the actual effects of testosterone.
If this metabolite is missing, symptoms similar to those of testosterone deficiency occur. Similar to testosterone, DHT binds to an androgen receptor in the target cell. This androgen-receptor complex, in turn, binds to specific hormone response elements (HRE) of the DNA, controlling the activity of androgen-regulated genes in the promoter region. This is true for both testosterone and DHT.
However, both hormones produce different effects. While testosterone is involved in the differentiation of the Wolffian ducts, DHT ensures the external masculinization and growth of the prostate. With a corresponding genetic predisposition, DHT can destroy the hair roots, resulting in hair loss.
So, the drug finasteride works by inhibiting the conversion of testosterone to DHT. It stops prostate growth and prevents hair loss in men. Since DHT is more effective than testosterone, the typical symptoms of an androgen deficiency appear as side effects.
Symptoms, Ailments & Signs
Post-finasteride syndrome is characterized by impotence, low libido, decreased response to sexual stimuli, erection problems, poor orgasm, penile shrinkage, penile curvature and penile numbness. The testicles can also shrink.
Sometimes testicular pain also occurs. Gynecomastia (breast enlargement in men) is also common. In addition to these symptoms, the sufferer suffers from chronic fatigue, poor performance, muscle weakness, dry skin, slowed thought processes, depression, anxiety or sleep disorders. Headaches, heavy sweating and chest pains are also part of the symptom complex.
These symptoms may persist even after stopping the drug. In some cases they are permanent. However, it must be said that according to current knowledge, these side effects rarely occur, although there can be a significant number of unreported cases.
It is not known why the symptoms persist in some cases even after finasteride has been discontinued, especially since the hormone levels return to normal. It is assumed that in these cases there is a defect in the androgen receptors.
Diagnosis & course of disease
Post-finasteride syndrome is easy to diagnose. If these symptoms occur during treatment with finasteride and its discontinuation, post-finasteride syndrome can always be assumed.
As a rule, this syndrome itself is already a complication. Those affected suffer primarily from impotence and also from a significantly reduced libido. This can lead to tensions with the partner and a lack of sexual desire. Men suffer above all from a weak orgasm and also from a feeling of numbness in the penis itself.
Furthermore, there is pain in the testicles and also fatigue and exhaustion. Patients also suffer from many psychological disorders and depression. It can also lead to anxiety or insomnia. Patients often withdraw and are ashamed of these complaints. There is usually no improvement until the drug is stopped.
As a rule, with this syndrome, the drug must be discontinued and replaced by another. Complications do not arise and there are no further complaints. The life expectancy of those affected is also not reduced with this disease. The symptoms also usually disappear relatively quickly after stopping the medication.
When should you go to the doctor?
If any unusual symptoms occur after taking the hair restorer finasteride, the doctor should be consulted. If, for example, sexual or neurological problems occur, the urologist or the doctor responsible should be consulted. People who have been taking the drug for a long time should inform the doctor who prescribed the drug about the unusual symptoms and signs. In addition to the family doctor, you can also go to a urologist with the symptoms. Depending on the symptoms, neurologists and therapists can also be involved in the treatment. Under certain circumstances, a complete discontinuation of the preparation is necessary.
Since this is often associated with other side effects and the symptoms of post-finasteride syndrome can persist for months or years, it is important to see a doctor at an early stage. People who suffer from hormonal problems and, for example, have low estrogen levels are particularly at risk of developing post-finasteride syndrome. Other contacts are the sex therapist or a psychotherapist, always depending on the type and severity of the symptoms.
Treatment & Therapy
So far there is no effective therapy for post-finasteride syndrome. Many attempts at substitution with androgens were doomed to failure. Only some of the patients respond to this treatment. In other cases there is no reaction to the administration of androgen derivatives.
When measuring the hormone levels of these patients, it was noticed that the hormone levels had returned to normal, but the symptoms persisted. The reason for this is not yet clear. There could be defects in the androgen receptors. Testosterone and DHT cannot unfold their effect in this way.
However, why the receptors only show disturbances after treatment with finasteride has ended requires further research. Due to the increasingly well-known side effects of finasteride, there is a growing number of lawsuits against the manufacturer by those affected. Furthermore, many of those affected draw attention to the post-finasteride syndrome through spectacular actions such as a hunger strike in front of the company building of the pharmaceutical company.
Due to growing public interest, the PFS Foundation was established in 2012. The PFS Foundation has set itself the goal of further educating physicians, scientists and health organizations about the existence of the post-finasteride syndrome.
The aim is to draw attention to the need for basic research and the search for therapeutic approaches in this area. It is also not yet clear whether the post-finasteride syndrome is really very rare or whether it is a general problem in the treatment with finasteride.
The best way to prevent post-finasteride syndrome is to stop using finasteride.
Patients suffering from the post-finasterid syndrome should refrain from taking the drug finasteride according to the doctor’s recommendation. However, it makes sense to have a regular check-up with a doctor after stopping the drug in order to monitor the precise development. In addition to medical advice, those affected can also start their own individual aftercare.
This helps, for example, to resolve insomnia. Among other things, sleeping masks and earplugs help, and it also makes sense to adapt the sleeping environment to your needs. Apart from good hygiene in bed, a change in diet makes sense. Eating light meals in the evening makes it easier for those affected to fall asleep.
Social and sporting activities also counteract psychological problems and at the same time help to fall asleep. In order to avoid depressive moods associated with the syndrome, drug therapy may be worthwhile. Here it is important to strictly adhere to the recommendations of the doctor.
Alternative medicine provides effective remedies that have a calming effect. In this way, the typical signs can subside in the long term. Follow-up care also includes checking whether a secondary disease is already present. This would require separate medical treatment.
You can do that yourself
If the post-finasteride syndrome has been diagnosed, the preparation must first be discontinued in order to prevent further aggravation of the symptoms and complaints. The individual symptoms always require a medical diagnosis and can sometimes be combated independently. In the case of severe sleep disorders, measures must be taken to improve the quality of sleep. This includes wearing earplugs and a sleep mask, but also changing the bed linen regularly.
In addition, the diet should be adapted to the condition so that you can fall asleep in the evening without any problems. Sport and an active lifestyle help with severe fatigue, problems falling asleep and depressive moods. Accompanying this, drug treatment may be necessary. The doctor may be able to refer you to an alternative health practitioner who can prescribe natural tranquilizers. A balanced diet and regular exercise are often enough to combat the typical symptoms of the syndrome.
After a few weeks to months, the symptoms should have largely subsided. If the symptoms persist, medical advice is required. It is possible that another condition is the cause or secondary diseases have already developed that require separate medical treatment.