Originally published 8/30/2018
At the time we posted this blog in 2018, the term post-finasteride syndrome was still relatively new. Since then, more research has been added to the understanding of finasteride’s impact on a man’s overall health, well-being and quality of life.
Here are noteworthy updates that identify new side effects:
- Borgo, et al (2020) found biological evidence that the use of finasteride alters gut bacteria. They found that both the structure and composition of specific bacteria had been modified. Knowing what we now know about the relationship between the gut microbiome and total wellness, there’s a positive note to this study, which is the first of its kind. The authors note that “…these results suggest that gut microbiota composition might represent a diagnostic marker and a possible target for a therapeutic strategy aimed to counteract the important symptomatology occurring in these patients.”[i] In other words, strengthening the gut environment might mean fewer negative effects of finasteride.
- Finasteride use has been linked with increased incidence of insomnia. Gupta, et al (2020) demonstrated a specific relationship between the overlapping symptoms of post-finasteride syndrome and those of obstructive sleep apnea (OSA). They write, “A significant disproportionality reporting of OSA with the use of finasteride was observed. Finasteride use may be associated with a potential safety signal for OSA.”[ii]
- And now for something really different, True et al. (2019) posit a theory that post-finasteride syndrome may exist in some individuals as a delusional result of mass suggestion. In effect, they hint that perhaps there really isn’t a physical syndrome, but rather what is called a nocebo effect. That’s a phenomenon that occurs as a result of negative thinking or expectations. As an example, if a doctor says taking a certain drug may cause heart palpitations, a person may start looking for such a symptom, and therefore it shows up even if it’s not the drug that’s causing it. The authors note, “As yet, the condition is not recognized by the medical community, although individuals who suffer from PFS present with relatively homogenous symptoms.”[iii]
Despite the interesting hypothesis of the Trüeb paper, we believe that post-finasteride syndrome indeed exists and represents an alteration in a man’s biology. We invite you to read the original blog to learn more.
When you were a teenager, did your mom or dad warn you about the dangers of smoking cigarettes—but you went ahead and tried it anyway? According to estimates, about 20% of people go on to become adult smokers; in 2016 the CDC reported that 15.5% of adults were smokers, down from 20.9% in 2005. Well, by now we all know that smoking cigarettes is the number one source of preventable death and disease, so it’s pretty hard to deny that the potential consequence are harsh.
Warnings about a common medication for BPH and balding
Very few people welcome aging and its effects. For men, two conditions can trouble the body and bruise the ego. The first, benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that can lead to urinary problems: more frequent urination, getting up at night, difficulty starting urination, etc. The second, male pattern baldness, can occur due to gradual hormonal loss plus genetic factors; balding can impact a man’s self-image and his social activities if he feels less attractive or manly.
A medication called Finasteride is prescribed for both conditions, though the dosage may differ. Finasteride is a class of drug called a 5-alpha reductase type II enzyme inhibitor. This basically means that without diminishing testosterone (male hormone) production, it blocks testosterone from interacting biochemically with cells. When it’s used to treat BPH, the trade name is Proscar. For balding, it’s called Propecia.
Finasteride has been around for over two decades. Proscar was approved for BPH treatment in 1992, and Propecia for baldness in 1997. However, in 2012 the FDA introduced warning labels for both preparations. According to a CBS News story,
Propecia labels will now include warnings for libido disorders, ejaculation disorders, and orgasm disorders that continued for men even months after stopping the drug, the FDA says. Proscar’s label will include a “decreased libido” warning that continues after drug discontinuation. Both drugs’ labels will also include a new description of reported cases of male infertility and poor semen quality that improved after patients stopped taking the drug.[iv]
However, that was just the tip of the iceberg. Here it is, six years later, and the list of possible side effects has been expanded to include not just sexual problems, but also physical and psychological issues: breast development, fatigue, increased body fat, ringing in the ears, impaired memory and cognitive function, depression, anxiety, suicidal thoughts, etc. Some men experience penile and scrotal shrinkage.
How long do these effects last?
One would think that if side effects occur and are hard to live with, just stopping Finasteride use would make the effects disappear. Unfortunately, this is often not the case. In fact, the effects can linger for months, even years. Persistent side effects are becoming so recognized that they have been given a name: the Post-Finasteride Syndrome, or PFS. Why does this happen?
An international hair loss clinic that claims to be “The World’s Leading Hair Loss Clinic” has this to say about Propecia side effects (which also applies to Proscar for BPH): “…whether we like it or not, losing ones hair (in most cases) is a perfectly natural consequence of the ageing process, depending of course on the genes we inherited. To intervene in such a process is, as with all medications, forcing the body to behave in a way that it against its will.”[v] Yet scientists have not yet figured out the molecular processes that create side effects that persist even to the point where they become irreversible. As of this writing, there is no known treatment for lifelong PFS.
Perhaps worst of all, despite that fact that it is the minority of men who are so drastically affected, there is no way to predict who will or won’t suffer the aftermath of taking Finasteride. However, PFS is now so prevalent that it has its own foundation, the Post-Finasteride Syndrome Foundation, where you can acquire a great deal of sobering information, enough to make you wonder why anyone would take the drug to begin with.
“It probably won’t happen to me”
Why is it that when it comes to what we put in our bodies, many people seem to ignore warnings? It is a fact that the majority of men on Finasteride will not develop side effects, and this may help account for why so many men are eager to pee normally or regain hair in spite of known risks. It could be something called unrealistic optimism. The Atlantic published a 2017 essay that applies here:
“People don’t say, ‘It can’t happen to me.’ It’s more like, ‘It could happen to me, but it’s not as likely [for me] as for other people around me.’” People predict that they’re less likely than others to experience illness, injury, divorce, death, and other adverse events—even when they’re exposed to the same risk factors.[vi]
At the Sperling Prostate Center, we’re not just concerned about the health of your prostate. We are concerned about the overall physical, mental, emotional and spiritual health of our patients. We believe the warnings about Finasteride are justified. Before filling a prescription, please discuss this medication – and any medication – with your doctor to learn the personal benefits vs. risks for you as an individual.
[i] Ryan Jaslow. “FDA adds sexual side effects warning to baldness drug Propecia.” CBS News. April 13, 2012. https://www.cbsnews.com/news/fda-adds-sexual-side-effects-warning-to-baldness-drug-propecia/
[iii] Carolyn Beaton. “Humans are Bad at Predicting Futures that Don’t Benefit Them.” The Atlantioc. Nov. 2, 2017. https://www.theatlantic.com/science/archive/2017/11/humans-are-bad-at-predicting-futures-that-dont-benefit-them/544709/