Post-finasteride syndrome - does it really exist?
Maksym et al., 2019
“PFS occurs in susceptible individuals even after small doses of the drug and can last for a long time after the discontinuation of treatment. A deterioration in the quality of life in affected individuals does not justify use of the drug.”
In a literature review, Maksym et al. judged that the lasting consequences of antiandrogen therapy on the organism remain obscure, and can be highly complex and multilateral. They note the extensive metabolism of steroid hormones in sexual function and the central nervous system, as well as evidence for roles in broader physiological functions including metabolism, bone density and tear film. These provide a biological involvement of antiandrogen treatment in the symptom domains of PFS.
They state the coexistence of adverse events should be considered rather as a distinct syndrome with its own pathogenesis rather than a random co-occurrence of signs.
They conclude that, despite the lack of final proof as to causation, the presence of severe and persistent effects caused by the treatment of an aesthetic issue raises great concern for the clinician given the widespread use in young and healthy individuals, and that a low estimated prevalence of PFS cannot excuse nonvigilance.
Wider recognition and knowledge regarding PFS is suggested to allow appropriate judgement regarding prescription of 5alpha reductase inhibitors, a genuinely informed consent from the patient, and eventual therapies for those suffering.
