(135) Post-Finasteride Syndrome: A Case Presentation and Discussion

Abstract:

Background:

5-alpha reductase inhibitors such as finasteride are commonly prescribed to adult men for androgenetic alopecia. Recently, some men have complained of a constellation of side effects that persist even after stopping treatment, commonly referred to as Post-Finasteride Syndrome.



Case:

A 44-year-old male presented for voluntary psychiatric admission following several months of difficulty sleeping and suicidal ideation. He is a former finasteride user, which he stopped taking in 2014 after 11 years of use; since then, he endorsed sexual dysfunction, anxiety, weakness, and “central nervous system problems,” which he attributes to finasteride. His psychiatric history is pertinent for obsessive compulsive disorder and major depressive disorder, with no pertinent medical history.

Initial mental status exam revealed a calm, cooperative male appearing stated age without any obvious motor or gait abnormalities. Speech was fast, but not pressured, and mood was anxious. Affect was constricted, but associations were appropriate. Thought process was linear but ruminative. Thought content was notable for suicidal ideation and guilt. He denied hallucinations. Cognition was intact.



Discussion:

Several symptoms, including loss of libido, sexual dysfunction, and gynecomastia, are generally accepted to occur with finasteride use, but recede after stopping the medication. Recently, 5-alpha reductase inhibitors have also been linked to psychiatric disorders. Some patients complain of “Post Finasteride Syndrome” (PFS), a constellation of neuropsychiatric symptoms that persist even after stopping treatment.¹ A review study revealed that on average patients with exposure to finasteride had a statistically significant increased risk for depression, though no significance was established for disparities in suicidal ideation.² Furthermore, post-finasteride syndrome has been linked to neurohormonal changes, including decreased allopregnanolone levels.³ However, an investigation into studies of PFS concluded that nearly all studies were of low quality or recruited from biased samples.⁴ Some consider PFS the result of mass suggestibility, as frequency of PFS cases parallels media coverage.⁵

Conclusion/Implications:

PFS has been associated with an identifiable, though often vague and nonspecific, constellation of symptoms. Studies examining PFS are generally of low quality. The status of PFS as a true disease process remains controversial.



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