Evidence of gene expression correlating with observed biologic differences, including significant Androgen Receptor overexpression, was reported in a landmark investigation of patients with post-finasteride syndrome.

Significant disproportional signals for suicidality and psychological adverse events were associated with finasteride use in young men using the drug for hair loss. This was not seen in older patients using the drug for urological treatment.

Adverse drug reactions reported with finasteride are dose independent and more common, numerous and severe in younger patients using the 1mg dose, particularly in sexual and mental domains.

A majority of PFS patients were found to have penile vascular abnormalities. Clinical findings indicated persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes can occur even after finasteride discontinuation. Two study participants committed suicide.

Six suicide victims who took finasteride for treatment of androgenic alopecia were characterised according to clinical records. Common persistent symptoms included insomnia and sexual dysfunction.

In a thorough review, Traish argues epigenetic susceptibility plausibly underlies the constellation of persistent symptoms following Finasteride use. Unacceptable dismissal of PFS is challenged. Pathomechanistic investigation and due diligence by clinicians is urged.

Gene promoter methylation of 5-alpha reductase type 2 was identified in cerebrospinal fluid samples of a majority of PFS patients evaluated.

Literature review concluded that, although rare, the effect of severe and persistent side effects on the quality of life of individuals affected by PFS does not justify use of the drug. Education regarding PFS and further study is urged.

Literature review concluded that the unknown predisposition PFS is a real problem, and that genetic and clinical studies are needed to understand the pathophysiology leading to the onset and continuation of side effects in men who have used finasteride.

FAERS data revealed a significant array of symptoms in several sexual, physical, and psychological domains reported in association with finasteride use, particularly in young men using the 1mg preparation.

In a vital literature review, Traish provides plausible mechanistic hypothesis and asserts that the medical community have an obligation not to turn a blind eye to this rare and debilitating condition.

Literature review determined existing evidence well supports an association between 5α-reductase inhibitor use and persistent adverse sexual, physical, and central effects.

Comprehensive literature review showed that although uncommon, adverse sexual and reproductive outcomes associated with the use of 5α-RIs can be serious and persistent.

300 self reports from SSRI, 5ar inhibitor and isotretinoin users revealed overlap in post-drug symptoms including erectile dysfunction, libido loss, genital numbness, pleasureless orgasm, premature ejaculation, emotional blunting, loss of nocturnal erections, penile or testicular pain and atrophy, and watery ejaculate.

26 of 27 patients (96%) demonstrated lack of homogeneity and hyperechoic/hypoechoic regions in erectile tissue upon penile duplex Doppler ultrasound examination.

PFS Patient self-reports on propeciahelp.com were characterised as antiandrogenic effects, estrogenic effects, central effects and nonspecific severe adverse effects.

Objective markers of pudendal neuropathy were found in PFS patients, along with broad disruption of neuroactive steroids - important physiological regulators of brain function.

Analysis of clinical records revealed an association between debilitating persistent sexual dysfunction and exposure to finasteride or dutasteride.

A man assessed pre-finasteride as having good sexual function and psychiatric health developed persistent post-withdrawal sexual dysfunction, depressive symptoms and generalised vitiligo.