Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia
Khera et al., 2020
“The present study supports the conclusion that 5ARI use may predispose to persistent sexual, genitourinary, psychocognitive, and anti-androgenic changes even after 5ARI therapy is discontinued.”
This clinical study reported important clinical findings in Post-Finasteride Syndrome patients. Chiefly, 17 of 24 patients who underwent Penile Duplex Doppler Ultrasound examination were found to have vascular abnormalities. Eight patients had arterial insufficiency, while 5 patients fell into the “gray zone” of possible erectile dysfunction.. Four patients had venous leak. This second clinical report confirms tissue abnormalities of the penile structure occur in PFS patients.
The International Prostate Symptom Score questionnaire was used to assess urinary symptoms. Post-Finasteride Syndrome patients scored significantly worse than controls (median 10 v 3), particularly in questions regarding weak stream, incomplete emptying, frequent urination and overall quality of life. PFS patients were found to be more likely to have signs and symptoms of hypogonadism per the Androgen Deficiency in the Ageing Male Questionnaire. Additionally, PFS patients had high rates of anhedonia per the Patient Health Questionnaire.
A significant difference in total International Index of Erectile Function score between post-finasteride patients and the control group was observed. However, significant differences were only seen in sexual desire and overall satisfaction. No significant difference was found in erectile function per IIEF score.
Importantly, 76% of patients reported at least one musculoskeletal complaint. 45% of post-finasteride subjects reported fatigue, and 25% reported muscle atrophy. 12% reported gynecomastia, weight loss, back pain, lower extremity pain and visual disturbance. 8% reported weight gain, ocular hyperhidrosis, throat tightness, constipation, polydipsia, and cold flashes. 4% mentioned tremors, xeroderma, xerophthalmia, hypothermia, palpitations, muscle spasms, rapid aging, swollen face, and facial flushing.
Alarmingly, two PFS patients (8%) committed suicide during or after the study period.
The authors suggest further clinical studies to assess non-sexual side effects that persist after discontinuation of the drug. They additionally suggest, owing to the significance of the observed and potential side effects, patients should be extensively counselled and monitored for possible side effects after both initiation and discontinuation of this medication class.
“Khera’s findings are particularly meaningful because many physicians frequently dismiss PFS patients’ sexual complaints as having a psychogenic cause.”
