Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride
Ganzer, Jacobs, & Iqbal, 2014
“Many clinicians are unaware of the scope of the persistent physical and psychological adverse effects of finasteride. Symptoms range from minor to severe.”
Ganzer et al. reported a characterisation of the persistent physical, psychological, and cognitive symptoms experienced by PFS patients who had used the drug for at least 3 months and suffered health problems after cessation of finasteride.
100 patients who had sought medical assistance were invited to a survey by email, and additional patients were recruited from propeciahelp.com. No participant had a pre-existing sexual dysfunction or psychiatric condition. 93% reported having used the 1mg finasteride preparation.
84% of patients reported that they were asymptomatic during use of the medication and symptom onset began after cessation; rapidly so in 68% of patients.
Respondents reported experiencing physical symptoms of fatigue (69%), muscle atrophy and weakness (56%), fasciculations (47%), decreased oil and sebum (41%), dry skin (68%), metabolic changes and increased fat deposition (54%). 14% of respondents reported a finding of raised fasting glucose and triglycerides.
Sexual dysfunction included diminished libido (93%), loss of spontaneous and morning erections (89%), complete impotence (40%), reduced semen volume and ejaculatory force (82%), orgasm dysfunction (40%) and sexual anhedonia (70%). Penile atrophy (79%) scrotal atrophy (51%) and sensory changes were reported. 20% reported Peyronie’s disease.
Cognitive complaints were highly prevalent, including severe memory impairment (56%), mental cloudiness or brain fog (75%), impaired problem solving (69%) and attentional deficits (74%). Chronic insomnia was reported by 58% of men. Nearly three quarters of respondents reported increased anxiety, low mood, and anhedonia.
Of concern, 63% of respondents had suicidal ideation and felt they could not keep living on with their extreme side effects.
93% of men were frustrated by clinical ignorance, inadequate recognition of the validity of their symptoms, and were dissatisfied with the medical care that they received.
The authors conclude the multi-domain symptom profile could constitute a definable syndrome, and more investigation is needed.
