Post-Finasteride Syndrome: About 2 Cases and Review of the Literature
Garreton et al., 2016
“The symptoms reported in this and other related publications, as well as clinical suspicion, are fundamental in the evaluation and diagnosis of these patients, but especially important in their emotional support, given that they don’t usually find an answer to their problems. ”
They reported two cases, both following use of finasteride 1mg/day for hair loss. Both cases displayed a pattern of worsening following withdrawal.
The first case was a 27 year old male who, after using finasteride for a few months, paused and later resumed the medication. Weeks after resumption he experienced low libido, loss of morning erections and penile shrinking. Discontinuing the drug, he experienced a remission, however soon after symptoms returned, associating a "flaccid but rigid” penile state, less penile length and girth, scrotal shrinking, more visible superficial penile veins, mild flaccid penile pain, mild distal penile curvature, severe post ejaculatory weakness and malaise, and less muscle tone and strength. Surprisingly, his hair loss remained halted.
The second case was a 23 year old who experienced adverse effects the day after his first dose. He developed severe erectile dysfunction progressing to complete erectile dysfunction, lack of any morning erections, less penile length and girth which caused “excessive penile skin”, penile numbness, more visible superficial penile veins, penile, testicular and perineal pain, hypospermia and a “more watery” semen, less intense orgasms. He developed miodesopsias, insomnia, panic attacks and mood disorders. Asthenia, articular and muscular pain (but without any muscle mass loss), intense headaches, ocular and retroocular pain, miodesopsias, xeroіalmia, red eyes and photophobia also developed, with some progressive improvement.
They note both patients reported adverse effects attributable to the use of finasteride, being similar cases except for the fact it only took 1 dose of 1mg finasteride for one of them to suffer adverse effects that persisted and progressed after withdrawal. This, they write, warns about a possible time and/or dose independent characteristic of the syndrome.
They conclude the need for more studies into the pathophysiology, and that awareness should be promoted about the existence of the syndrome so as to give the best assistance to patients until the disease is better understood.
