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From the Summer/Fall 2015 Quest
Finasteride is a drug used to treat hair loss in men (Propecia or generics) or enlarged prostate (Proscar or generics). The drug treats both conditions by blocking the body's production of a male hormone called dihydrotestosterone. Finasteride may help control these conditions, but it will not cure them. If men discontinue treatment, the conditions will return.

In recent years, the medical community and the U.S. government have begun examining the safety of finasteride. As with any treatment, finasteride has potential side effects. One possible side effect is an increased risk of developing high-grade prostate cancer, which spreads more quickly than other types of prostate cancer.

Post-Finasteride Syndrome

The U.S. National Institutes of Health also now recognizes Post-Finasteride Syndrome (PFS) through its Genetic and Rare Diseases Information Center. Post-Finasteride Syndrome (PFS) describes persistent sexual, neurological, and physical adverse reactions in patients who have taken finasteride. Reported symptoms include loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronie's disease, penile shrinkage, gynecomastia, muscle atrophy, cognitive impairment, insomnia, severely dry skin and tinnitus. The condition can have a severe impact on victims and their families.

Expert opinions
Dr. Patrick Walsh,
Johns Hopkins University:

Apparently these men may have prolonged/permanent suppression of androgen secretion with all of the side effects. It has been repeatedly reported to the point that I can see why the FDA can no longer ignore it. From my standpoint it is a blessing. I continue to see men who have been on Propecia for 10 years who walk in the door with highgrade disease.

Dr. William J. Catalona,
Northwestern University:

Because several studies have reported a significantly greater rate of high-grade prostate cancer in men who have been taking these drugs (finasteride in Proscar and Propecia and dutasteride in Avodart and Jalyn) and the more recent concerns about the Post-Finasteride Syndrome, I do not recommend them to patients.

Examining the safety of finasteride

A recent study in JAMA analyzed 34 clinical trial reports for finasteride treatment of male pattern baldness (androgenic alopecia, or AGA). None of the trials had adequate safety reporting. "Published reports of clinical trails provide insufficient information to establish the safety profile for finasteride in the treatment of AGA," the authors concluded.

The NIH website notes that, "Studies are underway to understand the safety profile of 5-alpha reductase inhibitor drugs with respect to adverse events ... and their permanency."

Finasteride use in young men

Finasteride is a popular therapy for male pattern baldness in young men.

A study published in July analyzed 4,910 adverse events reported for men aged 18-45 years who were taking lowdose finasteride. Researchers reported that 11.8% of those reports involved persistent sexual dysfunction and 7.9% involved suicidal ideation.

Approximately 60% of the reported sexual dysfunction cases were serious in nature. Among men who experienced both sexual dysfunction and suicidal ideation, 88% of the suicidal ideation events were serious. "Our findings provide a strong hypothesis for pharmacoepidemiologic studies to further examine this association," the authors concluded.

No treatment for PFS

According to the Post-Finasteride Syndrome Foundation, there are currently no effective treatments for PFS. As an increasing number of men report their persistent side effects to health and regulatory agencies worldwide, medical and scientific communities are only beginning to realize the scope of the problem. Determining the underlying biologic mechanisms of PFS requires further clinical and basic science research.

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