Post-Finasteride Syndrome

Hello, everybody, and welcome to episode 18 of the Hair Loss Show. I’m Dr. Russell Nudson.

And I’m Dr. Vickram Jash. Boy, do we have a hot topic for you today: Post Finasteride Syndrome – is it a thing?

This condition was only described in 2011, which kind of amuses me because the drug has been around since 1992. Men who are older than the typical age for balding were taking five times as much as the recommended dose for hair loss, which is 5 milligrams a day for prostate treatment, and nobody ever complained about post-finasteride syndrome when we were using it for 50-year-old men at 5 milligrams a day.

Yet, here we have this sudden emergence of a group of patients claiming they’ve had prolonged side effects after stopping a 1-milligram dose per day. It got into the medical literature in a rather strange roundabout way. A researcher conducted a telephone survey of people on the internet who were complaining about this. It goes against all the normal research protocols for selecting participants, so it was hard to give a lot of scientific credibility to the initial report. However, once it was in the literature, it took off.

We’re going to try and dissect this issue briefly today because it is a controversial subject. People like myself and Vickram, who have been in the field a long time and treated a lot of patients, don’t really see it. But there is a group of people on the internet making these complaints, and we have to take them seriously. So, we’re not saying that it’s not a thing or that everyone is lying. We know that guys taking finasteride do experience side effects, and issues like low libido or erectile dysfunction are well-documented side effects of the drug.
We can divide these reactions into two groups of individuals.

The first group reacts within weeks of starting the medication. They experience side effects fairly quickly. The second group, however, may not experience side effects immediately. It could take months or even years before symptoms show up. The longest I’ve had documented is 18 months after starting finasteride before the symptoms appeared.
In the second group, side effects tend to occur months or even years after starting the medication. But it’s important to note that these individuals are typically not as sensitive to finasteride as the first group. Over time, as the drug builds up in the system, the side effects may emerge.

For the people who experience side effects within the first few weeks, the response is usually quick. If you stop or reduce the dose, the side effects typically go away quickly. However, for those in the second group, it can take months for the drug to clear from your system. If side effects appear after 9 months, it might take three months to clear from your system before you start feeling better.

So, how do we manage this?

When patients in the second group return after experiencing side effects, we often advise them to stop the medication for a few months. We reassure them that they won’t lose a significant amount of hair during this time, as the levels of the drug will wash out. After that, they can come back to baseline and restart the medication. This gives the body a chance to recalibrate.

Alternatively, we can try a slower approach: have them take the medication once a week for a month and monitor their reaction. If no side effects appear, we gradually increase the dose. This slow approach can sometimes be very effective.

For patients who take the medication for 6, 7, or 8 months before symptoms emerge, we suggest a strategy of taking the medication for five months, then taking a month off. This helps to clear the drug from the system periodically, which can reduce the chances of side effects.

If you find yourself in this situation, we hope this information helps you understand what’s going on. It’s essential to consult with your prescribing physician to get the best advice based on your specific case.

Some scientists estimate that about 1% or even half a percent of finasteride users experience long-term symptoms, but even then, the prevalence is lower than the general population’s rate of erectile dysfunction. That means, statistically, the occurrence of post-finasteride syndrome is much rarer than the symptoms it aims to address.

We want to reassure everyone that this is not a huge issue, and it primarily affects a very specific group of people. The majority of men taking finasteride do not experience these long-term side effects.

That said, we acknowledge that some people experience ongoing side effects, but the numbers are far smaller than what the internet might suggest. We also need to keep in mind that millions of men who are taking finasteride don’t go online to share their positive experiences.

So, we hope this addresses the issue of post-finasteride syndrome. There is a lot of talk on the internet, and while we acknowledge that this condition exists, it’s not as widespread or as severe as some may think. It’s manageable, and we hope this information proves useful to those who might be affected.

If you found this video helpful, please hit like, subscribe to the channel, and leave a comment or question. We’ll see you in the next episode!

Goodbye for now!