| Revision as of 09:38, 25 March 2021 view sourceSugarhouse90 (talk | contribs)56 edits ←Created page with '{{subst:AfC submission/draftnew}}<!-- Important, do not remove this line before article has been created. --> '''Post-Finasteride Syndrome''' describes a range...'Tag: Visual edit | Latest revision as of 01:10, 4 May 2021 view source MusikBot II (talk | contribs)Bots, Interface administrators, Administrators102,806 editsm Adding missing protection template (more info) | ||
| (82 intermediate revisions by 22 users not shown) | |||
| Line 1: | Line 1: | ||
| #REDIRECT ] | |||
| {{AfC submission|t||ts=20210325093657|u=Sugarhouse90|ns=118|demo=}}<!-- Important, do not remove this line before article has been created. --> | |||
| {{R to section}} | |||
| '''Post-Finasteride Syndrome''' describes a range of sexual, physical and neurological side effects that are reported to persist and develop after cessation of the ] ].<ref name=":0">{{Cite journal|last=Than|first=Jeffrey K.|last2=Rodriguez|first2=Katherine|last3=Khera|first3=Mohit|date=2018-09-01|title=Post-finasteride Syndrome: A Review of Current Literature|url=https://doi.org/10.1007/s11930-018-0163-4|journal=Current Sexual Health Reports|language=en|volume=10|issue=3|pages=152–157|doi=10.1007/s11930-018-0163-4|issn=1548-3592}}</ref><ref name=":1">{{Cite journal|last=Traish|first=Abdulmaged M.|date=2020-01-01|title=Post-finasteride syndrome: a surmountable challenge for clinicians|url=https://www.fertstert.org/article/S0015-0282(19)32599-3/abstract|journal=Fertility and Sterility|language=English|volume=113|issue=1|pages=21–50|doi=10.1016/j.fertnstert.2019.11.030|issn=0015-0282|pmid=32033719}}</ref><ref name=":2">{{Cite journal|last=Frye|first=Cheryl A.|last2=DaCosta|first2=Dan|last3=Lembo|first3=Vincenzo F.|last4=Walf|first4=Alicia A.|date=2020-12-01|title=Advances in Knowledge of Androgens: How Intentional and Accidental Neurosteroid Changes Inform Us of Their Action and Role|url=https://doi.org/10.1007/s11930-020-00276-2|journal=Current Sexual Health Reports|language=en|volume=12|issue=4|pages=209–220|doi=10.1007/s11930-020-00276-2|issn=1548-3592}}</ref> Adverse drug reactions reported in association with finasteride are dose independent and more common, numerous and severe in younger patients using the 1mg dose to prevent androgenic alopecia.<ref>{{Cite journal|last=Harrell|first=Matthew B.|last2=Ho|first2=Kaylee|last3=Te|first3=Alexis E.|last4=Kaplan|first4=Steven A.|last5=Chughtai|first5=Bilal|date=2020-06-28|title=An evaluation of the federal adverse events reporting system data on adverse effects of 5-alpha reductase inhibitors|url=https://doi.org/10.1007/s00345-020-03314-9|journal=World Journal of Urology|language=en|doi=10.1007/s00345-020-03314-9|issn=1433-8726}}</ref><ref>{{Cite journal|last=Baas|first=Wesley R.|last2=Butcher|first2=Michael J.|last3=Lwin|first3=Aye|last4=Holland|first4=Bradley|last5=Herberts|first5=Michelle|last6=Clemons|first6=Joseph|last7=Delfino|first7=Kristin|last8=Althof|first8=Stanley|last9=Kohler|first9=Tobias S.|last10=McVary|first10=Kevin T.|date=2018-10-01|title=A Review of the FAERS Data on 5-Alpha Reductase Inhibitors: Implications for Postfinasteride Syndrome|url=https://www.goldjournal.net/article/S0090-4295(18)30590-9/abstract|journal=Urology|language=English|volume=120|pages=143–149|doi=10.1016/j.urology.2018.06.022|issn=0090-4295|pmid=29960004}}</ref><ref name=":3">{{Cite journal|last=Walf|first=Alicia A.|last2=Kaurejo|first2=Shan|last3=Frye|first3=Cheryl A.|date=2018-07-01|title=Research Brief: Self-Reports of a Constellation of Persistent Antiandrogenic, Estrogenic, Physical, and Psychological Effects of Finasteride Usage Among Men|url=https://doi.org/10.1177/1557988317750989|journal=American Journal of Men's Health|language=en|volume=12|issue=4|pages=900–906|doi=10.1177/1557988317750989|issn=1557-9883|pmc=PMC6131463|pmid=29318957}}</ref> | |||
| {{pp|small=yes}} | |||
| Preclinical evidence demonstrates interference by 5alpha-reductase inhibitors in sexual, cognitive and physical domains relevant to reported persistent symptoms.<ref name=":1" /><ref name=":2" /> The existence of the condition is often considered controversial, owing to both the underlying biological mechanism and the incidence of the condition being unclear.<ref>{{Cite journal|last=Gray|first=Shelly L.|last2=Semla|first2=Todd P.|date=2019-08-09|title=Post-finasteride syndrome|url=https://www.bmj.com/content/366/bmj.l5047|journal=BMJ|language=en|volume=366|pages=l5047|doi=10.1136/bmj.l5047|issn=0959-8138|pmid=31399423}}</ref> A lack of clear diagnostic criteria and the variable reporting fraction in different health-care settings make the problem challenging to evaluate.<ref name=":4">{{Cite journal|last=Maksym|first=Radosław B.|last2=Kajdy|first2=Anna|last3=Rabijewski|first3=Michał|date=2019-10-02|title=Post-finasteride syndrome – does it really exist?|url=https://www.tandfonline.com/doi/abs/10.1080/13685538.2018.1548589|journal=The Aging Male|volume=22|issue=4|pages=250–259|doi=10.1080/13685538.2018.1548589|issn=1368-5538|pmid=30651009}}</ref> | |||
| == Symptoms == | |||
| Symptoms of Post-Finasteride syndrome include penile atrophy and tissue changes, decreased ejaculate volume and quality, libido loss, erectile dysfunction, dry skin, metabolic changes, muscle and strength loss, anxiety, panic attacks, insomnia, anhedonia, concentration problems, memory impairment and suicidal ideation.<ref name=":0" /><ref name=":3" /><ref name=":4" /><ref name=":5">{{Cite journal|last=Traish|first=Abdulmaged M.|date=2018-09-01|title=The Post-finasteride Syndrome: Clinical Manifestation of Drug-Induced Epigenetics Due to Endocrine Disruption|url=https://doi.org/10.1007/s11930-018-0161-6|journal=Current Sexual Health Reports|language=en|volume=10|issue=3|pages=88–103|doi=10.1007/s11930-018-0161-6|issn=1548-3592}}</ref> | |||
| == Clinical Findings == | |||
| Case-control study of symptomatic post-finasteride syndrome patients has revealed significantly higher expression of the androgen receptor in penile skin, alterations in levels of neuroactive steroids, and markers of neuropathy of the pudendal nerve.<ref>{{Cite book|last=Patisaul|first=Heather B.|url=https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199935734.001.0001/acprof-9780199935734-chapter-5|title=Receptor and Enzyme Mechanisms as Targets for Endocrine Disruptors|last2=Belcher|first2=Scott M.|date=2017-05-18|publisher=Oxford University Press|volume=1|language=en|doi=10.1093/acprof:oso/9780199935734.003.0005}}</ref> (CAG)n and (GGN)n repeat lengths in the AR gene have been correlated to the symptoms reported by PFS patients. PFS patients have also been found to exhibit neural abnormalities as assessed by functional magnetic resonance imaging.<ref name=":5" /> | |||
| == Cause == | |||
| The rarity, variability and dose independence of the syndrome has been hypothesised to depend upon epigenetic phenotype. Finasteride-induced epigenetic changes in gene expression, including upregulation of the androgen receptor, may result in undesirable biological outcomes such as impairment of dopaminergic signalling and modulation of other neurotransmitter receptors, causing persistent or permanent adverse effects.<ref name=":1" /> | |||
| A dermatologist suggested an alternative hypothesis of mass delusion.<ref name=":1" /> | |||
| == Controversy == | |||
| Adverse event reports have increased over time, leading to suggestions of a potential nocebo effect.<ref>{{Cite journal|date=2020-05-01|title=Post-finasteride syndrome: An emerging clinical problem|url=https://www.sciencedirect.com/science/article/pii/S235228951930061X|journal=Neurobiology of Stress|language=en|volume=12|pages=100209|doi=10.1016/j.ynstr.2019.100209|issn=2352-2895}}</ref> However, significant adverse event reported signals were determined to exist before and after 2011, irrespective of the public’s knowledge of sexual dysfunction as a safety concern associated with finasteride.<ref>{{Cite journal|last=Ali|first=Ayad K.|last2=Heran|first2=Balraj S.|last3=Etminan|first3=Mahyar|date=2015|title=Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study|url=https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.1612|journal=Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy|language=en|volume=35|issue=7|pages=687–695|doi=10.1002/phar.1612|issn=1875-9114}}</ref> | |||
| Of 34 clinical trials assessing the safety of finasteride for use in androgenic alopecia, meta-analysis concluded that none were found to have had adequate safety reporting.<ref>{{Cite journal|last=Belknap|first=Steven M.|last2=Aslam|first2=Imran|last3=Kiguradze|first3=Tina|last4=Temps|first4=William H.|last5=Yarnold|first5=Paul R.|last6=Cashy|first6=John|last7=Brannigan|first7=Robert E.|last8=Micali|first8=Giuseppe|last9=Nardone|first9=Beatrice|last10=West|first10=Dennis P.|date=2015-06-01|title=Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia|url=https://jamanetwork.com/journals/jamadermatology/fullarticle/2212246|journal=JAMA Dermatology|language=en|volume=151|issue=6|pages=600|doi=10.1001/jamadermatol.2015.36|issn=2168-6068}}</ref> | |||
| A 2019 Reuters investigation revealed that Merck, the manufacturer of Propecia, had found evidence of persistent side effects in their original clinical trials and chose not to disclose it in their original warning label.<ref>{{Cite web|title=U.S. court let Merck hide secrets about popular drug's risks|url=https://www.reuters.com/investigates/special-report/usa-courts-secrecy-propecia/|access-date=2021-03-25|website=Reuters|language=en}}</ref> Use of the drug by younger men for hair loss has also been associated with reports of suicidality and completed suicide.<ref>{{Cite news|last=Terhune|first=Dan Levine, Chad|date=2021-02-03|title=Exclusive: Merck anti-baldness drug Propecia has long trail of suicide reports, records show|language=en|work=Reuters|url=https://www.reuters.com/article/us-merck-propecia-suicide-exclusive-idUSKBN2A32XU|access-date=2021-03-25}}</ref><ref>{{Cite journal|last=Nguyen|first=David-Dan|last2=Marchese|first2=Maya|last3=Cone|first3=Eugene B.|last4=Paciotti|first4=Marco|last5=Basaria|first5=Shehzad|last6=Bhojani|first6=Naeem|last7=Trinh|first7=Quoc-Dien|date=2021-01-01|title=Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride|url=https://doi.org/10.1001/jamadermatol.2020.3385|journal=JAMA Dermatology|volume=157|issue=1|pages=35–42|doi=10.1001/jamadermatol.2020.3385|issn=2168-6068}}</ref> | |||
| == References == | |||
| <!-- Inline citations added to your article will automatically display here. See en.wikipedia.org/WP:REFB for instructions on how to add citations. --> | |||
| {{reflist}} | |||
Latest revision as of 01:10, 4 May 2021
Redirect to:
- To a section: This is a redirect from a topic that does not have its own page to a section of a page on the subject. For redirects to embedded anchors on a page, use {{R to anchor}} instead.