What is finasteride?

Finasteride, along with its cousin Dutasteride, is a medication Urologists have been describing for decades. Some of you may also know these medications by the names Proscar, Avodart, and Propecia.

These medications are FDA-approved to treat benign prostatic hyperplasia (BPH, enlarged prostate) as well as androgenic alopecia (male-pattern baldness). Recently, these medications have gained some popularity as you can order these medications shipped to your door through companies like Roman and Hims.

How does finasteride work?

Finasteride and dutasteride block Testosterone’s conversion to DHT (dihydrotestosterone) by inhibiting many cell receptors in the body. DHT is very potent, and contributes to prostate enlargement, male pattern balding, facial hair growth, and acne. DHT receptors are located in the prostate, testes, brain, skin, and in many other human tissues.

By blocking the receptors, men on finasteride have less DHT which shrinks an enlarged prostate and helps slow hair loss. 50% of men will suffer from BPH once over age 50 and 50% of men will lose hair by age 40 – it is easy to understand why so many men take these medications.

What are the risks?

Post-Finasteride Syndrome (PFS) encompasses a constellation of adverse symptoms that can affect a man physically, neurologically, psychiatrically, and sexually when taking finasteride. These symptoms include:

  • Erectile dysfunction (ED)
  • Decreased desire for sex
  • Chronic fatigue
  • Atrophy (tissue breakdown) of genitals
  • Muscle wasting
  • Increased fat deposits
  • Breast tissue growth
  • Anxiety & “Brainfog”
  • Blunted affect or emotional sensitivity

Obviously, this is a very long list of side effects and there are others reported as well. PFS can start shortly after starting the medication and can possibly last months to years after stopping. Decreasing the dosage strength is unlikely to reduce the risk of PFS. Patients considering using these medications should be very careful and speak to a Urologist in person about risks, benefits, and indications of treatment.

I take finasteride, what should I do?

There is much to still learn about PFS, and more long-term studies are needed before we decide to stop prescribing these medications entirely. For now, my recommendation if you are taking finasteride is to schedule an appointment with me to discuss alternatives to medication for enlarged prostate.

It is important to note that medications like finasteride typically only mask the symptoms of BPH but do not offer a cure for symptoms of enlarged prostate. Definitive treatment is becoming the key to preserving bladder health and avoiding harmful side effects of medication as mentioned above.

For example, the UroLift System can get men off medication and cure BPH symptoms in an office procedure in under 10 minutes. If the prostate is significantly enlarged, a TURP may be needed which can be performed under anesthesia without incisions or need for post-operative pain medication.

For more information on PFS, please visit the PFS Foundation website.