Comment on 'The Post-Finasteride Syndrome: Possible Etiological Mechanisms and Symptoms'

The document comments on the post-finasteride syndrome (PFS), which is associated with the use and discontinuation of finasteride, a drug used for male pattern baldness. The author, Michael A. Perelman, provides background information based on his experience treating men with PFS and as a consultant reviewing over a thousand cases in lawsuits against Merck & Co, the manufacturer of Propecia™. He notes that while the majority of men who discontinue finasteride recover sexual function, a small minority experience persistent PFS, characterized by sexual, neurologic, hormonal, and psychiatric symptoms. The document discusses the differences in side effect reporting between patients using finasteride for benign prostate hypertrophy (BPH) and those using it for hair loss, suggesting that informed consent and patient age may play roles. It also mentions that while finasteride is implicated in PFS, conclusive evidence of permanent physical damage causing the syndrome is lacking. The document highlights the importance of informed consent and acknowledges the real suffering of PFS patients, suggesting that sex therapists can help manage the condition. It also notes that despite lawsuits, the prevalence of PFS is low compared to the number of finasteride users, and that the FDA has required label changes to warn about potential post-treatment discontinuation syndrome.