Discriminating in Favor of or Against Men with Increased Risk of Finasteride-Related Side Effects?

This article discusses the use of finasteride for the treatment of male pattern baldness (MPB) and benign prostatic hyperplasia (BPH). Finasteride is a competitive inhibitor of type 2 5a-reductase which prevents conversion of testosterone to dihydrotestosterone (DHT) resulting in decreased DHT levels in the scalp. Several studies have demonstrated that 1mg oral finasteride daily is effective in prevention and treatment of MPB. However, there have been reports on sexual side effects that may persist despite discontinuation of medication. The post-finasteride syndrome has been claimed to occur in men who have taken oral finasteride to treat either MPB or BPH. Reported symptoms include: loss of libido, erectile dysfunction, reduction in penis size, penile curvature or reduced sensation, gynecomastia, muscle atrophy, cognitive impairment, severely dry skin, and depression. There are no predictive factors for the risk of development of post-finasteride syndrome, and no known treatment for the condition.