Finasteride is a 5-alpha reductase inhibitor used to treat androgenic alopecia and benign prostatic hyperplasia. An increasing number of patients report long-term symptoms after discontinuation of finasteride, known as Post-Finasteride Syndrome (PFS). Symptoms include persistent sexual dysfunction (SD), cognitive impairment, mood changes, and other systemic effects. This study aims to characterize the demographic, sexual, psychological, and systemic features of individuals reporting PFS through a cross-sectional questionnaire-based analysis.

An anonymous Qualtrics survey was distributed via online support forums and social media platforms, such as X, Reddit, and Facebook, targeting individuals who reported persistent symptoms post finasteride use. Inclusion criteria required being 18 years of age and side effects after finasteride discontinuation. Respondents who had a history of isotretinoin use were excluded from the study as isotretinoin can lead to similar side effects.

Accounting for inclusion criteria, 310 individuals completed the survey. Demographics included an average age of 34.5 with 85.8% being male. Responses were collected around the world; 32.8% from Europe, 32% from the United States, 6.5% from Canada, and 15.8% from 24 other countries. Most respondents obtained finasteride through their dermatologist (37.1%) and a third (32.1%) received their prescription online (Hims, Keeps, etc.). Only 40.1% of respondents stated they were aware that finasteride could lead to sexual dysfunction while taking it. Side effects were the primary reason for drug continuation (89.7%). SD during treatment included reduced libido (73.9%), erectile dysfunction (ED; 71.0%) or vaginal dryness, and orgasmic dysfunction (56.8%), with 36% reporting symptoms starting within the first week of taking medication. After stopping, persistent SD increased to 85.9% (libido), 83.3% (ED/vaginal dryness), and 66.7% (orgasmic dysfunction). Additional symptoms included cognitive impairment (76.6%), mood changes (76.6%), and skin changes (53.1%), among others. Prior to use, 56.6% reported no depression/anxiety versus only 9.4% post-use and severe depression/anxiety increased from 1% to 31.1%. 65.4% experienced suicidal thoughts at least 1-2 per week.

Individuals identifying with PFS report substantial, multi-systemic symptoms and deteriorations in mental health. In addition, our study indicated that there is poor education related to the potential side effects of finasteride, which may be in part due to the ease through which finasteride can be obtained at online retailers.

Awareness remains limited among healthcare providers, and treatment efficacy appears low. Further investigation is needed to better understand and support this patient population and informed consent is crucial.