Finasteride side effects...

Finasteride is associated with several side effects, some of which can be serious. The most common adverse reactions, reported in clinical trials, include decreased libido (1.8%), erectile dysfunction (1.3%), and ejaculation disorder (1.2%). These sexual side effects were more frequent in the first year of treatment and tended to decrease with continued use.[1]

Postmarketing experience has identified additional adverse reactions, including hypersensitivity reactions (such as rash, pruritus, urticaria, and angioedema), persistent sexual dysfunction (including erectile dysfunction, libido disorders, ejaculation disorders, and orgasm disorders), male infertility, testicular pain, hematospermia, male breast cancer, breast tenderness and enlargement, and psychiatric effects (such as depression and suicidal ideation).[1][3]

While some of these side effects, like hypersensitivity reactions and psychiatric effects, can be serious, the incidence of these events is not well-defined due to the voluntary nature of postmarketing reports. It is important to monitor patients for these adverse effects and consider discontinuation of the drug if serious side effects occur.

Recent studies have further elucidated the potential side effects of finasteride, particularly focusing on its psychological and sexual adverse effects. A significant body of evidence has emerged regarding post-finasteride syndrome (PFS), which includes persistent sexual, neurological, and physical side effects that may continue even after discontinuation of the drug. These side effects can be severe and debilitating, affecting a subset of men who are potentially predisposed to these adverse outcomes.[4]

A pharmacovigilance study published in JAMA Dermatology investigated the association between finasteride use and psychological adverse events, including suicidality. The study found a significant disproportionality signal for suicidality (reporting odds ratio [ROR], 1.63; 95% CI, 1.47-1.81) and psychological adverse events (ROR, 4.33; 95% CI, 4.17-4.49) in finasteride users. Younger patients (≤45 years) and those using finasteride for alopecia were particularly at risk. This suggests that younger patients may be more vulnerable to the psychological side effects of finasteride, and these risks should be carefully considered when prescribing the medication.[5]

In summary, while finasteride is effective for treating androgenetic alopecia and benign prostatic hyperplasia, it is associated with serious side effects, including persistent sexual dysfunction and significant psychological adverse events. Clinicians should weigh these risks against the benefits and monitor patients closely for any adverse effects, particularly in younger individuals and those using the drug for hair loss.

1.

PROPECIA. Label via DailyMed.

Food and Drug Administration

Updated date: 2024-10-14

2.

PROPECIA. Label via DailyMed.

Food and Drug Administration

Updated date: 2013-06-11

3.

PROSCAR. Label via DailyMed.

Food and Drug Administration

Updated date: 2024-12-23

4.

Post-Finasteride Syndrome: A Surmountable Challenge for Clinicians.

Traish AM.

Fertility and Sterility. 2020;113(1):21-50. doi:10.1016/j.fertnstert.2019.11.030.

5.

Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride.

Nguyen DD, Marchese M, Cone EB, et al.

JAMA Dermatology. 2021;157(1):35-42. doi:10.1001/jamadermatol.2020.3385.

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