Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss.
Some men who use finasteride for hair loss report persistent sexual and other symptoms after discontinuing finasteride therapy.



To determine whether these persistent symptoms after discontinuation of finasteride use are due to androgen deficiency, decreased peripheral androgen action, or persistent inhibition of steroid 5α-reductase (SRD5A) enzymes.



Finasteride users, who reported persistent sexual symptoms after discontinuing finasteride (group 1); age-matched finasteride users who did not report sexual symptoms (group 2); and healthy men who had never used finasteride (group 3).



Sexual function, mood, affect, cognition, hormone levels, body composition, functional magnetic resonance imaging (fMRI) response to sexually and affectively valenced stimuli, nucleotide sequences of androgen receptor (AR), SRD5A1, and SRD5A2; expression levels of androgen-dependent genes in skin.



Academic medical center.



Symptomatic finasteride users were similar in body composition, strength, and nucleotide sequences of AR, SRD5A1, and SRD5A2 genes to asymptomatic finasteride users and nonusers. Symptomatic finasteride users had impaired sexual function, higher depression scores, a more negative affectivity balance, and more cognitive complaints than men in groups 2 and 3 but had normal objectively assessed cognitive function. Testosterone, dihydrotestosterone, 5α-androstane-3α,17β-diol-glucuronide, testosterone to dihydrotestosterone and androsterone glucuronide to etiocholanolone glucuronide ratios, and markers of peripheral androgen action and expression levels of AR-dependent genes in skin did not differ among groups. fMRI blood oxygen level-dependent responses to erotic and nonerotic stimuli revealed abnormal function in brain circuitry linked to sexual arousal and major depression.



We found no evidence of androgen deficiency, decreased peripheral androgen action, or persistent peripheral inhibition of SRD5A in men with persistent sexual symptoms after finasteride use. Symptomatic finasteride users revealed depressed mood and fMRI findings consistent with those observed in depression.
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Shehzad
S
Basaria
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Ravi
R
Jasuja
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Grace
G
Huang
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Whitney
W
Wharton
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Hong
H
Pan
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Karol
K
Pencina
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Zhuoying
Z
Li
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Thomas G
TG
Travison
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Jag
J
Bhawan
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Renaud
R
Gonthier
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Fernand
F
Labrie
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Alain Y
AY
Dury
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Carlo
C
Serra
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Allen
A
Papazian
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Michael
M
O'Leary
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Sami
S
Amr
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Thomas W
TW
Storer
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Emily
E
Stern
Research Program in Men's Health: Aging and Metabolism (S.Ba., R.K., G.H., K.P., Z.L., C.S., A.P., T.W.S., S.Bh.), Harvard Medical School, Functional Neuroimaging Laboratory (H.P., E.S.), Department of Radiology, and Section of Urology (M.O.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Neurology (W.W.), Emory University, Atlanta, Georgia 30322; Program on Aging (T.G.T.), Hebrew Senior Life, Roslindale, Massachusetts 02131; Department of Dermatology (J.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Endoceutics (R.G., F.L., A.Y.D.), Quebec City, Canada G1V 4M7; and Department of Pathology (S.A.), Harvard Medical School, Boston, Massachusetts 02115.
Shalender
S
Bhasin
D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects*; D000328:Adult; D000505:Alopecia / Q000188:drug therapy*; D000728:Androgens / Q000097:blood*; D003865:Major Depressive Disorder / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology; D018120:Finasteride / Q000009:adverse effects*; D015870:Gene Expression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011944:Receptors, Androgen / Q000378:metabolism*; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology; D020018:Sexual Dysfunctions, Psychological / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology; D055815:Young Adult
D058891:5-alpha Reductase Inhibitors; D000728:Androgens; D011944:Receptors, Androgen; D018120:Finasteride
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