Recovering from Post-Finasteride Syndrome

Finasteride is used as a treatment for male pattern hair loss, and is offered and marketed by ‘medical hair centres’ throughout the world without mention of the possible complications.

It’s use can have serious side effects (which you probably already know about as you are reading this article):

• Sexual dysfunction including erectile dysfunction (ED) and loss of libido (1, 2)
• Neuroinflammation (brain fog and slow cognition) (3)
• Insomnia, obstructive sleep apnea (4)
• Panic attacks, depression, suicidal idealization (5)
• Reduced muscle mass even with Testosterone supplementation (6)

Post-Finasteride-Syndrome has been referred to as a ‘man made myth’ and a ‘delusional disorder’ (7).

But it’s real and has a growing body of research to prove it.

It’s effects on hormones and their metabolites can also be seen clearly in advanced hormonal testing panels.

In the body, Testosterone can be metabolised to 5-alpha and 5-beta metabolites; Each of these metabolites affects the body differently. 5-alpha makes Testosterone more potent, and whilst it supports sexual function and gaining muscle, in excess it may be linked to male pattern baldness.

Finasteride, is used by hair loss clinics, as it is what is called a 5-alpha reductase inhibitor and blocks the conversion of Testosterone to the more potent 5-alpha DHT. Instead the Testosterone is converted into the 5-beta metabolite (the conversion of hormone metabolites is pictured in this image).

However, a deficiency in 5-alpha can lead to a dysregulation of hormones and sexual dysfunction including erectile dysfunction.

Testosterone has many functions in the body besides sexual function and gaining muscle. Blocking the 5-alpha pathway can have further effects including reduced insulin sensitivity, dysregulated Thyroid and less dopamine.

PFS can leave those affected with sexual dysfunction, brain fog and feeling like their hormones are a mess and their energy low.

Post Finasteride Syndrome is a disease that has been reported to occur in some male patients who have taken finasteride.

Reports of symptoms include sexual, physical and neurological symptoms that may persist after the patient has stopped taking finasteride (10)

In lab testing of individuals with PFS, I see the conversion of Testosterone preferentially down the 5-beta pathway in some individuals, but not all.

There is a second type of hormonal dysregulation which is characterised, not by a 5-alpha/5-beta imbalance but by an excess amount of Estrogen and neuro-inflammation.

These 2 types of hormonal imbalances should be treated differently and so it’s important to know what is going on with a person’s hormones through an advanced hormone test like the DUTCH test (available from us in Australia and the US) before precise treatment can begin.

Additionally, it’s useful to know if sex hormone binding globulin (SHBG) and prolactin are within the normal range – these tests are available through regular pathology.

Some of the symptoms reported in PFS may be related to gene expression being altered by the drug (8). We can support proper gene expression, and a process in the body called methylation, through diet, supplements and lifestyle (see below).

These suggestions are based on the protocol developed by Dr Kara Fitzgerald and proven effective in a randomised control trial (8):

• Focus on getting getting good quality sleep of at least seven hours per night.
• 6 to 8 serves of vegetables a day
• 1 or 2 serves fruit only a day + unlimited berries
• Eating the rainbow of plants (2 of each colour)
• A greens powder daily, such as athletic greens
• Organic chicken or ox liver twice a week are some of the most nutrient-dense foods available to us. Chicken liver can be made into a pate or fried with coconut milk, garlic, onions and bacon. Ox liver can be added to mince if you want to mask its flavour somewhat.
• At least five days a week of 30 minutes exercise at a perceived exertion of 60 to 80%.
• Lactobacillus plantarum probiotic twice a day as “Lactobacillus plantarum 299v. L. plantarum has been shown to be a folate producer…; it also has been demonstrated to alter gene expression “. Jarrow Ideal Bowel support probiotic contains this strain.
• 5 grams a day of glycine in supplemental form also supports methylation and methylated B-Vitamins, either from food or in supplemental form, may be needed

Exercise

• Lift heavy stuff at the gym: Dead lifts, burpees, jump squats etc.
• High intensity interval training. For example, sprint 4-6 times for 6 secs with a good rest in between sprints.
• Remember, excessive exercise, particularly cardio, can result in over training and decrease Testosterone so don’t overtrain
• Lower body fat may increase Testosterone levels

Supplements

• Test your Zinc levels and supplement or eat oysters if needed
• Creatine – 5mg a day.  Best in two portions so it’s better absorbed.
• Tribulus Terrestris herb
• Withannia (Ashwaghanda) herb
• Niacin, particularly if high blood pressure, as it dilates blood vessels

Food

• Include some carbs as a very low carb diet may lower testosterone and thyroid hormones
• Eat enough protein and calories!
• Wild-caught oily fish, such as sardines or salmon, at least twice a week or a good quality fish oil
• Avoid or at least limit alcohol
• Focus on good fats such as avocado, grass fed butter, coconut and olive oil. Unsaturated fats, such as those found in flax seed and vegetable oils, may inhibit the 5-alpha pathway (9)

I recommend you start by doing an advanced hormone test, such as the DUTCH test, so that you know exactly what is going on with your sex and adrenal hormones and how they are being metabolised. We now offer this test in Australia, Canada and New Zealand, and the United States. For most people with PFS, I also recommend testing their Thyroid (TSH, T3, T4), Vitamin D status, Zinc levels, sex hormone binding globulin (SHBG) and prolactin.

But remember, not everyone with PFS will see any imbalances in their hormones even following detailed testing. More and more, I believe a holistic Functional medicine approach to treating PFS that includes gut health, diet and lifestyle is the best approach and many people will see the most significant improvement when they improve the health of their gut.