Male androgenetic alopecia and Post‐Finasteride Syndrome
Objectives: The hair cycle and hair follicle structure are highly affected by various hormones. Androgens-such as testosterone(T), dihydrotestosterone(DHT), and their prohormones - are the key factors in terminal hair growth. They bind to intracellular androgen receptors in the dermal papilla cells of the hair follicle. The majority of hair follicles also require the intracellular enzyme 5-alpha reductase to convert T into DHT.
Introduction: Androgenetic alopecia (AGA) is the most common form of hair loss consisting of a characteristic receding frontal hairline. Although a variety of medical, surgical, light-based and nutraceutical treatment options , it can be challenging to select appropriate therapies for this chronic condition.The literature has shown finasteride to be effective in treating patients with AGA and long‐term use of up to 5 years has shown significant hair growth and permanent stabilization of hair loss.
Materials / method: Finasteride and dutasteride can trigger an enduring sexual dysfunction that persisted even after stopping treatment. This includes erectile dysfunction, libido disorders, ejaculation disorders and orgasm disorders that continued after discontinuation of finasteride. Additional finasteride effects that can occur independently of any sexual difficulties but may also accompany sexual problems include: cognitive impairment depression, suicidality.
Results: Due to the risk of sexual side effects, clinicians should exercise caution when treating AGA patients with finasteride. The International Post‐Finasteride Syndrome(PFS) Foundation was established to provide public education and support for those patients living with PFS. The World Health Organization Programme for International Drug Monitoring’s database currently contains 21 274 finasteride adverse drug reaction, including 3725 reports of erectile dysfunction, 5204 reports of psychiatric disorders. Additionally, the database currently contains 103 cases of completed suicide.
Conclusion: The report discusses possible mechanisms of PFS development, including the nocebo effect. Possible methods of prevention and treatment of PFS are proposed.
