From the Guidelines
The side effects of finasteride, including depression and erectile dysfunction, are generally reversible for most people after stopping the medication, though some individuals may experience persistent symptoms. When finasteride (commonly prescribed as Propecia 1mg for hair loss or Proscar 5mg for prostate issues) is discontinued, many patients see improvement in sexual function and mood within weeks to months as the drug clears from their system. However, there is a documented phenomenon called Post-Finasteride Syndrome (PFS) where some men report long-lasting or potentially permanent sexual, neurological, and psychological side effects even after stopping the medication. The exact mechanism for these persistent effects isn't fully understood but may relate to finasteride's interference with neurosteroid production and androgen signaling pathways in the brain and genital tissues. If you're experiencing these side effects while taking finasteride, consult your healthcare provider before making any changes to your medication regimen. They may recommend gradually tapering the dose, switching to a topical alternative, or discontinuing treatment entirely depending on your specific situation and the severity of side effects, as suggested by the American College of Physicians 1, 2, 3, 4. Some key points to consider include:
- The prevalence of erectile dysfunction varies from 12.5% to 36% in studies of men with ED, and the evidence regarding the utility of routine hormonal blood tests was inconclusive 1.
- Treatment with an oral PDE-5 inhibitor demonstrated statistically significant and clinically relevant improvements in sexual intercourse and erectile function in patients with ED, with a weighted mean percentage of successful sexual intercourse attempts of 69% for sildenafil versus 35.5% for placebo 4.
- The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use, and base the choice of a specific PDE-5 inhibitor on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile 1, 2, 3. It is essential to weigh the benefits and risks of finasteride treatment and consider alternative options, such as PDE-5 inhibitors, under the guidance of a healthcare provider.
From the FDA Drug Label
- sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e. g. reduced ejaculate volume).
- depression
- Normalization or improvement of poor seminal quality has been reported after discontinuation of finasteride.
The side effects of finasteride, including depression and erectile dysfunction, may be reversible in some cases, as normalization or improvement of poor seminal quality has been reported after discontinuation of finasteride. However, it is also reported that sexual dysfunction, including erectile dysfunction, can continue after discontinuation of treatment. The independent role of finasteride in these events is unknown 5.
From the Research
Side Effects of Finasteride
- The side effects of finasteride, including depression and erectile dysfunction, have been studied in several research papers 6, 7, 8.
- According to a study published in 2012, finasteride has been associated with sexual side effects that may persist despite discontinuation of the medication, suggesting the possibility that the dysfunction may be permanent 6.
- Another study published in 2021 found that finasteride is associated with adverse psychiatric effects, including depression, anxiety, and suicidal ideation, which can persist even after discontinuing the treatment 7.
- A 2011 review discussed the potential persistent side effects of 5α-reductase inhibitors, including finasteride, and suggested that a subset of patients may experience prolonged adverse effects on sexual function, such as erectile dysfunction and diminished libido 8.
Reversibility of Side Effects
- The reversibility of the side effects of finasteride is not well established, with some studies suggesting that the effects may be permanent 6.
- A study published in 2012 found that 96% of subjects with persistent sexual side effects associated with finasteride continued to experience these effects after 9-16 months, despite discontinuation of the medication 6.
- Another study published in 2021 found that the risk of sustained sexual dysfunction was high (60.1%) in patients treated with finasteride, and that the risk of suicidal ideation or behavior was also greater in these patients 7.
Treatment Options
- Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, have been found to be efficacious in the treatment of erectile dysfunction (ED) 9, 10.
- A 2011 review discussed the use of PDE5 inhibitors in the treatment of ED and identified the main clinical, demographic, and relational factors influencing the choice of treatment 9.
- A 2017 review provided an overview of the pharmacology, tolerability, and efficacy of PDE5 inhibitors, including the sildenafil orodispersible tablet formulation, and found that these medications are well tolerated and effective in the treatment of ED 10.