Finasteride / Dutasteride
Finasteride and dutasteride are prescription medications that inhibit 5-alpha-reductase, the enzyme responsible for converting testosterone into dihydrotestosterone (DHT). They are most commonly prescribed for androgenetic hair loss and benign prostatic hyperplasia (BPH), with dutasteride inhibiting a broader range of 5-alpha-reductase isoenzymes than finasteride. By lowering DHT levels, these drugs can effectively reduce hair loss progression and prostate volume in many users. However, they are also central to discussions around post-finasteride syndrome (PFS) due to reports of persistent sexual, neurological, and emotional symptoms following discontinuation in a subset of individuals.
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This page summarizes anecdotal reports and community observations, not medical evidence. Reports may be incomplete, biased or inaccurate and are not medical advice or recommendations. “Risk” here refers to how frequently severe or prolonged symptom worsening is reported, not to proven causation or population-wide probability. Individual responses vary widely, and absence of issues in some users does not rule out significant reactions in others.
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Within PFS/PSSD/PAS communities, finasteride and dutasteride are discussed in relation to their direct inhibition of 5-alpha-reductase, which blocks the conversion of testosterone to dihydrotestosterone (DHT) and reduces synthesis of 5-alpha-reduced neurosteroids. From a mechanistic standpoint, two commonly discussed hypotheses involve androgen signaling and neurosteroid/GABA-A modulation. One hypothesis suggests altered androgen receptor regulation and downstream gene expression following androgen disruption, potentially leading to longer-lasting changes in androgen-dependent tissues. Another focuses on reduced synthesis of 5-alpha-reduced neurosteroids (such as allopregnanolone), which normally modulate GABA-A receptors involved in mood, stress response, and sleep. These mechanisms are proposed models rather than settled facts, and may interact with pathways that are already dysregulated in PFS / PSSD / PAS.
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Reports of Severe and Sometimes Lasting Worsening (for PFS/PSSD/PAS):
Among individuals who already have PFS/PSSD/PAS, finasteride and dutasteride are approached with the highest caution as they are consistently described in community reports as preceding symptom worsening, with accounts describing both acute exacerbations and longer-lasting declines in baseline. Although the severity and duration of these reactions vary between individuals, reports within this subgroup show a largely consistent direction toward worsening rather than improvement. Many users report that re-exposure or cycling on and off anti-androgenic medications is particularly destabilizing. In light of this pattern, many within the community view finasteride and dutasteride as carrying a meaningful risk for those with established PFS/PSSD/PAS, even in the absence of controlled data.
For individuals without these conditions, finasteride and dutasteride are widely prescribed and tolerated by many, but there remains a subset of users who report persistent adverse effects after discontinuation. Given the uncertainty around mechanisms, the variability of outcomes, and the potential severity described in some reports, some people judge the risk to outweigh the cosmetic or preventative benefits.
Evidence basis: Anecdotal reports (online forums, patient self-reports); limited and ongoing research into mechanisms; no definitive clinical consensus.
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Public comments reflect individual experiences and opinions. They are not medical advice and may not be accurate or representative.