What is post-finasteride syndrome? | Peter Attia & Mohit Khera

[@carlamccall8271]

Thank you for covering this topic. My brother was taking finasteride for about 7 years to treat alopecias. He told our father about the sexual disfunction that had eventually, consequently occurred and then a month later he committed suicide at the age of 49.

[@dawnwilliamson4660]

I'm so sorry for your loss

[@PostFinasterideSyndromeNorway]

:( its a real horror drug

[@carlamccall8271]

@@dawnwilliamson4660 thank you

[@DimitriTheBarbarian]

Crazy shit. Thank you for telling this story. It will save lives

[@Daniël-j7p6v]

Thank you so much for making a video about PFS. I think awareness is very important. My life has been completely ruined because of finasteride, I only took it for 2 months (1mg every other day) and got very sick from it. It started with ball pain, then progressed to swollen nipples, then also dry eyes, dry skin, blurry sight, lethargy, muscle spasms, muscle weakness, not being able to get it up with my gf, not being able to orgasm anymore, etcetera. Yes I know PFS is rare, but it really is a thing. I think it's a neurological issue first and foremost. Why a small percentage of men get this? I have no idea.

[@weidrake]

I have the same thing from low dose topical finasteride. It's time the world knew the truth.

[@mortenskov1802]

I find it interesting that the patients have to convince the health agencies that this in fact real. The patients who are weak and isolated. It should the be the pharma companies who keep testing their products long term to ensure that they dont cause irreversible damage like with Post Finasteride Syndrome.

[@meltedsnowman9637]

If it exists it’s so unbelievably rare that tons of huge randomised controlled trials are unable to show that it actually exists. As of now, there’s no good evidence it actually exists beyond being psychosomatic/a nocebo effect.

[@ethanbaggoo1513]

I have Post Finasteride syndrome and it is simply awful - thank you for raising awareness

[@naftalicoan9651]

Thank you so much for covering pfs. It needs way more coverage.

[@Armondahad]

So glad to see this getting more coverage. My experience with PFS was a living hell and my healthcare provider did nothing to warn me or check in with me about it. Sadly, I had no idea while I was going through it (partially due to an unimaginably horrible state of mind) that it was due to the medication.

[@petercoderch589]

I never experienced hormonal disruption on finasteride. But I had to quit because I just couldn't handle the psychological side effects. Finasteride makes me feel awful. Not that my natural mood is any good(I felt awful my whole life, with generalized anxiety disorder and anxious depression). But finasteride made me feel like truly roping myself. Just this awful feeling of constant apprehension and negativity. I love my hairline, but I *really* cannot afford to take a drug that makes me feel bad, because it's not like I have joy to spare. Me taking finasteride is like forcing an anemic to be a blood donor. I *really* need whatever tiny little bit of joy and peace of mind I can get, because I have so very little of it. I really have no joy to "spare" so to speak. Some of my friends told me that once the hair follicle due to the action of DHT, it's gone forever and no hair implant compares to your natural hair. So I am on a "window" to save my hair line and can't afford to be off. I get it. But I really don't have a choice. I almost threw myself from the balcony the other day. I I allow finasteride to sap away the very last bit of joy that I have, I will be losing a lot more than just5 my hairline. I just can't afford to deal with the psychological side effects of this drug.

[@DimitriTheBarbarian]

Who cares about stupid hair??! Please stay safe friend ❤

[@petercoderch589]

@@DimitriTheBarbarian Well, I care. I'm not exactly a looker. Losing the one good thing that I have sucks. Can't go from ugly to uglier. But thanks anyway.

[@DimitriTheBarbarian]

@@petercoderch589 most men are ugly. Just build muscles and put on nice clothes

[@robertpesche]

After taking finasteride 1 mg daily for six months, I developed ED and anorgasmia. I could ejaculate but felt nothing when doing so, nothing. Thankfully due to other videos of Dr. Attila, I knew about PFS and ceased taking finasteride, and things reversed gradually over about six weeks.

[@c_rob1]

It would be great if Peter would let the guy finish a thought without interruption

[@IakonaWayne]

Bought some finasteride from Amazon and haven’t used it yet. This was one of the reasons why, always have to weight your risk.

[@PostFinasterideSyndromeNorway]

PFS destroyed my life. This is no joke.

[@dario4177]

Hold on

[@sebasD343]

In what way has this ruined your life? I find it difficult to say whether I now suffer from this too. I have been using Essengen 6 plus for 8 months, which also contains finasteride. In the first few weeks I suddenly started having trouble maintaining eye contact, this only got worse. Now I have an anxiety disorder as a result. I can not say whether this is due to the finasteride, but it is striking that this started to develop a few weeks after using it. Three months ago I stopped using Essengen 6 plus. I actually saw regrowth of the hair, but I can not say whether this played a role in the anxiety disorder that I now have. That is why I stopped just to be sure.

[@PostFinasterideSyndromeNorway]

@@sebasD343 yup i have the same. horrible anxiety, almost autism like. i cant watch people in the eyes, 24/7 panic mode inside. cant relax. +20 other symptoms. worst symptom is the complete removal of emotions. ahedonia.

[@karensuarez2113]

Almost 70 YO female here, whose bad testosterone was high, probably due to T pellets and my system not converting properly- for whatever reason, probably some genetic polymorphisms neither my doctor or I am aware of. He prescribed Finasteride and it took 4 months for my bad T to return to normal values. At this point, I see my egfr going down. In my mind correlation equals causation, as nothing else as far as diet, etc, changed. Printed off a study showing where Finasteride ‘can’ affect renal function and handed it to my doctor, telling him I took myself off the drug. So now taking OTC supplement called Absotace with zinc, selenium, saw palmetto and nettle root in it. Will see what bloodwork shows in about a week, been off the Finasteride for about 2 months. If bad T rises again, I might forego the pellets. Definitely do not want to have post Finasteride syndrome.

[@cccalifornia7206]

Thank you gentleman!!!💖👍🇺🇸🇺🇸🇺🇸

[@ceylonlife]

Any idea on topical finasteride?

[@weidrake]

What Dr Attia is saying regarding 8% suicide rate within the finasteride population being explicable by this population already suffering from alopecia, representing already depressed mental state, could be valid until you consider that the population of those who are distressed by their alopecia do not have a suicide rate of 8%. Those who use minoxidil, which is a similar indication that the patient is distressed by their alopecia, do not have an 8% suicide rate. Additionally, the rate of suicide for those with depression is not 8%. There is something specific about finasteride that is leading to these disastrous outcomes in a small subset of men. For what it's worth, I developed post-finasteride syndrome (PFS) and it is hell on earth. I have over 30 symptoms which came on mostly overnight, spanning neurological, physical, and sexual domains. This is a multisystemic syndrome, not a matter of hormonal imbalance or even just depression or sexual dysfunction. Until doctors understand the full scope of the disease, they will forever continue to prescribe a drug which can completely destroy lives.

[@MichaelMerritt]

Would the explanation for PFS be similar how a subset of men who take steroids are never able to recover their natural levels? Is it the body just stops producing certain hormones or neurological chemical messengers?

[@PostFinasterideSyndromeNorway]

Androgen receptor overexpression. or simply AR Disfunciton. Androgen receptors are everywhere in the body; brain, penile tissue, gut,muscle. you name it. when your Androgen receptors dont work properly, you get tons of different symptoms.

[@shaker8984]

Hormones do go back to normal, it’s not connected with that. Which means also the enzyme that creates DHT also works normally. It has to be something different.

[@PostFinasterideSyndromeNorway]

@@shaker8984 its the AR

[@MrPelham32]

I remember when I first tried oral finasteride 1mg.. and I remember having crazy brain fog, ED, and it was very difficult for me to go to sleep. I couldn't tough it out even on 1 mg every other day. I switched to topical finasteride and the side effects went away 90%. apparently research says that topical finasteride will still descrease dht serum levels 50%.. Research is showing that topical dutasteride is showing 90% scalp dht levels reductions and only 20 % reduction in serum dht levels. The only cons seem to be the practicality of use compared to just taking a pill and the price is more than double. For now I'm still on topical finasteride

[@RAMjbeiha]

Dilute your topical finasteride. You will get no side effects

[@MrAlexius1992]

We need to know if Professor Khera is conducting new studies; can you ask him? it's a very relevant topic. There are thousands of people out there with ED that want to be normal again and having a sexual life

[@Excaliburhope]

Is there any data that indicates HCG as a possible treatment for PFS? Any information regarding how long cognitive side effects persist after cessation of finasteride? Thank you.

[@lordmolyneaux8675]

I've heard something like this happening from Paxil. Any truth to that?

[@MileHiGuy95]

It's called pssd it's pretty much the same

[@lordmolyneaux8675]

@@MileHiGuy95 Didn't realize they had name for it. Thanks.

[@stevetentler1925]

What if it's topical?

[@guille8756]

It has the same systemic absorption, topical dutasteride is better

[@polespinosa4858]

Meso dutasteride destroyed me

[@shaker8984]

Topical dutasteride is also absorbed systematically

[@MorganHayes_Composer.Pianist]

not without risk

[@RAMjbeiha]

@@guille8756false who told you ? You can use a lower dose that only reduces 10-20 percent systemic

[@Yiahi65]

Thank you post finasteride Syndrome is such a terrible disease

[@Ahdbfbfbeh]

Europe uses finasteride and sduetasteride very often for hair loss

[@robinmorris8201]

My husband has been in a low does for 18 years with no issues. His hair loss stopped immediately, and he still has a whole head of hair.

[@muza45]

What dosage?

[@DimitriTheBarbarian]

Why do you care if he has hair or not. Serious question. You are an adult not a dam child

[@robinmorris8201]

@@muza45 1mg

[@robinmorris8201]

@DimitriTheBarbarian Your question makes no sense. It was his choice to treat his hair loss. What does this have to do with me? I was just sharing his outcome so that people know that not everyone has side effects. That being said, there is nothing wrong with wanting to keep your hair or caring about your appearance. And if you think physical attraction is irrelevant, you are a damn child for sure.

[@DimitriTheBarbarian]

@@robinmorris8201 as an adult woman you care about your middle aged husband’s hair? You sound immature. And thanks for your concern about my appearance - I maintain perfect physique and at this age I get way more attention than in my early days when I had full head of hair. Go figure

[@MorganHayes_Composer.Pianist]

02:40 less than 5% is still a lot....are you sure the packaging says this?

[@robertpesche]

Dr. Attia & Team, if you see this, hair doctors have found 0.5 mg finasteride three days a week is enough for most men seeking hair regrowth, and after regrowth, once a week will maintain it. Might be worth validating this and spreading the word.

[@joellim7010]

The blue Shirt guy needs to stop interrupting the other guy when he is speaking. Keeps interrupting every 5 seconds. Wtf, AHAD is it?!

[@Kyle_Bu]

Okay then make a robust study with a good methodology that proves this. Ive seen every claimed PFS study and they have extreme selection bias, no baseline measurements, and many rely on animal models that receive the human equivalent of 3-5grams of finasteride or Dutasteride (they also have different physiology thats not 1-to-1 with humans by no means). The truth is, many of these men have been negatively conditioned and have Nocebo effect.

[@KevinJDildonik]

This. Insecure guys think everything causes or cures erectile issues. I'm sure someone on Reddit right now is saying you can use avocados to treat finasteride problems, and someone else is saying avocado blocks finasteride from working, and someone else... Etc. Millions of men are on finasteride. Side effects, so far as I can tell from the best research I can find, seem to be well within placebo range. If Finasteride was as bad as the internet says, hundreds or thousands of men would be falling dead in the streets. We'd notice.

[@tracewaybos]

Finding someone to fund a "robust" study is a problem. Many drugs have longterm side effects that are disregarded. Look at Accutane or even baby powder for example... Don't dismiss something just because the current studies don't elucidate your bias.

[@Kyle_Bu]

@tracewaybos nice excuse. It doesn't justify accepting anything that someone claims they have or a bunch of people in an internet forum where these mental pathologies are cultivated

[@adamhouse8465]

As an epidemiologist, I can confirm there is strong evidence supporting Post-Finasteride Syndrome (PFS). Multiple studies have documented persistent changes in androgen receptor signaling, epigenetic modifications, neurosteroid imbalances, and structural brain changes in PFS patients. For example, a study published in Journal of Clinical Endocrinology & Metabolism found reduced neuroactive steroids in cerebrospinal fluid of PFS patients. Another study in Andrology linked PFS to persistent dysregulation of the 5-alpha reductase pathway. Research in Molecular Medicine Reports also identified changes in gene expression related to androgen receptors. While earlier studies had limitations, these recent works use robust methodologies and objective biomarkers. Additionally, Merck faced legal action for concealing known risks during trials, further supporting the credibility of these findings. The drug companies had to amend their pamphlets to include the risks of persistent sexual and psychiatric dysfunction AFTER stopping the medication. The “nocebo effect” argument ignores the biological markers and consistent results across studies, dismissing real scientific evidence and the experiences of those affected. There are also stronger studies in the works that should be released in the upcoming years. Finasteride has faced growing scrutiny in Europe and other areas of the world, yet all its supporters tout it in a way not seen with any other drug. Like they are in a cult. Frankly, it’s disturbing and highlights their poor ability to mentally cope with hair loss that’s been exacerbated by the psychiatric effects of the drug, particularly its decreasing in gabaergic transmission in the GABA_A receptor. Anybody who thinks finasteride is safe is either desperate to keep there hair and is willfully ignoring the increasing scientific consensus that this condition is not only real, but life altering, or they are making money off the medication like those pop up tele-health clinics. I’m looking forward to the publication of a few more robust research articles soon. Finasteride is already under growing scrutiny by EU bodies and has been banned in some European countries. Additionally, it’s prudent to talk about Post Finasteride Syndrome as a neuromuscular systemic disease. Often only the hallmark symptoms of sexual dysfunction and psychiatric deterioration are reported, in reality this disease affects multiple systems including renal, neurological and muscular. Symptoms that do not get discussed are vision loss, decreased kidney function, poor sleep, significant decreases in cognition, alterations in skin sebum production and severe fatigue. It’s a disease that will prevent you from living life normally. Not one that you can remain functional with.

[@Kyle_Bu]

@@adamhouse8465 Interesting how you cite your profession. Then you out of all people should know better as the studies you're referring to do not prove causality that finasteride or even Dutasteride caused any of those problems. Interesting how you don't mention the studies titles. Anyway, it's a nice day in Chicago but I'll humor your write up for a bit to show how dishonest you are and how you are part of the problem of affirming Mass psychosis. Among the weaknesses, one might identify that the study "Altered methylation pattern of the SRD5A2 gene in the cerebrospinal fluid of post-finasteride patients: a pilot study" by Melcangi et al. (2019) includes a limited sample-a group of 16 PFS patients and a control group consisting of 20 individuals, even fewer CSF samples. One major limitation is that the control group consisted only of healthy people receiving spinal anesthesia, and did not involve those taking finasteride who never developed PFS- which would have been a far more meaningful control. Gee I wonder why that wasn't included in the study? Remember, you're making an epigenetic claim here that this mutation is unique to pfsers and might be the cause of their condition. It is also not clear whether the SRD5A2 methylation in CSF represents a pre-existing condition, was induced by finasteride, or is unrelated altogether. The study points out the tissue-specific methylation, but it does not provide ANY in-depth view into either the mechanisms or how these changes relate to symptoms like depression or sexual dysfunction. ALSO, the findings do not indicate a clear correlation of methylation status with the severity of such symptoms, and this raises questions about the importance of such methylation. Again, why not include healthy people who take finasteride and dutasteride? There's no excuse here. And finally while sometimes useful, both the retrospective design and technical challenges associated with extracting DNA from CSF are added limitations of this study. CSF doesn't always give a clear indication neurosteroid levels in the brain. So you didn't say anything new here. It's bad evidence.

[@ACRemote-z8x]

When you say “subset” please give a rough measurement, especially because you’re talking about a subset of subset (men who have pfs from among men who experience side effects from finasteride). The fraction of people who experience side effects is already so small that the multiplicative probability will be really small.

[@vinaysai2445]

Please don't use finasteride my sincere advice

[@SenorSiesta]

Peter Attia & Mike Isreatel do an interview with Dr Oz. How good would it be?

[@BlaatSchaap85]

Mike Israetel thinks dr Oz is an evil quack.

[@Sam-uk4mb]

jesus christ Pete stop interrupting your guest

[@bioptimization]

Post Lions Mane anyone?

[@timpoos4635]

Peter, please let the man talk!!!!

[@PostFinasterideSyndromeNorway]

He keeps cutting off the brown guy

[@breach6000]

I also had side effects, but the opposite way. My sex drive went up, and started to have sex twice a day, that at 40 years old had not happened to me for at least two decades. Also my testosteron went up from 700 ng/dl to 1070 ng/dl, though there might be other confounders to that.

[@polespinosa4858]

Thats how It works. Libido will crash if you stop taking it. Mine went up to 1300 ng/dl Estrogen up to 70 pg/dl From Duta mesotherapy Libido extremely high, penile and nipple pain, extreme stress, urine incontinence... And HAIRLOSS my hairline advanced a lot and its very fine and weak hair. Duta left me numb and depressed. Extremely vulnerable to stress. Unable to fall in love or truly desire. wich sucks with high libido. It depends on how "hungry" its your brain for neurosteroids. Your baseline T levels, and aromatase activity.

[@MrAlexius1992]

@@polespinosa4858 The sad thing is that ALLO has been marketed in the USA for post partum depression but no one is trying to give it to people with post finasteride syndrome

[@wasteman3259]

This guy really doesn’t seem to be confident in what he’s saying

[@fabioserenelli]

To Believe. To Not believe … great science talk…

[@jonathonkibble8792]

You mean how attia talks about anything? Lol He says it with much more certainty though to be fair, he’s caused 20 year olds with LDLs of 100 to take statins LOL

[@KenOtwell]

Men who have this syndrome have the syndrome... uh, what?

[@neilkinsella8753]

It seems like Peter is trying to justify his decision not to take finasteride all those years ago when his hair started to fall out

[@jonathonkibble8792]

I feel like attia doesn’t care about his hair that much

[@Sam-uk4mb]

or maybe he's perfectly happy with his lack of hair and you're projecting your own insecurities on him

[@DimitriTheBarbarian]

Smart man. He is healthy fit successful. I think he is professional cyclist. And he is one of the most recognizable social media influencers. Not bad

[@8Wylie]

Those that self-reported feeling depressed were more likely to commit suicide 🤨

[@sdkid294]

Bro I will send you my list of symptoms and you tell me what you think my head hurt the whole 5 years I’ve never heard of depression causing that

[@Rad6866]

This guest is quite clearly not credible. His analysis and justification is so wrong. Keeps saying “I believe …” this ain’t religion.

[@MaximusStetich]

There are also arguable claims to be made in science, which entail being honest and leveraging one’s expertise against another’s in the statement of beliefs - hypotheses - as to what is occurring. Yours is a puerile and neutered science. We can pick apart his arguments all day - I find plenty of them fallacious myself - but he is properly qualifying what he states as hypothesis and what he states as established scientific consensus. Would you prefer he make no qualifications, and be scientifically dishonest?

[@robertpesche]

It's an interview, not a study. He's much more credible than you: "Mohit Khera, M.D., M.B.A., M.P.H., Associate Professor, is the Director of the Laboratory for Andrology Research at McNair Medical Institute, Baylor College of Medicine. He is also the Medical Director of the Executive Health Program at Baylor. Dr. Khera is a Board-certified urologist specializing in male infertility, male and female sexual dysfunction, and declining testosterone levels in aging men."

[@robertpesche]

What are your qualifications to evaluate his hypothesis that finasteride blocking the conversion of progesterone to allopregnanolone can cause suicidality in a small subset of men?

[@mikes6403]

@radmehrabdolahi you start taking it and prove he is wrong 😂

[@cocopopsbrahhh]

You clearly don’t understand how scientists are trained to speak, and you are missing the point - when you have a claim that is currently absent of a definitive body of evidence you MUST preface it with “I believe”, otherwise you would be speaking definitively and would be a charlatan. The fact that he says “I believe” shows that he is being transparent about the current state of the evidence.

[@iosifkovalenko8364]

It could very well be because many men who took finasteride in the first place are insecure and depressed about their hair loss to begin with. While, some men accept the hair loss and may even embrace their bald (often shaved) head.

[@TruthsSake]

This has been scientifically dismantled and debunked by the KZbinr Hair Cafe (Kevin Mann). With well established evidence.

[@forestgiest1380]

What is post-finasteride syndrome? Not real.

[@jonathonkibble8792]

Why would you doubt that it’s a thing for a small subset of the population? Copium?

[@sdkid294]

This is great and all but why don’t you interview the people who “have pfs” and see if you can explain the symptoms

[@sdkid294]

My mom had to watch me walk around brain dead for 5 years like I had brain cancer if finasteride caused this my story is out there on redit and moral medicine

[@zrk5487]

Interviewer must learn to STFU and let guests talk

[@iosifkovalenko8364]

It could very well be because many men who took finasteride in the first place are insecure and depressed about their hair loss to begin with. While, some men accept the hair loss and may even embrace their bald (often shaved) head.

[@MileHiGuy95]

You're wrong. This happened to me and I don't care about hair anymore. I'd trade it all to be healthy again

[@iosifkovalenko8364]

@ Calm down. I never said that it was every case. I used the word “many.”

[@Yiahi65]

This honestly is just so incredibly wrong lol

[@mflynnnj1]

@@iosifkovalenko8364 How 'bout you calm down. Pretty rude.

[@iosifkovalenko8364]

@@mflynnnj1 Oh please Mr hypocrite. You didn’t barge in to be polite.