Post-Finasteride Syndrome: how to resolve it by…

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Post-finasteride syndrome is leaving behind a slew of victims in its trail.

Some say it’s all in the mind, a made-up myth…but those who suffer from it surely know they’re not just a hypochondriac.

It’s real alright.

Mechanisms of finasteride

So let’s discuss what the drug, finasteride, does in the first place.

Finasteride is a 5-alpha reductase inhibitor and this blocks the conversion of testosterone to DHT. What few people know is that there are 5β-R and 3 types of 5α-R enzymes and that they’re not only involved in the conversion of testosterone to DHT, but also in the:

  • synthesis of bile (5β-R specifically), which is essential for the digestion of fat and absorption of fat-soluble vitamins. Bile also acts as an anti-bacterial and anti-microbial substance which keeps the gut clean and prevents SIBO and SIFO.
  • conversion of:
    • androstenedione → 5α-androstanedione
    • progesterone → α-dihydroprogesterone (a very important neuroactive steroid and precursor to allopregnanolone)
    • deoxycorticosterone → dihydrodeoxycorticosterone (DHDOC)
    • cortisol → 5α-dihydrocortisol (for the deactivation of cortisol)
    • aldosterone → 5α-dihydroaldosterone, which increases the excretion of salt, the opposite of aldosterone

Many of the benefits of testosterone, such as enhanced insulin sensitivity, reduced catabolism, higher dopamine, increased thyroid hormone production, are mediated by DHT, and blocking DHT production prevents those effects/benefits.

PFS isn’t fun. It scrambles your hormones, libido and cognition all over the place, right into the gutters, and leaves you feeling like an empty dysfunctional husk. Additional side effects of finasteride include:

  • dry skin or thinning of the skin, weight gain, elevated glucose and lipids and worsening of insulin sensitivity (R). 
  • insomnia, obstructive sleep apnea (R), panic attacks, brain fog, suicidal idealization, slow cognition, anhedonia (a sign of elevated serotonin and low dopamine)
  • diminished libido, erectile dysfunction, ejaculatory complaints, penile discomfort, loss of scrotal sensitivity, scrotal discomfort, loss of pubic hair, increased sperm density and gyno (R).
  • involuntary muscle spasms, loss of muscle tone, increased body weight (R).
  • kidney disease. DHT is highly protective to the kidney and an elevated estrogen:androgen ratio is destructive to the kidney (R).
  • accumulation of fat in the liver and the progression of fatty liver (causes NAFLD) (R). Cortisol antagonist can help reverse some of these effects, which just indicate that 5-AR can prevent fatty liver by deactivating cortisol.
  • reduced muscle mass gains even while on testosterone (R).
  • alteration in the gut microbiota, which can lead to digestive issues, skin issues, mental issues, etc. (R)
  • neuroinflammation (R). Neurosteroids such as 5α-DHP and allopregnanolone stimulate neurogenesis, neuronal survival, neuronal differentiation, synaptogenesis, glial differentiation, myelin formation, synaptic function, and synaptic plasticity (R). In addition, under pathological conditions, neuroactive steroids exert neuroprotective actions, promoting neuronal survival and re-myelination and decreasing neuroinflammation.
  • anti-androgenic actions (R). Due to the structural similarity of finasteride to DHT, it is postulated that finasteride could bind to the androgen receptor. It turns out that finasteride happens to be a potent anti-androgen, independent of lowering DHT.
  • Osteoporosis (R)
  • Adrenal insuffeciency (R). “A putative mechanism is that elevated bile acids inhibit inactivation of cortisol in liver by 5α-reductases type 1 and type 2 and 5β-reductase, resulting in compensatory downregulation of the hypothalamic-pituitary-adrenal axis and adrenocortical atrophy.“
  • Excess cortisol (R). DHT is needed to shut down the HPA axis, so blocking it increases cortisol. 5AR is also needed to deactivate cortisol, so without enough 5AR, someone can be in a hyperstressed state all the time.
  • Messes with bile synthesis and excretion, creating toxic bile acids and cholestasis (R). “Due to the failure to synthesize primary bile acids in the AKR1D1 deficiency and the production instead of a spectrum of highly cholestatic and hepatotoxic 3-oxo-Δ4 bile acids[3], bile flow is impaired, leading to cholestasis. Since bile acids are essential for micellar solubilization of lipids, fat and fat-soluble vitamin deficiency occurs quite often.”

Hormonal and neurotransmitter alterations due to finasteride

A low DHT state can lead to low dopamine (R), high estrogen (R), high prolactin (due to reduced dopamine), high cortisol (due to reduced clearance) (R), elevated serotonin (due to elevated estrogen and lower dopamine) and hypothyroidism (R).

But always do blood tests first to see what is really going on. Do tests to see pregnenolone, progesterone, testosterone, DHT, thyroid (TSH, total and free T4 and T3, rT3), estradiol, estrone-sulfate and cortisol (both blood and 24h saliva).

In some people with PFS, DHT might be normal, but testosterone and cortisol low and estrogen and prolactin high. With proper testing you know where to focus on. 

If you’ve already done blood tests and want to learn how to interpret them, check out these articles:

If DHT is high, then you don’t have to focus on boosting DHT, but maybe rather allopregnanolone through increasing 5-AR type 1.

If prolactin is high, dopamine is most likely low and serotonin elevated, so then it would be good to focus on lowering prolactin.

If estrogen is high, focus on lowering that, as estrogen is a potent inducer of serotonin and prolactin.

If cortisol is low in blood tests, then you can focus on increasing that, but if cortisol is low in saliva tests but high in blood tests, focus on calming the adrenals.

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Increase DHT

Let’s say your DHT is low, here are the top 7 supplements you can use to increase it:

  • Creatine
  • Boron
  • Butea Superba
  • Caffeine
  • Tribulus Terrestris
  • 11-keto DHT
  • Androsterone

If you want additional methods on increasing DHT apart from supplements, check out my comprehensive article on boosting DHT:

> How to increase DHT

Increase allopregnanolone

If DHT is normal and you still feel off, mainly anxious, not confidence, shy, nervous, experiencing brain fog, etc., you might be low in allopregnanolone.

5α-R type 1, which creates the neurosteroids 5α-DHP and allopregnanolone downregulate the glutamatergic system. Low levels of these hormones increase glutamate and may account for the appearance of behavioural disorders such as anxiety, aggression, and cognitive dysfunction.

Here is how you focus specifically on increasing allopregnanolone:

  • Niacinamide
  • Glycine
  • Caffeine
  • 5α-DHP
  • Alcohol (not a long term or good strategy really)
  • Androsterone – both allopregnanolone and androsterone are potent GABA agonists, so might substitute to a degree for each other. DHEA potently increases androsterone levels, and that is how it’s thought to lower anxiety.
  • Topical progesterone – the skin is rich in 5-AR, so applying progesterone to the skin should increase allopregnanolone.
  • THC has been shown to increase brain pregnenolone, but this study shows that cannabis users have higher pregnanolone (a 5β-metabolite) and lower allopregnanolone (a 5α-metabolite) (R). However both are GABA agonists, weed might not be the best thing to use as it might even lower 5α-R in favour of 5β-R.

Lower estrogen

The optimal range for estrogen is around 20pg/ml and if yours is much higher, it would be best to make it a priority to lower it.

A few top supplements to lower estrogen include:

  • Zinc
  • Caffeine
  • Androsterone
  • Calcium-D-glucarate
  • B-complex

For more a comprehensive guides on lowering estrogen, check out this article:

Increase dopamine

Dopamine, testosterone and DHT go hand in hand with improving cognitive function, creativity, determination, positivity, problem-solving, euphoria, etc.

You definitely want high dopamine and low serotonin to optimize cognition and mindset.

Here are a few good ways to increase dopamine:

  • Destress
  • Get lots of sunlight, especially in the morning
  • Wake barefoot in nature
  • Use Catuaba bark extract, mucuna pruriens, Tribulus Terrestris, etc.

For more a comprehensive guide on boosting dopamine, check out this article:

> How to increase dopamine

Lower prolactin

If dopamine is low, then prolactin will most likely be high. Prolactin is a bugger when it comes to mood and cognitive function. Keeping it low, below 7ng/ml, is absolutely key to improving.

A few of the best ways to lower prolactin include:

  • Vitamin E
  • Dopamine agonists, such as mucuna pruriens, huperzine A, Catuaba bark extract, etc.
  • Tribulus Terrestris
  • High dose vitex
  • Estrogen antagonists
  • Serotonin antagonists

For more a comprehensive guide on lowering prolactin, check out this article:

> How to lower prolactin

Lower serotonin

Serotonin is most often high in all mental and physical disorders and there is always a serotonin receptor/s gone rogue. Some might be upregulated and some downregulated, so you might experience heightened serotonin responses.

Some people actually report dramatic improvements in their symptoms after starting a certain SSRI. “How do you explain that? Huh? Punk?”

Well, SSRI drugs almost never only inhibit the reuptake of serotonin, but they often also increase allopregnanolone, decrease serotonin receptor sensitivity, block certain serotonin receptors, release dopamine and histamine, etc.

See? It’s really not the serotonin that’s so beneficial.

A few good ways to lower serotonin include:

  • Destressing
  • Increasing carbon dioxide production. CO2 keeps serotonin in check.
  • Get lots of sunlight
  • Salt
  • Vitamin B2
  • Lower estrogen

For a more comprehensive guide on lowering serotonin, check out this article:

> How to lower serotonin

Additional tricks

Apart from just focusing on hormones and neurotransmitters, you can also focus on diet and lifestyle. Here are a few things you can do:

  • Destress
  • Get lots of sunlight
  • Grounding
  • Get proper sleep
  • Do explosive exercises, such as uphill sprints, muscle-ups, jump squats, burpees, etc.
  • Fix the liver
  • Lower inflammation
  • Eat truly organic
  • Avoid all environmental plastics and toxins
  • Be with supportive fun people
  • Be active and do fun, exploratory things
  • Cold and hot exposure, such as swimming in a cold river and doing sauna sessions
  • Optimize thyroid. 5α-reduced steroids are significantly increased in a hyperthyroid state.

How soon can you expect to see results?

Finasteride binds to 5α-R type 2 with high affinity and dissociates very slowly with a half-life of 31 days. Furthermore, finasteride inhibits CYP3A4 (which is the enzymes that detox finasteride) and that can cause a significant buildup of finasteride in the body over time.

With that in mind, DHT can take anywhere from 4 weeks to 2 years or more to recover (R). But that does not mean you have to live with all the symptoms for that long. It just means that you might have to implement certain strategies and use certain supplements for quite some time before the enzymes normalize.

Very high levels of finasteride might then also be able to block 5βR, which will reduce bile flow. Are you sensitive to dietary fats and have greasy stool with fat floating on the surface of the water after pitching a loaf? If so you might have reduced bile flow. You might thus benefit from things that stimulate bile flow such as taurine and TUDCA. But check your bilirubin just in case.

A few additional tests you can do include:

  • Bilirubin. Like mentioned above, it can help see if you have reduced bile flow
  • Total cholesterol, LDL and HDL. These might be distorted by the drug, so keep an eye on them to see if they improve over time with what you’re doing.
  • Vitamin D. Most people are low in vitamin D and vit D is very helpful to people with PFS.
  • Liver enzymes. The buildup of the drug could cause liver damages, so have your liver enzymes tested to find out if you need to focus on your liver or not.
  • Check 3adiolG for increases and 3adiol for decreases

42 thoughts on “Post-Finasteride Syndrome: how to resolve it by…”

  1. Hey mate I have just stopped finasteride after 7 yrs on it. I’m 3 weeks off cold turkey. I had no noticeable sides until sexual problems which started 3 weeks ago so I stopped. I would appreciate some specific help if you could get back to me. I have blood and hormones test results if u want. Cheers

    Reply

  2. I am 29 now and started at 22. I am quite distressed atm and hope this is not permanent and everyone is telling me I’m just hypochondriac but I know my sexual function is inhibited for the time being. I started losing hair about 18 yrs old if that helps

    Reply

  3. Hi I got post finasteride syndrome like side effects from saw palmettherbal blend of dht natural inhibitors from amazon https://www.amazon.com/product-reviews/B004PVLWW0/ref=acr_dp_hist_2?ie=UTF8&filterByStar=two_star&reviewerType=all_reviews#reviews-filter-bar and i did blood work (rosch eclia methodology) but endos can’t find anything that could cause all the side effects im dealing with. I am doing a High sensativity blood panel soon, would you be able to also look at my blood work to see what could be the problem with everything i am experiencing?Thanks

    Reply

  4. is a recovery really possible? i been suffering for close to a year from just 3 weeks of usage. I have had retraction of penis and man boobs. I took and i am taking many of the supplements listed with no real improvements.

    Reply

      • Hi, being a young guy with PFS since 8 months this article has been very helpful to furthermore understand what is possibly going on, so thank you. I’ve made a 80% recovery so far and I keep improving however your hypothesis is quite scary.
        You do think that these hypothetical damages can be reversed ?
        Thanks

      • Hi man, what have you done so far that helped you to 80% recovery?
        It can be reversed yes. I think it’s a combination of low energy production due to cellular damage and excess ROS production. So optimizing cellular function with CoQ10, necessary vits and minerals, thyroid hormones, neurosteroids, etc., should all be helpful at restoring the problem.

  5. Thanks for this great article.

    What do you think about a PCT strategy to see if that helps? Like clomid, nolvadex, HCG?

    Reply

    • Hey Peterson,
      Thanks for the positive feedback and I’m glad it’s helpful.
      Some people do have success with HCG, but less so with clomid. Do you generally feel overstimulated and suffer from insomnia?

      Reply

      • Hi, no I don’t have insomnia. My biggest issue is low/no libido.

        So far I tread Clomid and nolvadex cycles but I only had one day where libido returned, rest of time didn’t feel anything good or bad when on it.

        What do you think about proviron and other DHT derived steroids? I found some recovery stories with these compounds.

      • Some people get results, but often only 1 steroid isn’t enough. So combining progesterone + DHEA and allopregnanolone + DHT can be is even better.

  7. Hello. I find this amazing article. I suffered PFS till 4 years with many problems:
    Bone pain
    Muscle pain
    Brian fog
    No libido
    Prostatis
    Acufene
    Etc… Etc…
    I want to try HCG 50 UI per day. My test blood is perfect. The only problem is that I have an high PROGESTERONE and High colesterol out of higher range both.
    HCG will increase progesterone or will decrease it?
    Thanks in advance.

    Reply

  8. Good morning,
    I’m in PFS from February 2018. I tried only. Natural solution without any success.
    I want to try a solution like HCG low dose:
    From 50UI per day.
    My blood level are ok only progesterone and colesterolo are higher than the max range. What’s happening to the progesterone if I try HCG?

    My sides are:
    – Bone pain
    – Brain fog
    – no libido
    – prostatis
    – cold penis
    – shrink penis.

    Thanks for the responses

    Reply

    • I think progesterone is high because it’s not converted further downstream possibly due to 5AR downregulation.
      Have you tried getting loads of sunlight? Do you have any digestive issues?

      Reply

  9. Hey man,

    I got Post Accutane Syndrom, which is related to PFS, there is a down regulation of 5 alpha reductase 1.
    How much Glycin and Niacinamid do you recommend? I will start Progesterone cream with tongkat ali soon. Also do you recommend an androsterone supplement, I haven’t heard of that option so far.

    Reply

  10. What do you think of TRT is PCT to recover from PFS? Also it’s strange. My physical and psychological strength is coming back. Sexual functioning is returning to some extent. Both are inconsistent. If I work out too much or my job is extra stressful I become symptomatic. The brain fog has never gone away. I’m wondering if that Has to do with gut health. I am on the transcrotal cream. Four clicks per day at .25 mL each. My total t is 650 ng/dl. 200 mg of pregnenalone per day. Will start vitamin K soon. Thank you so much for your time

    Reply

  11. Also I jumped the gun on TRT out of frustration and desperation. I’m starting to find websites like yours with good advice. I’m not beholden to trT. I am investigating other solutions. There are some nice recovery stories on TR. Although, they would like you to believe testosterone replacement is the only solution to make a full recovery. As I read websites like yours and CDsNuts. You can argue with the theoretician but you can’t argue with the anecdotal stories of successful recovery.

    Reply

  12. wow very helpful articular and explains my symptoms exactly. been putting it off, but this convinced me to see a doctor and gives me hope. really have been feeling like an empty husk like described lately, almost like a part of me was ripped out, but maybe one day i can find it again. thank you, i will try to update in the future.

    Reply

  13. Hi Hans,

    Love the site. Just wanna ask advice from a casual weed smoker – as in vaping on weekends – what would be a good supplement/nutritional addition to counter any negative effects?

    I just picked up Gaba, i’m assuming this is a good idea?

    I train a lot, heavy resistance, HIIT, play sport, drink very little. Cannibus is my only vice, so any suggestions would be greatly appreciated.

    Reply

  14. Hi Hans Amato,

    I have had PFS for 15 years, just came across your article, would you be interested in looking at my labs for comment?
    I want to try a combination of what you have listed above mainly to try and increase dopamine.
    I tried an illegal drug that increases dopamine and all of my issues went away briefly, so i think dopamine is a big piece of the puzzle here, especially with penis sensitivity.

    I just want to make sure i don’t make any mistakes. I have tried a few of the a above already alone with no improvement however I think a holistic combination may be the answer.
    After 15 years of research i also believe mycotoxins are playing a big role in this, mycotoxins damage the grey matter in your brain which would cause dopamine issues, then a cascade of issues from hpa axis dysfunction, gut issues, hormone issues which wont go away under a complete mycotoxin detox is done.
    Finasteride blocks the glutathione production leading to mycotoxin build up if you were living or working near mould and not knowing it.

    Reply

  15. Hi Hans,

    Thanks for helping people with this truly debilitating syndrome, in my case I was an othewise healthy active 66 year old that was prescribed Dudasteride for an enlarged prostate 3 months ago , after 7 weeks I stopped taking the drug and within several days I came down with a host of symptoms. Chronic insomnia , I am now taking Trazodone which helps me get to sleep, I also have myoclonic twitches and brain zaps while trying to fall asleep and my auditory system is super sensitive any small noise at night makes my me jump even when wearing ear plugs. Now two months after stopping Dudasteride, my twitches and brain zaps are now greatly diminshed, insomnia is still a problem though. To help with sleep I am also I use Magnesium , Lemon Balm, Taurine, Theanine and other sleep-aid herbs . My goal is to get off Trazodone as quickly as possible, any recomendationsto further aid with insomnia ?

    I also started taking Allopregnalone ( Ideal Labs ) along with coconut oil whcih has helped with my mood and anxiety. I also had dysbiosis in my gut which is slowly being resolved with the help of probitics. Any other advice that would help is greatly appreciated.

    Thanks in advance,

    Karl

    Reply

  16. Hey Hans,

    Who would have thought trying to enhance the hairline would cause bigger problems! No one informed me this could be a risk! I took a topical of Fin/Minoxidil for less than 3 months and just recently have experience whole body weakness, stiffness, joint pain, brain fog and a lower feeling of well-being/happiness. If I can increase my DHT levels again by upping my TRT and take an estrogen blocker (blood levels were elevated) with regular workouts how long do you think it would take to return to normal?

    Reply

    • Hi Gary,
      Yep, the medical system doesn’t care about what happens to you. Topical TRT will increase DHT even more. If you stop with fin, then DHT should be back to normal in about 1-2 weeks (tissue binding lasts 4-5 days).

      Reply

  18. Topical Finasteride caused severe problems for me. Do you have any fixes for penile tissue damage that caused my ejaculatory anhedonia consistently for over one year after quitting Topical Fin?

    Reply

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