Neuroactive steroid levels and psychiatric and andrological features in post-finasteride patients

J Steroid Biochem Mol Biol. 2017 Jul:171:229-235. doi: 10.1016/j.jsbmb.2017.04.003. Epub 2017 Apr 10.


Recent reports show that, in patients treated with finasteride for male pattern hair loss, persistent side effects including sexual side effects, depression, anxiety and cognitive complaints may occur. We here explored the psychiatric and andrological features of patients affected by post-finasteride syndrome (PFS) and verified whether the cerebrospinal fluid (CSF) and plasma levels of neuroactive steroids (i.e., important regulators of nervous function) are modified. We found that eight out of sixteen PFS male patients considered suffered from a DSM-IV major depressive disorder (MDD). In addition, all PFS patients showed erectile dysfunction (ED); in particular, ten patients showed a severe and six a mild-moderate ED. We also reported abnormal somatosensory evoked potentials of the pudendal nerve in PFS patients with severe ED, the first objective evidence of a neuropathy involving peripheral neurogenic control of erection. Testicular volume by ultrasonography was normal in PFS patients. Data obtained on neuroactive steroid levels also indicate interesting features. Indeed, decreased levels of pregnenolone, progesterone and its metabolite (i.e., dihydroprogesterone), dihydrotestosterone and 17beta-estradiol and increased levels of dehydroepiandrosterone, testosterone and 5alpha-androstane-3alpha,17beta-diol were observed in CSF of PFS patients. Neuroactive steroid levels were also altered in plasma of PFS patients, however these changes did not reflect exactly what occurs in CSF. Finally, finasteride did not only affect, as expected, the levels of 5alpha-reduced metabolites of progesterone and testosterone, but also the further metabolites and precursors suggesting that this drug has broad consequence on neuroactive steroid levels of PFS patients.

Keywords: 5α-Reductase; Erectile dysfunction; Major depressive disorder; Pregnenolone; Progesterone; Testosterone.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 5-alpha Reductase Inhibitors / adverse effects*
  • 5-alpha Reductase Inhibitors / therapeutic use
  • Adult
  • Alopecia / drug therapy
  • Case-Control Studies
  • Depressive Disorder, Major / blood
  • Depressive Disorder, Major / cerebrospinal fluid
  • Depressive Disorder, Major / chemically induced*
  • Depressive Disorder, Major / epidemiology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Drug Monitoring
  • Erectile Dysfunction / chemically induced*
  • Erectile Dysfunction / epidemiology
  • Erectile Dysfunction / metabolism
  • Erectile Dysfunction / physiopathology
  • Evoked Potentials, Somatosensory / drug effects
  • Finasteride / adverse effects*
  • Finasteride / therapeutic use
  • Humans
  • Incidence
  • Italy / epidemiology
  • Longitudinal Studies
  • Male
  • Pregnenolone / blood
  • Pregnenolone / cerebrospinal fluid*
  • Progesterone / analogs & derivatives
  • Progesterone / blood
  • Progesterone / cerebrospinal fluid*
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Pudendal Nerve / drug effects
  • Pudendal Nerve / physiopathology
  • Pudendal Neuralgia / chemically induced
  • Pudendal Neuralgia / epidemiology
  • Pudendal Neuralgia / metabolism
  • Pudendal Neuralgia / physiopathology
  • Severity of Illness Index
  • Testosterone / analogs & derivatives
  • Testosterone / blood
  • Testosterone / cerebrospinal fluid*
  • Young Adult


  • 5-alpha Reductase Inhibitors
  • Testosterone
  • Progesterone
  • Finasteride
  • Pregnenolone