Department of Urology, Bagcilar Training and Research Hospital, Istanbul, TurkeyTurkey
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With their increased popularity in the treatment of benign prostate hyperplasia (BPH), physicians are encountering with the side effects of 5 alpha reductase inhibitors (5ARIs) (finasteride and dutasteride) more often. Although reports regarding the persistence of these problems raise the concerns of physicians and BPH patients alike,1,2 annual 5ARI sales continue to increase, generating approximately half billion dollars in the United States, according to Information Management System (IMS) data.3 The United States Food and Drug Administration (FDA) approval of finasteride for androgenic alopecia (AGA) contributes to the 5ARI market and broaden the population who may suffer from side effects by decreasing the age span.4
Keywords: benign prostate hyperplasia (BPH); Food and Drug Administration (FDA); finasteride for androgenic alopecia (AGA); Information Management System (IMS); side effects of 5 alpha reductase inhibitors (5ARIs); androgenic alopecia (AGA)
UROLOGY AND ANDROLOGY Open Journal http://dx.doi.org/10.17140/UAOJ-1-e002 Urol Androl Open J ISSN 2572-4665 Omer Onur Cakir, MD; Ege Can Serefoglu, MD, FECSM* Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey *Corresponding author Ege Can Serefoglu, MD, FECSM Department of Urology Bagcilar Training and Research Hospital Istanbul, Turkey E-mail: egecanserefoglu@hotmail.com Article History Received: September 12th, 2016 Accepted: September 12th, 2016 Published: September 15th, 2016 Citation Cakir OO, Serefoglu EC. Post- Finasteride Syndrome: An un - derestimated phenomenon. Urol Androl Open J. 2016; 1(1): e3-e4.
doi: 10.17140/UAOJ-1-e002 Copyright ©2016 Serefoglu EC. This is an open access article distributed un- der the Creative Commons Attribu- tion 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the origi - nal work is properly cited.
Volume 1 : Issue 1 Article Ref. #: 1000UAOJ1e002 Post-Finasteride Syndrome: An Underestimated Phenomenon Page e3 Editorial With their increased popularity in the treatment of benign prostate hyperplasia (BPH), physicians are encountering with the side effects of 5 alpha reductase inhibitors (5ARIs) (fin- asteride and dutasteride) more often. Although reports regarding the persistence of these prob- lems raise the concerns of physicians and BPH patients alike,1,2 annual 5ARI sales continue to increase, generating approximately half billion dollars in the United States, according to In- formation Management System (IMS) data.3 The United States Food and Drug Administration (FDA) approval of finasteride for androgenic alopecia (AGA) contributes to the 5ARI market and broaden the population who may suffer from side effects by decreasing the age span.4 Although the exact mechanism of the side effects of 5ARIs are not completely eluci - dated yet, the inhibition of testosterone (T) conversion to its active metabolite dihydrotestos- terone (DHT) may play a role. Consequent alterations in penile nitric oxide (NO) metabolism may be responsible for erectile dysfunction (ED) whereas alterations in the neurotransmitters in the central nervous system may cause ejaculatory dysfunction and decreased libido. These sexual side effects seem to be more frequent in higher doses and in the beginning of the 5ARI therapy.5,6 Although sexual problems induced by 5ARIs diminish after the second year of the therapy in the majority of cases, some persist during the treatment or even after treatment ces- sation.7 When the side effects of 5ARI persist even three months after cessation of the drug and are accompanied by other physical, mental and neurological adverse effects, this clinical entity is named post-finasteride syndrome (PFS). 8 Although, the prevalence of the PFS is not exactly determined, the number of men reporting these persistent sexual side effects to health professionals is increasing worldwide. The symptomatology of PFS is quite variable and the symptoms may range from minor to severe. In addition to the aforementioned sexual side ef- fects, the PFS patients may report psychological issues such as emotional sensitivity, attention deficiency depression, panic attacks and anxiety leading to functional decline and even suicidal ideation. Other physical symptoms of PFS include muscle atrophy, dry and thin skin, chronic fatigue, tinnitus, gynecomastia, scrotal and penile shrinkage and the Peyronie’s disease Today, there is no known cure or any effective treatments of PFS; however, medi- cal communities and societies are recently beginning to realize the scope and burden of this problem.4 Until the actual pathophysiology of PFS is determined and effective therapies are discovered, we all have to think twice before prescribing a 5ARIs for our patients with either BPH and/or AGA. Meanwhile, professional organizations may provide educational materi - als for physicians in order to increase their awareness regarding the scope of these persistent catastrophic adverse effects of finasteride and dutasteride. Considering the thousands of suffer- ers who already have PFS, the scientific world immediately need to conduct more research to determine how to effectively treat this horrible symptom complex.
CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.
UROLOGY AND ANDROLOGY Open Journal http://dx.doi.org/10.17140/UAOJ-1-e002 Urol Androl Open J ISSN 2572-4665 Page e4