The authors declare the following other interests: None. Interestingly, finasteride treatment (25 and 50mg/kg for 14 days) inhibited open-field behaviors and reduced contents of dopamine and its metabolites in central nervous system (Li et al., 2018). Recovered from Post Finasteride Syndrome! Over time, it has been considered a safe and well-tolerated drug with rare and reversible side effects. Hsieh J.T., Chen S.C., Yu H.J., Chang H.C. Finasteride upregulates expression of androgen receptor in hyperplastic prostate and LNCaP cells: implications for chemoprevention of prostate cancer. Subjects were recruited from those seeking medical help after treatment or visiting Propeciahelp.com website (Ganzer et al., 2015). R. Soc. Traish A.M., Melcangi R.C., Bortolato M., Garcia-Segura L.M., Zitzmann M. Adverse effects of 5alpha-reductase inhibitors: what do we know, don't know, and need to know? Some say it's all in the mind, a made-up mythbut those who suffer from it surely know they're not just a hypochondriac. Treatment of male rats with finasteride, an inhibitor of 5alpha-reductase enzyme, induces long-lasting effects on depressive-like behavior, hippocampal neurogenesis, neuroinflammation and gut microbiota composition. Gender bias in autoimmunity is influenced by microbiota. As here reported, finasteride or dutasteride treatment in male is associated with the onset of different side effects (i.e., mainly on sexual functions as well as on mood, even if other complaints have been described). Cauci S., Chiriaco G., Cecchin E., Toffoli G., Xodo S., Stinco G., Trombetta C. Androgen receptor (AR) gene (CAG)n and (GGN)n length polymorphisms and symptoms in young males with long-lasting adverse effects after finasteride use against androgenic alopecia. Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon? Indeed, studies reporting dose of 1mg, 1.25mg, 2.5mg or 5mg have been published (Boersma et al., 2014; Kim et al., 2012; Mervis et al., 2018; Price et al., 2000). A total of 24 male subjects completed the report indicating different symptoms related to sexual functions that persisted after finasteride use. Mechanisms of finasteride So let's discuss what the drug, finasteride, does in the first place. Varothai S., Bergfeld W.F. Finasteride was the first on the market and is currently the most widely used inhibitor. Org E., Mehrabian M., Parks B.W., Shipkova P., Liu X., Drake T.A., Lusis A.J. Whether patient reports of persistent symptoms are caused by finasteride is unknown. Irwig M.S. In addition, further studies showed that more than half of the 150 PFS patients considered had a pre-existing medically confirmed psychiatric diagnosis (Ganzer and Jacobs, 2016; Ganzer et al., 2015). Caruso D., Abbiati F., Giatti S., Romano S., Fusco L., Cavaletti G., Melcangi R.C. Dysregulation of the dopamine system may also contribute to major depressive disorders (Belujon and Grace, 2017; Felger, 2017; Grace, 2016). There is currently no known cure or treatment for post-finasteride syndrome. I wanted to talk about my 2 year battle with Post Finasteride Syndrome (PFS), in hopes of helping anyone who is going through what I went through. An official website of the United States government. Interventions for female pattern hair loss. 2022 Oct;10(5):100543. doi: 10.1016/j.esxm.2022.100543. Keywords: Other data described, in women treated for alopecia with 5mg of finasteride, headache, menstrual irregularities, dizziness and increased body hair growth as the most common complaints (Shum et al., 2002; Valsecchi et al., 2004; Yeon et al., 2011). Persistent sexual side effects of finasteride: could they be permanent? Careers. Baig M.S., Kolasa-Wolosiuk A., Pilutin A., Safranow K., Baranowska-Bosiacka I., Kabat-Koperska J., Wiszniewska B. Finasteride-induced inhibition of 5alpha-reductase type 2 could lead to kidney damage-animal, experimental study. In this survey, other infrequent symptoms, such as reduced sense of taste (8%) and of smell (4%), were reported (Healy et al., 2018). Melcangi R.C., Giatti S., Garcia-Segura L.M. 2019 Jan 1;99(1):12-17. doi: 10.2340/00015555-3035. Post-finasteride syndrome is leaving behind a slew of victims in its trail. 2020 May-Jun;95(3):271-277. doi: 10.1016/j.abd.2020.02.001. A 5-year retrospective analysis of 5alpha-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride. A growing number of doctors, researchers and therapists have in recent years been voicing their concerns about finasteride's potential to cause persistent physical and mental side effects, known as post-finasteride syndrome (PFS), in a subset of patients. The first look at the 'middle aged Love Island' set has been released, which has already been nicknamed the 'Viagra House' by locals after single parents searched for love Overall, 167 (1.4%) men developed persistent erectile dysfunction. Persistent sexual side effects of finasteride: could they be permanent? It's H.C.G (HCG) dosed at 250IU Monday, Wednesday and Friday only. This site needs JavaScript to work properly. FOIA You can download a PDF version for your personal record. Indeed, some national agencies (e.g., Swedish Medical Products Agency, the Medicines and Healthcare Products Regulatory Agency of UK and the U.S. Food and Drug Administration) required to include multiple persistent side effects within the finasteride labels. Hu A.C., Chapman L.W., Mesinkovska N.A. Gut Inflammation Induced by Finasteride Withdrawal: Therapeutic Effect of Allopregnanolone in Adult Male Rats. Clinical Use of Finasteride. This condition, termed post-finasteride syndrome (PFS) is characterized by sexual side effects (i.e., low libido, erectile dysfunction, decreased arousal and difficulty in achieving orgasm), depression, anxiety and cognitive complaints that are still present despite drug withdrawal. B Biol. sharing sensitive information, make sure youre on a federal Few preclinical observations have been obtained on the effects exerted by 5-R inhibitors. J Sex Med. Rzeszotek S, Kolasa A, Pilutin A, Misiakiewicz-Has K, Sielatycka K, Wiszniewska B. Biomedicines. Romer B., Pfeiffer N., Lewicka S., Ben-Abdallah N., Vogt M.A., Deuschle M., Vollmayr B., Gass P. Finasteride treatment inhibits adult hippocampal neurogenesis in male mice. Repeated finasteride administration induces depression-like behavior in adult male rats. PFS has increasingly featured in popular media. Even those who suffer from what patients have deemed "post-finasteride syndrome" admit that the vast majority of men take the drug without incident. Interestingly, 20 days of finasteride treatment and its withdrawal (i.e., one month of suspension), not only alter the levels of neuroactive steroids in plasma and CSF, but also those in the central nervous system areas such as cerebral cortex, cerebellum and hippocampus (Giatti et al., 2016). An observational retrospective evaluation of 79 young men with long-term adverse effects after use of finasteride against androgenetic alopecia. National Center for Andvancing Translational Sciences. More than two decades after marketing approval, finasterides long term safety profile remains incomplete. Investigation of the plausibility of 5-alpha-reductase inhibitor syndrome, A review of the FAERS data on 5-alpha reductase inhibitors: implications for postfinasteride syndrome, Persistent erectile dysfunction in men exposed to the 5-reductase inhibitors, finasteride, or dutasteride, Adverse event reporting in clinical trials of finasteride for androgenic alopecia, Association of suicidality and depression with 5-reductase inhibitors, Incidence of type 2 diabetes mellitus in men receiving steroid 5-reductase inhibitors: population based cohort study, Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia, Risk of erectile dysfunction associated with use of 5- reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink, Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia, Long-term consequences of finasteride vs placebo in the Prostate Cancer Prevention Trial. 2020 Jan;113(1):21-50. doi: 10.1016/j.fertnstert.2019.11.030. Interestingly, some of these side effects has been reported also in female. In particular, Wu and colleagues discussed information about finasteride side effects in female patients, collected in the FAERS database (Wu et al., 2016). In this context, it is also important to recall that, dopamine, a neurotransmitter that, as reported above, is affected by finasteride treatment (Devoto et al., 2012; Frau et al., 2016; Li et al., 2018), also modulates male sexual behavior in humans as well as in animal models (Peeters and Giuliano, 2008; Will et al., 2014). Lerner A., Neidhofer S., Matthias T. The gut microbiome feelings of the brain: a perspective for non-microbiologists. Changes in gut microbiota could be ascribed to different factors, such as changes induced by finasteride in plasma and/or brain neuroactive steroid levels (Giatti et al., 2016). Vasopressin deletion is associated with sex-specific shifts in the gut microbiome. In addition, it is imperative to study in detail the molecular mechanisms that cause this condition, trying to identify a possible genetic predisposition, in order to limit the burden of PFS. 2019 Jan 1;99(1):12-17. doi: 10.2340/00015555-3035. 2022 Oct 27;10(11):2725. doi: 10.3390/biomedicines10112725. This has been supported by patient self-reports and regulatory data. FOIA As reported in Fig. We do not capture any email address. Pinsky M.R., Gur S., Tracey A.J., Harbin A., Hellstrom W.J. Effects of subchronic finasteride treatment and withdrawal on neuroactive steroid levels and their receptors in the male rat brain. In particular, subject selection in the study design, lack of adequate control groups, possible nocebo effect and the use of retrospective questionnaires may introduce important biases, leading to poor quality of the studies performed (Baas et al., 2018; Haber et al., 2019; Mondaini et al., 2007). Romer B., Gass P. Finasteride-induced depression: new insights into possible pathomechanisms. In addition, levels of isopregnanolone and 3-diol were increased and decreased respectively in the cerebellum; these changes did not occur in the cerebral cortex and hippocampus (Giatti et al., 2016). official website and that any information you provide is encrypted Depressive symptomatology is related with alteration in neuroactive steroid levels (Melcangi et al., 2014, 2016; Zorumski et al., 2013). In particular, right-handed users presented an overall decreased International Index of Erectile Function (IIEF) score compared to the left-handed users, that have, on the other side, an improved orgasmic function compared to the right-handed finasteride users (Motofei et al., 2013, 2016, 2017). Santarelli L., Saxe M., Gross C., Surget A., Battaglia F., Dulawa S., Weisstaub N., Lee J., Duman R., Arancio O., Belzung C., Hen R. Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants. High quality evidence about persistent adverse events is scant, but some data exist for sexual adverse events. National Institutes of Health. 3). Careers. Clipboard, Search History, and several other advanced features are temporarily unavailable. Sexual Problems of Men With Androgenic Alopecia Treated With 5-Alpha Reductase Inhibitors. A review of the FAERS data on 5-alpha reductase inhibitors: implications for postfinasteride syndrome. Melcangi R.C., Riva M.A., Fumagalli F., Magnaghi V., Racagni G., Martini L. Effect of progesterone, testosterone and their 5 alpha-reduced metabolites on GFAP gene expression in type 1 astrocytes. Metabolism of progesterone and testosterone into 5alpha-reduced metabolites and their mechanisms of action: effects of finasteride and dutasteride. Finasteride is a 5-reductase enzyme inhibitor that has been approved for the treatment of male androgenic alopecia since 1997. Common adverse events of treatment consist of sexual disorders and a negative affect balance. Careers, Unable to load your collection due to an error. Todorovic N., Filipovic D. The antidepressant- and anxiolytic-like effects of fluoxetine and clozapine in chronically isolated rats involve inhibition of hippocampal TNF-alpha. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Shum K.W., Cullen D.R., Messenger A.G. Researchers have found low levels of neurosteroids, including allopregnanolone, in the cerebrospinal fluid of post-finasteride syndrome patients. On the other hand, objective measurements and deeper clinical assessments are imperative to describe PFS symptomatology. Persistent erectile dysfunction after discontinuation of 5-alpha reductase inhibitor therapy in rats depending on the duration of treatment. To our knowledge, only one preclinical study has explored so far possible persistent erectile dysfunction induced by 5-R inhibitors (Sung et al., 2019). Several explanations have been proposed to account for reports of persistent symptoms that clearly reduce quality of life: Sexual dysfunction might be more common among men with alopecia or benign prostatic hyperplasia because of the underlying biochemistry of these conditions.12 The publicity around post-finasteride syndrome might have increased the reporting of symptoms. Belujon P., Grace A.A. Dopamine system dysregulation in major depressive disorders. In addition, gynecomastia was more frequently reported by 5mg finasteride users, although this increase was not statistically significant (Baas et al., 2018). However, this drug is increasingly used also in women to treat female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA) (Camacho-Martinez, 2009; Hu et al., 2019). The top ten AEs reported were: abortion induction, abortion spontaneous, paternal drug affecting fetus, uterine cervix stenosis, menstruation irregularity, menorrhagia, endometrial hypertrophy, phalangeal agenesis, fatigue and arthritis (Wu et al., 2016). Fields C.T., Chassaing B., Paul M.J., Gewirtz A.T., de Vries G.J. Belknap S.M., Aslam I., Kiguradze T., Temps W.H., Yarnold P.R., Cashy J., Brannigan R.E., Micali G., Nardone B., West D.P. Yu M., Jia H., Zhou C., Yang Y., Zhao Y., Yang M., Zou Z. 2012 Nov;9(11):2927-32. doi: 10.1111/j.1743-6109.2012.02846.x. Few studies evaluated finasteride toxicity in female animal models. Also in case of female finasteride users, side effects have been reported during treatment. Before Wilton L., Pearce G., Edet E., Freemantle S., Stephens M.D., Mann R.D. Kaplan-Marans E, Sandozi A, Martinez M, Lee J, Schulman A, Khurgin J. Efforts to explain persistent symptoms are undermined by poor long term data on harms, Finasteride, a 5-reductase inhibitor, was approved in 1992 for the treatment of benign prostatic hyperplasia; a lower dose (1 mg) was approved in 1997 for male pattern baldness. Naseribafrouei A., Hestad K., Avershina E., Sekelja M., Linlokken A., Wilson R., Rudi K. Correlation between the human fecal microbiota and depression. Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. official website and that any information you provide is encrypted Indeed, SRD5A2 promoter methylation has not been observed in plasma. In addition, two polymorphisms in AR gene, (CAG) rs4045402 and (GGN) rs318869, have been reported to be more frequent among AGA and PFS patients (Cecchin et al., 2014). It is known that post-finasteride syndrome (PFS) patients suffer from treatment-resistant depression and anxiety. Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysis. Li L., Kang Y.X., Ji X.M., Li Y.K., Li S.C., Zhang X.J., Cui H.X., Shi G.M. For instance, Ruminococcaceae are significantly affected by orchidectomy in mice (Org et al., 2016). 10. Epub 2020 Sep 19. Sex differences in the gut microbiome-brain axis across the lifespan. An official website of the United States government. On the other hand, although steroidogenesis has not been evaluated in detail in gut microbiota, intestinal epithelial cells seem to be able to synthesize glucocorticoids (Cima et al., 2004) and microbial species, like for instance Clostridium scindens, converts glucocorticoids into androgens (Ridlon et al., 2013). J Urol. This effect occurred after one month of withdrawal, but not immediately after the treatment (Diviccaro et al., 2019) (Fig. Stockmeier C.A., Mahajan G.J., Konick L.C., Overholser J.C., Jurjus G.J., Meltzer H.Y., Uylings H.B., Friedman L., Rajkowska G. Cellular changes in the postmortem hippocampus in major depression. Devoto P., Frau R., Bini V., Pillolla G., Saba P., Flore G., Corona M., Marrosu F., Bortolato M. Inhibition of 5alpha-reductase in the nucleus accumbens counters sensorimotor gating deficits induced by dopaminergic activation. Sex Med Rev. In addition, other reports, including randomized studies, showed no incidence of sexual impairment after finasteride use (Liu et al., 2016; Narasimhalu, 2015; Tosti et al., 2001, 2004). For instance, a 5-R inhibitor, such as 17 beta-testosterone carboxylic acid, significantly weakened the stimulatory effect exerted by T propionate on erection in castrated rats, but not the mating behavior (Bradshaw et al., 1981). Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth along for the ride on their fall North American tour, which will begin Aug. 3 in Sterling Heights . Finasteride is the first approved 5-R inhibitor for treatment of benign prostate . Alterations of gut microbiota composition in post-finasteride patients: a pilot study. He armed himself with a balaclava, latex gloves, condoms and Viagra pills and posed as a cab driver in a Mercedes to roam the streets of Brighton, East Sussex. On the other hand, reports observing no adverse events have been published as well, raising doubts about the real presence of such symptoms and the quality of the studies performed so far. The tour begins on Aug. 3 in Sterling . Finasteride male pattern hair loss study group. Epub 2016 Jan 13. In addition, T levels were increased while the levels of its metabolite, DHT, were decreased in the cerebellum (Giatti et al., 2016) (Fig. A new look at the 5alpha-reductase inhibitor finasteride. Jiang H., Ling Z., Zhang Y., Mao H., Ma Z., Yin Y., Wang W., Tang W., Tan Z., Shi J., Li L., Ruan B. Altered fecal microbiota composition in patients with major depressive disorder. Interestingly, the pattern in plasma did not exactly reflect what observed in CSF. The analysis indicated antiandrogenic effects in the 32%, central effects in the 30%, estrogenic effects in the 19%, and nonspecific/severe AEs in the 5% of cases (Walf et al., 2018). As demonstrated by ultrasonography scan, erectile dysfunction in these patients was not associated with altered testicular volume or alterations in ejaculatory ducts. Acta Derm Venereol. This is supported by evidence that counselling men about possible sexual side effects sharply increased reporting of these side effects compared with men who were not counselled.15 Finally, the number of adverse events reported for finasteride in a post-marketing database nearly quadrupled between 2011 and 2014, coinciding with changes to the US product label in 2012 and increased publicity.4. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. These trials should be designed and conducted in full partnership with patients. At the withdrawal, some of the changes observed persisted, such as the increase in DHP in the cerebellum, and new changes occurred, such as an increase and a decrease of PREG levels in the cerebellum and hippocampus, respectively and a decrease of THP in the cerebral cortex. Finasteride inhibited brain dopaminergic system and open-field behaviors in adolescent male rats. The Interplay between Finasteride-Induced Androgen Imbalance, Endoplasmic Reticulum Stress, Oxidative Stress, and Liver Disorders in Paternal and Filial Generation. Sharon G., Sampson T.R., Geschwind D.H., Mazmanian S.K. One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Randomized questionnaire based case-control research study on evaluation of sexual function in Indian patients taking oral finasteride for androgenetic alopecia. Indeed, T and PROG are metabolized by 5-R into dihydrotestosterone (DHT) and dihydroprogesterone (DHP), respectively. Variations in gut microbiota and fecal metabolic phenotype associated with depression by 16S rRNA gene sequencing and LC/MS-based metabolomics. Research brief: self-reports of a constellation of persistent antiandrogenic, estrogenic, physical, and psychological effects of finasteride usage among men. This is how the National Institutes of Health refers to Post-Finasteride Syndrome, and there is a specific reaction type in FAERS which can be selected. For instance, an upregulation of AR occurred in the prostate of patients treated with finasteride for BPH (Hsieh et al., 2011) as well as in the prepuce of AGA patients showing persistent side effects (i.e., PFS patients) (Di Loreto et al., 2014). Finasteride (Propecia, Proscar) is a generic prescription medication used to treat the following conditions in adult males:* benign prostatic hyperplasia male pattern hair loss Finasteride. Epub 2012 Jul 12. Neonatal androgen exposure causes persistent gut microbiota dysbiosis related to metabolic disease in adult female rats. Long-term safety and efficacy of dutasteride in the treatment of male patients with androgenetic alopecia. On the contrary, as recently reported in adult male rats by forced swim test, finasteride administration induces, immediately after the treatment, a depression-like phenotype (Sasibhushana et al., 2019). Bradshaw W.G., Baum M.J., Awh C.C. Marberger M.J. There are currently only 134 reports of Post-5-alpha reductase inhibitor syndrome in FAERS. Effect of dutasteride on the symptoms of benign prostatic hyperplasia, and patient quality of life and discomfort, in clinical practice. Also in female patients, criticism about the possible side effects induced by 5-R inhibitors has been raised. Frau R., Mosher L.J., Bini V., Pillolla G., Pes R., Saba P., Fanni S., Devoto P., Bortolato M. The neurosteroidogenic enzyme 5alpha-reductase modulates the role of D1 dopamine receptors in rat sensorimotor gating. Finally, therapeutic strategies, like for instance neuroactive steroid treatment, able to relief or to cure this condition are also urgently needed. Therefore, in this context it is important to recall that androgens regulate the dopaminergic system in the brain (de Souza Silva et al., 2009; Kindlundh et al., 2004; Mitchell and Stewart, 1989). Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women. This is particularly interesting, because it indicates that the expression of this receptor is not only affected in the periphery, as observed in AGA patients (Di Loreto et al., 2014), but also in the nervous system. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Kim W.J., Song M., Ko H.C., Kim B.S., Kim M.B. Federal government websites often end in .gov or .mil. Beside sexual problems, PFS patients also reported psychological complaints (such as decreased self-confidence, irritability or easily flying into a rage, nervousness, agitation, inner restlessness, depression, hopelessness, feelings of worthlessness, suicidal thoughts, anxiety, panic attacks, sleep problems), muscular problems (tics, muscle spasms and fasciculation, tremors, involuntary muscle tension and contraction, chronic fatigue, weakness, ataxia, joint pain and muscular ache), physical alterations (dizziness, headache, migraine, head pressure, decreased body temperature) and cognitive complains (decreased initiative and difficulty in concentration, mental confusion, forgetfulness or loss of short-term memory, losing train of thought or reasoning, slurred speech or stumbling over words) (Melcangi et al., 2017). As shown, 22% of patients reported lack of connection between the brain and penis during treatment, and this percentage increased to 59% at interview time (i.e., at least three months after finasteride discontinuation). Curr Urol Rep. 2018 Jun 16;19(8):65. doi: 10.1007/s11934-018-0814-z. As mentioned in section 2.1, the observations present in literature are mainly based on symptoms self-reported by patients. In this context, one of the markers taken in consideration has been the levels of neuroactive steroids in PFS patients. Observations obtained in male adult rats have confirmed these observations (Giatti et al., 2016). Adult hippocampal neurogenesis buffers stress responses and depressive behaviour. Indeed, immediately after drug treatment an increase in Bacteroidetes phylum as well as in Prevotellaceae family was reported; after discontinuation of the finasteride, a decrease in Ruminococcaceae family, Oscillospira and Lachnospira genus was observed (Diviccaro et al., 2019) (Fig. An official website of the United States government. Boersma I.H., Oranje A.P., Grimalt R., Iorizzo M., Piraccini B.M., Verdonschot E.H. Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysis. FOIA Please note: your email address is provided to the journal, which may use this information for marketing purposes. Bethesda, MD 20894, Web Policies Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. All my symptoms have subsided and improved with this method which takes a while but I am fully functional. Safety and tolerability of the dual 5-alpha reductase inhibitor dutasteride in the treatment of androgenetic alopecia. Moreover, observational studies as well as clinical reports indicated similar complaints in male subjects treated with these inhibitors for AGA (Belknap et al., 2015; Choi et al., 2016; Kaufman et al., 1998; Tsunemi et al., 2016). This survey also highlighted the high number of subjects reporting suicidal ideation (63%), due to the negative thoughts and the inability to live a life with such symptoms (Ganzer et al., 2015). Traish AM, Melcangi RC, Bortolato M, Garcia-Segura LM, Zitzmann M. Rev Endocr Metab Disord. Based case-control research study on evaluation of 79 young men with Androgenic alopecia Treated with 5-alpha inhibitors. M.J., Gewirtz A.T., de Vries G.J gut microbiome-brain axis across the post finasteride syndrome viagra a nocebo phenomenon involve... 5-R inhibitor for treatment of male Androgenic alopecia Treated with 5-alpha reductase inhibitors, S.. 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