POST-FINASTERIDE SYNDROME AND THE IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON NEUROENDOCRINE AND METABOLIC AXES
Abstract
Objective: To analyze recent scientific evidence on the neuroendocrine and metabolic impacts associated with the chronic use of 5-alpha reductase inhibitors, with an emphasis on the pathophysiology of Post-Finasteride Syndrome. Methodology: An integrative literature review was conducted in the PubMed/MEDLINE and LILACS/VHL databases, selecting nine high-impact studies published between 2021 and 2026. The PICO strategy guided the analysis of clinical outcomes and molecular mechanisms. Results: Pharmacovigilance data consolidate PFS as a high-intensity multisystem entity, characterized by refractory sexual dysfunction, severe depression, and suicidal ideation, especially in young men. Enzymatic inhibition, particularly in the central nervous system, suppresses the synthesis of active metabolites such as allopregnanolone, resulting in GABAergic dysregulation and excitotoxicity. In the metabolic axis, the suppression of dihydrotestosterone is associated with insulin resistance, non-alcoholic fatty liver disease, Type 2 Diabetes Mellitus, and alterations in the gut microbiota. Polymorphisms in the SRD5A2 gene and epigenetic alterations, such as androgen receptor DNA methylation, were identified as sustaining the chronicity and potential irreversibility of symptoms. Conclusion: PFS transcends transient side effects, requiring a transition to personalized medicine models with pre-treatment genomic screening and rigorous informed consent protocols to mitigate permanent biopsychosocial risks.
Author Biographies
Ph.D. candidate in Health Sciences at the Faculty of Medical Sciences of the Universidade de Pernambuco.
Medical degree from Universidade Federal de Jataí.
Medical student at Centro Universitário de Mineiros (UNIFIMES).
Medical degree from Universidade de Vassouras (formerly Universidade Severino Sombra).
Medical student at Universidade de Rio Verde.
Medical degree from Universidade Cidade de São Paulo.
Medical student at Centro Universitário de Pinhais.
Medical degree from Universidade Federal do Oeste da Bahia.
Medical degree from Universidade Federal de Jataí.
Specialist at Fundação Oswaldo Cruz Mato Grosso do Sul (FIOCRUZ).
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