SÍNDROME POST-FINASTERIDA Y EL IMPACTO DE LOS INHIBIDORES DE LA 5-ALFA REDUCTASA EN LOS EJES NEUROENDOCRINO Y METABÓLICO
Resumen
Objetivo: Analizar las evidencias científicas recientes sobre los impactos neuroendocrinos y metabólicos asociados al uso crónico de inhibidores de la 5-alfa reductasa, con énfasis en la fisiopatología del Síndrome Post-Finasterida. Metodología: Revisión integrativa de la literatura realizada en las bases PubMed/MEDLINE y LILACS/BVS, seleccionando nueve estudios de alto impacto publicados entre 2021 y 2026. La estrategia PICO orientó el análisis de los resultados clínicos y los mecanismos moleculares. Resultados: Los datos de farmacovigilancia consolidan el SPF como una entidad multisistémica de alta intensidad, caracterizada por disfunción sexual refractaria, depresión severa e ideación suicida, especialmente en hombres jóvenes. La inhibición enzimática, particularmente en el sistema nervioso central, suprime la síntesis de metabolitos activos como la alopregnanolona, lo que resulta en una desregulación GABAérgica y excitotoxicidad. En el eje metabólico, la supresión de la dihidrotestosterona (DHT) se asocia con resistencia a la insulina, enfermedad del hígado graso no alcohólico, Diabetes Mellitus tipo 2 y alteraciones en la microbiota intestinal. Se identificó que los polimorfismos en el gen SRD5A2 y las alteraciones epigenéticas, como la metilación del ADN del receptor de andrógenos, sustentan la cronicidad y la potencial irreversibilidad de los síntomas. Conclusión: El SPF trasciende los efectos secundarios transitorios, exigiendo una transición hacia modelos de medicina personalizada con cribado genómico previo al tratamiento y protocolos rigurosos de consentimiento informado para mitigar los riesgos biopsicosociales permanentes.
Biografía del autor/a
Doctorando en Ciencias de la Salud en la Facultad de Ciencias Médicas de la Universidade de Pernambuco.
Graduado en Medicina por la Universidade Federal de Jataí.
Estudiante de Medicina en el Centro Universitário de Mineiros (UNIFIMES).
Graduada en Medicina por la Universidade de Vassouras (anteriormente Universidade Severino Sombra).
Estudiante de Medicina en la Universidade de Rio Verde.
Graduado en Medicina por la Universidade Cidade de São Paulo.
Estudiante de Medicina en el Centro Universitário de Pinhais.
Graduado en Medicina por la Universidade Federal do Oeste da Bahia.
Graduada en Medicina por la Universidade Federal de Jataí.
Especialista en la Fundação Oswaldo Cruz Mato Grosso do Sul (FIOCRUZ).
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