Finasteride is a common medication prescribed to offset hair loss, and it has helped men worldwide regain their confidence in the face of male-patterned baldness. Despite this successful treatment, the relief of luscious locks has been overshadowed by the other fallout and side effects called post-finestride syndrome (PFS). Men navigating PFS can experience a wide range of physical, neurological, psychological, and emotional symptoms even after stopping treatment. These symptoms can greatly impact one’s quality of life and need to be understood to prepare for and address them as part of a collaborative treatment plan between the biological and psychological sides. As a therapist, I supported many clients as they unpacked and made sense of these side effects, and helped them create a stable sense of self, including identity, purpose, and connection. In this blog, we will discuss the significance and impact of PFS and what support and recovery can look like from a psychological perspective.
What is Post-Finasteride Syndrome?
Post-Finasteride Syndrome is defined as a collection of symptoms that come as a result of taking finasteride treatment for hair loss. The symptoms can occur during treatment and months or years after treatment has stopped. We will break the categories of symptoms into Physical, Neurological, and Psychological:
Physical: Sexual dysfunction (loss of libido, erectile dysfunction, genital numbness), fatigue, muscle loss, and hormonal imbalance.
Neurological: “Brain fog”, memory impairment, difficulty concentrating, and insomnia.
Psychological: Depression, anxiety, emotional blunting, anhedonia, and, in extreme cases, suicidal thoughts.
Now, when we look at these symptoms, they span far and wide within the physical and psychological impacts this can have on men and their sense of self. Despite the exact cause of PFS being discussed and debated in many medical circles, the reality of the suffering and impact is real and must be respected.
The Psychological Toll of Post-Finasteride Syndrome
The Masculine Identity:
When looking at the symptoms, you can see how the impact greatly challenges how society constructs masculinity. The original challenge of hair loss stems from male beauty standards, which greatly impact self-esteem. Popular culture and society often celebrate individuals with thick hair into their later years. This has a significant impact on men’s sensitivity to hair thinning or loss, prompting them to discuss Finasteride with their doctor. This paints a picture of certain emotional challenges that may already be at play before the additional symptoms of PFS come in.
Sexual health is so closely tied to masculinity, so when libido, energy, and sexual function are impacted, it has a devastating impact on a man’s psyche, including a sense of grief. Not only for the loss of physical connection with themselves and others, but also for the sense of a loss of manhood or how they previously identified with the world and themselves. There is a fear of no longer knowing who they are and of never getting back to a place where they feel comfortable and confident again.
Isolation and Shame:
Some men are already challenged by being open and honest about their symptoms and emotions; this can become exponentially more difficult when the topic is so complex and sensitive. Feelings of isolation and shame can increase if they do build up the courage to communicate this to a provider or loved one, and they are not believed or met with invalidation. If it is not properly diagnosed and understood why these things are happening, it can feel as if this is a deficiency in themselves instead of a series of side effects. This can lead to depression and social withdrawal.
Online forums can be a great source of information, grounding, and connection for the early stages of figuring out what is going on and what to do next. Of course, with all online presence, it’s important not to get caught up in misinformation, despair, or hopeless stories.
Depression and Anxiety:
Certain chemicals within the Finasteride medication may directly impact mood, which may mimic or amplify existing depression and anxiety. This can impact sleep patterns and appetite, and lead to an overall loss of joy and a decrease in pleasure from activities they once enjoyed. Depression and anxiety, in this case, are both a biological response to the chemical change in the brain and a psychological response to self-judgement and doubt as a result of many other side effects. This overlap between biological and psychological distress causes a vicious cycle as hormone changes worsen the mood and cause sexual dysfunction, this increases stress, anxiety and negative self talk, which then further cycles back and impacts mood. This cycle can feel so overwhelming that, in some severe cases, individuals have reported suicidal ideation. If you or someone you know is experiencing this level of hopelessness and despair, it is important to contact a mental health professional immediately.
A Collaborative Treatment Plan:
If you are experiencing Post Finasteride Syndrome, it is important to engage with a team of supporters, including a Psychiatrist, Urologist or Endocrinologist, and a Mental Health Therapist. This will check all your boxes in order to make sure you are hitting the biological/hormonal side of things, provide some relief from depression and anxiety, and have someone to talk to in order to make sense and push through these challenges.
When speaking to a therapist, the first step in healing begins when someone finally listens and an individual is able to find a safe space to share the experience. In therapy, this often involves naming the loss, anger, and betrayal that accompany medical trauma. It’s not uncommon for individuals to feel detached from their providers and struggle to trust medical professionals. It is very common to reflect on the reality of grief and loss in how individuals perceive their masculinity and fear of judgment from external sources. Be prepared to reflect on how one identifies with and defines masculinity, and how these perceptions influence one’s self-judgment. The important thing to remember is that, despite these challenging times, the individual still has agency and can make changes and build connections to create a better life.
Destigmatizing Masculinity and Emotional Suffering:
At the root of this discussion is the broader challenge impacting men of all ages, which is an internalized insecurity and minimization of men’s emotional pain. It can’t be said enough in therapy, but avoiding or hiding from a problem does not make it go away; in fact, it makes it more insidious. The first step is to reach out and be open, honest, and vulnerable with those you trust and love. Vulnerability is not weakness; it is strength, and opening up on these difficult topics challenges the narrative that this isn’t something men should be talking about. This can open the door for you and, maybe, for someone else to get the support they need.
It’s important to note that although the collection of symptoms and impact does feel intense and complex, recovery is possible. We need to normalize this situation, as millions of men are quietly navigating it. We need to show grace and kindness to those who are silently struggling and create a space to heal and grow collectively.
