{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:06:02Z","timestamp":1775433962738,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Serenoa repens<\/jats:italic>\n                    <\/jats:styled-content>\n                    is widely used for benign prostatic hyperplasia and androgenetic alopecia due to its 5alpha\u2010reductase inhibitory activity. However, emerging reports describe sexual, psychiatric and somatic adverse effects resembling a post\u2010finasteride syndrome. Cases were identified from self\u2010reports submitted to an Italian online forum dedicated to post\u2010finasteride syndrome. All individuals underwent structured clinical evaluation at the CERFIT centre, including medical and psychiatric history, symptom assessment and available laboratory data. Reports were documented using the official Italian pharmacovigilance forms (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.vigierbe.it\/\">www.vigierbe.it<\/jats:ext-link>\n                    ), and causality was independently assessed by two clinicians using the Naranjo Scale. Reported doses ranged from 120\u2013900\u2009mg\/day, with adverse effects emerging within 1\u2009month in 61% of cases. Symptoms were severe and persistent (mean duration 4.7\u2009years), with complete remission in only three patients. According to the Naranjo Scale, causality was deemed \u2018probable\u2019 in 54% of reports; combined therapies (e.g.,\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>S.\u00a0repens<\/jats:italic>\n                    <\/jats:styled-content>\n                    plus finasteride) were associated with increased severity and persistence. A possible\n                    <jats:italic>post\u2010Serenoa syndrome<\/jats:italic>\n                    marked by persistent sexual and neuropsychiatric symptoms may represent an underestimated issue. Misbelief in the absolute safety of\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>S.\u00a0repens<\/jats:italic>\n                    <\/jats:styled-content>\n                    likely hinders reporting. Given its widespread, unsupervised use, further pharmacovigilance and clinical studies are warranted.\n                  <\/jats:p>","DOI":"10.1002\/bcp.70442","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T03:29:03Z","timestamp":1767929343000},"page":"1237-1246","source":"Crossref","is-referenced-by-count":0,"title":["Can we identify a post\u2010Serenoa syndrome (PSS)? A case series on sexual and psychiatric side effects of\n                    <scp>\n                      <i>Serenoa repens<\/i>\n                    <\/scp>"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0626-3947","authenticated-orcid":false,"given":"Filippo","family":"Firenzuoli","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine University of Florence  Florence Italy"},{"name":"CERFIT, Referring Centre for Phytotherapy University Hospital of Careggi  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernardo","family":"Firenzuoli","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Department of Molecular and Developmental Medicine University of Siena  Siena Italy"},{"name":"Department of Mental Health Azienda USL Toscana Centro  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Mascherini","sequence":"additional","affiliation":[{"name":"CERFIT, Referring Centre for Phytotherapy University Hospital of Careggi  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Firenzuoli","sequence":"additional","affiliation":[{"name":"Unit of Urological Robotic Surgery and Renal Transplantation Careggi Hospital, University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Menniti\u2010Ippolito","sequence":"additional","affiliation":[{"name":"National Centre for Drug Research and Evaluation, Italian National Institute of Health  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5676-1595","authenticated-orcid":false,"given":"Ilaria","family":"Ippoliti","sequence":"additional","affiliation":[{"name":"National Centre for Drug Research and Evaluation, Italian National Institute of Health  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4227-7214","authenticated-orcid":false,"given":"Valentina","family":"Maggini","sequence":"additional","affiliation":[{"name":"CERFIT, Referring Centre for Phytotherapy University Hospital of Careggi  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenia","family":"Gallo","sequence":"additional","affiliation":[{"name":"CERFIT, Referring Centre for Phytotherapy University Hospital of Careggi  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Cuomo","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Department of Molecular and Developmental Medicine University of Siena School of Medicine  Siena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Fagiolini","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Department of Molecular and Developmental Medicine University of Siena School of Medicine  Siena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian Franco","family":"Gensini","sequence":"additional","affiliation":[{"name":"CESMAV\u2014Centro Studi Medicina Avanzata  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Firenzuoli","sequence":"additional","affiliation":[{"name":"CERFIT, Referring Centre for Phytotherapy University Hospital of Careggi  Florence Italy"},{"name":"Centre for Excellence and Research on Clinical Phytotherapy, Fanfani Institute (CERFit)  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.12930"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15129"},{"key":"e_1_2_8_4_1","unstructured":"LaekemanGM VlietinckAJ.Assessment report onSerenoa repens(W. 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