{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:22:46Z","timestamp":1787775766577,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1\u20136","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Few dermatologic problems carry as much emotional overtones as the complaint of hair loss, while the best way to alleviate the emotional distress related to the hair loss is to effectively treat it. With the advent of effective pharmacologic agents, the options for managing male pattern hair loss (MPHL) and alopecia-related distress have expanded. Oral finasteride represents a major breakthrough, based on an understanding of the underlying pathophysiology, and observations on the phenotype of the respective genetic defect of type 2 5-alpha reductase. Clinical studies have demonstrated both a high efficacy of treatment and a favorable safety profile establishing the drug as first-line treatment. And yet, after 15 years of successful prescription, the postfinasteride syndrome has emerged. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of treatment. As yet, the condition is not recognized by the medical community. In fact, the concept has emerged from neuroendocrinological research and rodent models, while hair experts have performed investigations into the plausibility of the syndrome based on a comprehensive review of the respective medical literature, and found that persistent sexual side effects were only documented in low-quality studies with strong bias selection, and a significant nocebo effect. In fact, there is more evidence that the condition may represent a psychiatric disorder. In favor of this hypothesis are a striking similarity to Koro with regard to genital symptoms; emergence of the condition with media coverage; a known significant nocebo effect in patients informed about adverse effects of finasteride; high prevalence of personality disorders among men seeking treatment for MPHL; so far no consistent endocrinological or organic abnormalities; and quality of centrality: No matter how unlikely it is that these strange things are happening, the patient accepts them relatively unquestioningly.<\/jats:p>","DOI":"10.4103\/ijt.ijt_122_21","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T02:00:09Z","timestamp":1745028009000},"page":"6-12","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comment on Current Investigations into the Postfinasteride Syndrome"],"prefix":"10.4103","volume":"16","author":[{"given":"Ralph Michel","family":"Tr\u00fceb","sequence":"first","affiliation":[{"name":"Center for Dermatology and Hair Diseases Professor Tr\u00fceb, Wallisellen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngoc-Nhi Catharina","family":"Luu","sequence":"additional","affiliation":[{"name":"Center for Dermatology and Hair Diseases Professor Tr\u00fceb, Wallisellen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Caballero-Uribe","sequence":"additional","affiliation":[{"name":"Center for Dermatology and Hair Diseases Professor Tr\u00fceb, Wallisellen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reis Gavazzoni","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Universidade Federal Fluminense, Centro De Ci\u00eancias M\u00e9dicas, Hospital Universit\u00e1rio Antonia Pedro, Niter\u00f3i, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hudson Dutra","family":"Rezende","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Alvaro Alvim School Hospital, Campos Dos Goytacazes, Rio De Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"R1-20250428","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1046\/j.1365-2133.1999.03030.x","article-title":"The psychosocial consequences of androgenetic alopecia:A review of the research literature","volume":"141","author":"Cash","year":"1999","journal-title":"Br J Dermatol"},{"key":"R2-20250428","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/j.1365-4362.1991.tb05874.x","article-title":"Psychologic characteristics of men with alopecia androgenetica and their modification","volume":"30","author":"van der Donk","year":"1991","journal-title":"Int J Dermatol"},{"key":"R3-20250428","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1111\/j.1346-8138.2010.01126.x","article-title":"Oral finasteride improved the quality of life of androgenetic alopecia patients","volume":"38","author":"Yamazaki","year":"2011","journal-title":"J Dermatol"},{"key":"R4-20250428","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S0733-8635(05)70396-X","article-title":"Androgen metabolism as it affects hair growth in androgenetic alopecia","volume":"14","author":"Kaufman","year":"1996","journal-title":"Dermatol Clin"},{"key":"R5-20250428","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1126\/science.186.4170.1213","article-title":"Steroid 5a-reductase deficiency in man:An inherited form of male pseudohermaphroditism","volume":"186","author":"Imperato-McGinley","year":"1974","journal-title":"Science"},{"key":"R6-20250428","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/S0190-9622(98)70007-6","article-title":"Finasteride in the treatment of men with androgenetic alopecia. Finasteride male pattern hair loss study group","volume":"39","author":"Kaufman","year":"1998","journal-title":"J Am Acad Dermatol"},{"key":"R7-20250428","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1346-8138.2011.01378.x","article-title":"Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia","volume":"39","author":"Sato","year":"2012","journal-title":"J Dermatol"},{"key":"R8-20250428","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1001\/archdermatol.2010.256","article-title":"Efficacy and safety of finasteride therapy for androgenetic alopecia:A systematic review","volume":"146","author":"Mella","year":"2010","journal-title":"Arch Dermatol"},{"key":"R9-20250428","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1056\/NEJM199210223271701","article-title":"The effect of finasteride in men with benign prostatic hyperplasia. The finasteride study group","volume":"327","author":"Gormley","year":"1992","journal-title":"N Engl J Med"},{"key":"R10-20250428","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1515\/hmbci-2015-0015","article-title":"Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia","volume":"23","author":"Traish","year":"2015","journal-title":"Horm Mol Biol Clin Investig"},{"key":"R11-20250428","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1111\/j.1743-6109.2010.02157.x","article-title":"Adverse side effects of 5a-reductase inhibitors therapy:Persistent diminished libido and erectile dysfunction and depression in a subset of patients","volume":"8","author":"Traish","year":"2011","journal-title":"J Sex Med"},{"key":"R12-20250428","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1111\/j.1743-6109.2011.02255.x","article-title":"Persistent sexual side effects of finasteride for male pattern hair loss","volume":"8","author":"Irwig","year":"2011","journal-title":"J Sex Med"},{"key":"R13-20250428","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1111\/j.1743-6109.2012.02846.x","article-title":"Persistent sexual side effects of finasteride:Could they be permanent?","volume":"9","author":"Irwig","year":"2012","journal-title":"J Sex Med"},{"key":"R14-20250428","doi-asserted-by":"crossref","first-page":"e100237","DOI":"10.1371\/journal.pone.0100237","article-title":"Immunohistochemical evaluation of androgen receptor and nerve structure density in human prepuce from patients with persistent sexual side effects after finasteride use for androgenetic alopecia","volume":"9","author":"Di Loreto","year":"2014","journal-title":"PLoS One"},{"key":"R15-20250428","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/1557988314538445","article-title":"Persistent sexual, emotional, and cognitive impairment post-finasteride:A survey of men reporting symptoms","volume":"9","author":"Ganzer","year":"2015","journal-title":"Am J Mens Health"},{"key":"R16-20250428","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/phar.1612","article-title":"Persistent sexual dysfunction and suicidal ideation in young men treated with low-dose finasteride:A pharmacovigilance study","volume":"35","author":"Ali","year":"2015","journal-title":"Pharmacotherapy"},{"key":"R17-20250428","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.4088\/JCP.12m07887","article-title":"Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects","volume":"73","author":"Irwig","year":"2012","journal-title":"J Clin Psychiatry"},{"key":"R18-20250428","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000450617","article-title":"Investigation of the plausibility of 5-alpha-reductase inhibitor syndrome","volume":"2","author":"Fertig","year":"2017","journal-title":"Skin Appendage Disord"},{"key":"R19-20250428","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1159\/000497362","article-title":"Post-finasteride syndrome:An induced delusional disorder with the potential of a mass psychogenic illness?","volume":"5","author":"Tr\u00fceb","year":"2019","journal-title":"Skin Appendage Disord"},{"key":"R20-20250428","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1111\/j.1743-6109.2007.00586.x","article-title":"Koro \u2013The psychological disappearance of the penis","volume":"4","author":"Mattelaer","year":"2007","journal-title":"J Sex Med"},{"key":"R23-20250428","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1192\/bjp.180.4.300","article-title":"Protean nature of mass sociogenic illness:From possessed nuns to chemical and biological terrorism fears","volume":"180","author":"Bartholomew","year":"2002","journal-title":"Br J Psychiatry"},{"key":"R25-20250428","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1001\/archderm.1994.01690070062009","article-title":"Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia","volume":"130","author":"Maffei","year":"1994","journal-title":"Arch Dermatol"},{"key":"R26-20250428","first-page":"758","article-title":"An apparently irreversible syndrome of abnormal movements following phenothiazine medication","volume":"57","author":"Hunter","year":"1964","journal-title":"Proc R Soc Med"},{"key":"R27-20250428","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1126\/science.2422758","article-title":"Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor","volume":"232","author":"Majewska","year":"1986","journal-title":"Science"},{"key":"R28-20250428","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.pnpbp.2007.09.017","article-title":"Progesterone attenuates neuroleptic-induced orofacial dyskinesia via the activity of its metabolite, allopregnanolone, a positive GABA (A) modulating neurosteroid","volume":"32","author":"Bishnoi","year":"2008","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"key":"R29-20250428","doi-asserted-by":"crossref","first-page":"4669","DOI":"10.1210\/jc.2016-2726","article-title":"Characteristics of men who report persistent sexual symptoms after finasteride use for hair loss","volume":"101","author":"Basaria","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"R30-20250428","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/j.1346-8138.2002.tb00200.x","article-title":"Depression circumstantially related to the administration of finasteride for androgenetic alopecia","volume":"29","author":"Altomare","year":"2002","journal-title":"J Dermatol"},{"key":"R31-20250428","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1159\/000514365","article-title":"Suicidality and psychological adverse events in patients treated with finasteride","volume":"7","author":"Tr\u00fceb","year":"2021","journal-title":"Skin Appendage Disord"},{"key":"R32-20250428","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.psyneuen.2018.09.021","article-title":"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","volume":"99","author":"Diviccaro","year":"2019","journal-title":"Psychoneuroendocrinology"},{"key":"R33-20250428","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s11096-018-0661-5","article-title":"Finasteride use during pregnancy and early neonatal outcome:A case report","volume":"40","author":"AlSaad","year":"2018","journal-title":"Int J Clin Pharm"},{"key":"R34-20250428","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000520493","article-title":"How to deal with the issues of fertility, malignancies, and the postfinasteride syndrome while prescribing finasteride for male pattern hair loss","volume":"8","author":"Tr\u00fceb","year":"2022","journal-title":"Skin Appendage Disord Skin Appendage Disord"},{"key":"R35-20250428","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/psychiatry.IndianJPsychiatry_183_19","article-title":"Update on Koro research methodology","volume":"62","author":"Chowdhury","year":"2020","journal-title":"Indian J Psychiatry"},{"key":"R36-20250428","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00115-004-1822-4","article-title":"The syndrome of genital retraction from a transcultural psychiatric point of view. Chinese suo yang, Indonesian koro and non-Asian forms (koro-like symptoms)","volume":"76","author":"Freudenmann","year":"2005","journal-title":"Nervenarzt"},{"key":"R37-20250428","first-page":"60","article-title":"\u201cIncomplete koro\u201c\u2013A forerunner for mood disorder:Two case reports","volume":"35","author":"Damodaran","year":"1993","journal-title":"Indian J Psychiatry"}],"container-title":["International Journal of Trichology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijt.ijt_122_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:41:50Z","timestamp":1787773310000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijt.ijt_122_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":34,"journal-issue":{"issue":"1\u20136","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijt.ijt_122_21","relation":{},"ISSN":["0974-7753","0974-9241"],"issn-type":[{"value":"0974-7753","type":"print"},{"value":"0974-9241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2021-12-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}