Post-Finasteride Syndrome And The Impact Of 5-Alpha Reductase Inhibitors On Neuroendocrine And Metabolic Axes

This review analyzes recent scientific evidence on the neuroendocrine and metabolic impacts of chronic use of 5-alpha reductase inhibitors, focusing on Post-Finasteride Syndrome (PFS). The study, based on eight high-impact studies from 2021 to 2026, highlights PFS as a multisystemic condition linked to the use of 5-ARIs, with reports of refractory sexual dysfunction and mood disorders in young patients. The inhibition of enzymes in the central nervous system suppresses the synthesis of active metabolites like allopregnanolone, leading to GABAergic dysregulation and excitotoxicity. Metabolically, the suppression of dihydrotestosterone is associated with insulin resistance, non-alcoholic fatty liver disease, Type 2 Diabetes Mellitus, and changes in gut microbiota. Genetic polymorphisms in the SRD5A2 gene and epigenetic changes, such as DNA methylation of the androgen receptor, contribute to the chronicity of symptoms. The findings suggest that PFS extends beyond transient side effects, emphasizing the need for personalized medicine models and strengthened informed consent protocols to mitigate persistent biopsychosocial risks.