Changes in hormones:
– Total Testosterone:
Below what would be expected for the patient’s age. In many cases, such low levels that characterize hypogonadism
– LH and FSH:
Low-normal levels of LH and FSH. Similar to secondary hypogonadism. It is possible that finasteride may reduce pituitary activity in some men. As everything in this Syndrome, it is a theory that requires investigation. However, there are studies that show finasteride affects hippocampus.
Many show a high level of the hormone.
Some patients present an elevated prolactin level. However, MRI to investigate the possibility of prolactinoma shows no abnormality.
Androstanediol glucoronide is a hormone derived from DHT (the hormone inhibited by finasteride). In men affected by the PFS, the level of Androstanediol Glucuronide is not restored to previous finasteride levels. The result of the blood test hormone in these patients is generally below the scale or a very low result . It’s unnatural for adult men to have low levels of this molecule.
Only individuals who are born with intersex characteristics (hermaphrodites) have low levels of this hormone. It is essentially a masculinizing hormone and may have an effect on sexuality (science still knows very little about it). Women present low levels of Androstanediol Glucoronide naturally, since they produce little testosterone. Women who have high levels of this hormone, show reproductive problems (polycystic ovary), excess body hair and a more masculine appearance.
Some patients also have changes in TSH. There are cases where the Post-Finasteride Syndrome induced hypothyroidism. However, it is not most cases.
As finasteride inhibits the conversion of progesterone to allopregnanolone by blocking the enzyme 5-alpha reductase, a higher level of progesterone is also possible in these patients.
Many PFS patients have low levels of Vitamin D.
PFS Patients may present high or very high cholesterol.
Other possible alterations:
There are speculations that the level of zinc has also been affected in these patients.
There are concerns Finasteride may reduce the production of dopamine in these patients. The drug manufacturer has added depression as a possible side effect of this medication. A large decrease in the level of dopamine in these patients may also help explain the emergence of some sexual symptoms.
Produced from the conversion of Progesterone by the enzyme 5alpha-reductase , Allopregnanolone is a tranquilizer found in the brain. Allopregnanolone acts to modulate GABA-A in brain. There is evidence in studies that the level of allopregnanolone in these patients have been altered by finasteride.
– Changes in immune system, possibly aggravated by the sharp decline in testosterone level.Recent studies indicate that testosterone plays an important role in regulating the immune system in men.
As these men may present a large decrease in testosterone levels, it is plausible to relate the fact to changes in their immune systems. There are reports of patients with the syndrome who have developed food or skin allergies or skin, which they did not have before using Propecia (finasteride).Patients also report changes in how the body reacts to inflammation.
– Excess Cortisol release:
Virtually all reports of patients suffering from Post-Finasteride Syndrome have a description of what they call Post Finasteride crash. This endocrine crash usually occurrs a few days or weeks after the cessation of treatment with 1 mg finasteride in these patients. They report very high stress symptoms, which often develops into an episode of panic attack or anxiety attack.
Another related symptom is insomnia or light and disturbed sleep. It is worth mentioning here that these patients showed these symptoms of acute stress, before they learned about the Post-Finasteride Syndrome or the possibility of lingering effects related to finasteride, thus eliminating the possibility of placebo effect or psychosomatic effect.
To assess depression in men, a strong association was found between exposure to low-dose finasteride and depression. It is postulated that the mechanism, by which 5-IAR could cause depression, would be through the reduction of levels of neuro steroids in the brain, which has been detected in users of finasteride at low doses, even after its suspension.
Alterations of the sex hormones and some parameters of the spermiogram associated with the use of finasteride have been found in both healthy patients and infertile patients (Amory et al.). In turn, it was found that sperm concentration decreased by 21.5%, sperm motility by 10.5% and semen volume by 21.1% at 26 weeks of treatment, findings that resulted statistically significant.
Theories being investigated:
a) Finasteride would have shut down a gene in subjects genetically prone to this problem. (That would explain why some men develop the problem and others do not)
b) Finasteride would have bound to the androgen receptors, preventing these hormones to exert their function and it this would be a type of androgen insensitivity
c) Finasteride would have affected the level of free cortisol in the body. Cortisol is necessary to increase the efficiency of all functions in the body. So even if the individual shows normal results on thyroid hormone blood tests, cortisol deficiency could induce similar symptoms to hypothyroidism.
d) Epigenetics: possible epigenetic changes in the 5-alpha reductase enzyme or ADN methylation are a source of investigation in recents studies.