Parenting with PFS and PSSD
Raising children with PFS or PSSD? Planning around your worst hours, what to tell children at each age, and how to share the load.
Finding family life hard with post-finasteride syndrome (PFS) or PSSD? Parenting is possible, but it takes planning. It helps to build family life around your worst hours rather than wait for them to pass.
Planning matters because both conditions can last after stopping the medicine. The UK leaflet for Cipralex says sexual problems have, in some cases, “continued after stopping treatment”. The Propecia leaflet lists “persistent decrease in sex drive after discontinuation of treatment”.
So what changes, what do you tell the children, and who can help?
How do PFS and PSSD affect parenting?
They mostly affect the parts of parenting you can’t see. Many people describe feeling flat when their child is excited, or losing track halfway through a story. Some say tiredness and low mood hit hardest in the evening, just when children need most.
These conditions are more than sexual problems. The 2022 criteria describe emotional numbing and cognitive problems in PSSD, and depression and cognitive problems in PFS, sometimes with no sexual symptoms at all. That can make school runs and bedtimes hard.
None of that makes you a bad parent. Children need you to be there and be kind, and you can do that on a flat day too.
Write down when your symptoms are worst for two weeks. A pattern helps you decide when to plan the fun things, and when to keep life simple.
What should I tell my children?
Tell them something true that fits their age. You don’t need to mention sex or medicines to be honest.
- Young children: “My body is poorly, so some days I’m tired. It’s not because of anything you did.”
- Older children: “I took a medicine that left me with health problems. Some days are harder, and I’m getting help.”
- Teenagers: They may look things up. Give them a calm, short version and tell them they can ask you anything.
Children often blame themselves when a parent goes quiet. Saying out loud that it isn’t their fault matters more than the details. Our guides on talking to family about PFS and PSSD have more on what to say.
How do I share the load with my partner?
Agree on a plan before a bad day, not during one. A short list works: which tasks your partner takes on a hard day, and which you can still do from the sofa.
Reading a book, helping with homework or watching a film together all count as parenting. Let the tasks that need energy go to whoever has it that day.
Grandparents, friends and other parents can help too. Ask for one specific thing, such as “Could you take her to football on Saturdays?” People find it easier to say yes to something small and clear. Our article on relationships after a PFS crash covers the partner side in more depth.
On the hardest days, keep routines simple and the same each day. Children feel safe with routine, and it saves you decisions when your head is foggy.
Gentle movement, regular meals and sleep help some people feel steadier. They are not a cure, and you don’t have to feel guilty when they don’t work.
If low mood turns into thoughts of ending your life, tell someone today. In the UK, call the Samaritans on 116 123, free, at any hour. The Propecia leaflet says to stop taking it and talk to your doctor if you have depression or suicidal thoughts.
Where can I get support as a parent?
Talk to your GP about how the symptoms affect your daily life, not only the medicine. A referral for talking therapy can help with the strain of parenting, even though it can’t treat the condition.
Three questions for your GP
- Could anything else be adding to my tiredness or low mood?
- What support is there for me as a parent while this goes on?
- Who can I contact if things get worse between appointments?
You could start with: "I'm struggling to look after my children because of symptoms that started on a medicine."
Other parents with PFS and PSSD understand days that are hard to explain. Our community is a place to ask how they manage.
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Antidepressants shouldn’t be stopped suddenly; for finasteride, follow what the leaflet says.
Report it: it helps everyone
A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US.
- Use the right words. If symptoms continued after stopping an SSRI or SNRI, write Post-SSRI sexual dysfunction (MedDRA 10086208). After finasteride, write Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430).
Our reporting guide walks you through it
What else do parents ask?
Can my children inherit PFS or PSSD? There’s no evidence that either condition is passed on. Both start after taking a medicine, and nobody has shown that either is passed on. If you’re worried, ask your GP.
Should I hide my bad days from my children? You don’t need to share everything. Children notice changes, though, and many parents find a short honest explanation worries them less than silence.
Can I still have a close bond with my child? Yes. Closeness comes from time, attention and being there, and a flat day doesn’t take that away.
Start small this week: pick one routine your children can count on, whatever kind of day you’re having. Our pages on PFS and PSSD are there when you want to read more.
Sources
- Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed criteria developed through expert agreement. Section 3 (PSSD): ancillary non-sexual symptoms may include “emotional numbing”, “depersonalization”, “other sensory problems” and “cognitive impairment”. Section 5 (PFS): cognitive impairment, depression and suicidality “can occur independently of any sexual difficulties”.
- Lundbeck Limited. Cipralex (escitalopram) patient information leaflet, electronic Medicines Compendium. Section 2: “In some cases, these symptoms have continued after stopping treatment.”
- Organon Pharma (UK) Limited. Propecia 1 mg (finasteride) patient information leaflet, electronic Medicines Compendium. Section 4, frequency unknown: “persistent decrease in sex drive after discontinuation of treatment”. Section 4: “Stop taking Propecia and talk to your doctor if you experience” depression or suicidal thoughts.
- GOV.UK. Report a problem with a medicine or medical device.
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