PFS and PSSD journal: what to track

Not sure what to write down? A short daily note on your symptoms, mood and sleep is the best place to start a journal for post-finasteride syndrome (PFS) or post-SSRI sexual dysfunction (PSSD). Both can last after stopping the medicine, and a written record shows what changes over time.

Memory blurs on bad weeks. A dated record helps you spot patterns. It also makes a GP visit quicker and a side-effect report clearer.

What goes in it, and how do you use it?

What should I write down every day?

Keep the daily note to two minutes. Ten seconds of honesty beats a page you skip.

• Date and medicine status: “Day 412 since my last tablet.”
• Symptoms, scored 0 to 10: pick your five main ones and score the same five each day.
• Mood and feeling: “Flat, couldn’t feel anything watching the match.”
• Cognition: “Lost my words twice in a meeting.”
• Sleep: hours, and how rested you felt.
• Anything new: a supplement, alcohol, illness, a hard day at work.

Use your own words. “Touch feels numb” tells a doctor more than “sexual dysfunction”.

Track more than sex. The 2022 diagnostic criteria describe PSSD as a lasting change in genital sensation, often numbness, often with emotional numbing, cognitive problems and changes in other senses. For PFS they list cognitive problems, depression and suicidal thoughts, which can occur without any sexual problems.

For your main symptoms, choose from the areas people describe, so nothing gets forgotten:

• Sexual and genital: numb or reduced genital sensation, low desire, erection problems, orgasm with little or no pleasure, less ejaculate.
• Emotional: feeling flat, less pleasure in things you used to enjoy, low mood, anxiety, irritability.
• Cognition: brain fog, poor memory, trouble finding words or focusing.
• Body: fatigue, poor sleep, muscle or joint changes, skin changes, tinnitus.

You don’t need every item. A shorter list scored every day is worth more than a long one you give up on.

If your notes show thoughts of suicide, tell someone today. In the UK and Ireland you can call Samaritans free on 116 123, day or night.

How do weekly and monthly reviews help?

A weekly look back turns daily scores into a trend. Once a week, note:

• the symptom that bothered you most
• your best and worst day, and anything different about them
• one small thing that helped, even briefly

Once a month, write three lines: what is better, what is worse and what is the same. Over a year, those twelve entries show the shape of your condition. Some people’s symptoms rise and fall. A record lets you see that.

The journal is also somewhere to put the harder feelings. If writing about grief or anger helps, do it. If it makes you dwell, stick to scores and facts.

How can a journal help at the GP?

It turns a vague complaint into a clear timeline. Bring a one-page summary rather than the whole notebook:

1. Your medicine: “Finasteride 1 mg from March 2021, last tablet October 2022.”
2. What changed: “Genital numbness, no morning erections, feel emotionally flat.”
3. When it started: before, while taking it, or after stopping.
4. How it was before: “No problems before 2021.”
5. What your notes show: “Numbness scored 7 or more on most days since January.”

Bring the leaflet line too. The UK Propecia (finasteride 1 mg) leaflet lists “persistent difficulty having an erection after discontinuation of treatment”. The UK Cipralex (escitalopram) leaflet says sexual problems have, in some cases, “continued after stopping treatment”.

What can I do with my notes?

These medicines help many people. If you’re still taking one and have side effects, that’s a decision for you and your prescriber. For antidepressants, don’t stop suddenly. The finasteride leaflet says to stop and contact your doctor if your mood changes.

Your journal is also the evidence for a report. It has the dates, the dose and your symptoms in your own words. That’s what the form asks for. Nobody has counted how often PFS and PSSD happen yet. That’s why reports matter.

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 finasteride or dutasteride, write Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430). After an SSRI or SNRI, write Post-SSRI sexual dysfunction (MedDRA 10086208).

Our reporting guide walks you through it

What else do people ask?

Paper or app? Whichever you’ll keep using. Paper is private and easy. A phone note or spreadsheet makes it simpler to spot trends and print a summary. If you use an app, check where it stores your health data before you write anything personal in it.

I didn’t keep notes. Is it too late? No. Start today, and write a short timeline from memory: when you started and stopped the medicine, and when each symptom began. Old messages, photos and prescription records can help you pin the dates down.

Will a journal make me focus on symptoms too much? It can for some people. Keep the daily note short, score and move on, and save reflection for the weekly review. If it adds to your distress, track less often.

Start small: tonight, write the date, your five main symptoms and a score for each. Our pages on PFS and PSSD explain the conditions in more depth.

Sources

1. 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: “An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops”; ancillary symptoms may include “emotional numbing”, “other sensory problems” and “cognitive impairment”. Section 5: “Additional finasteride effects that can occur independently of any sexual difficulties” include cognitive impairment, depression and suicidality.
2. Organon. Propecia 1 mg film-coated tablets patient information leaflet, electronic Medicines Compendium. Section 4, frequency unknown: “persistent difficulty having an erection after discontinuation of treatment”. Also: if you have depressed mood, depression or suicidal thoughts, stop taking Propecia and contact your doctor.
3. Lundbeck Limited. Cipralex (escitalopram) patient information leaflet, electronic Medicines Compendium. Section 2: sexual problems “have continued after stopping treatment” in some cases.
4. GOV.UK. Report a problem with a medicine or medical device.
5. Samaritans, 116 123, free in the UK and Ireland.

Sources checked on 22 October 2026. AI-assisted writing and review, not clinical review.