PFS doctor: who to see

Post-finasteride syndrome (PFS) is the name for side effects of finasteride that can last after stopping, and it has no specialist of its own. Start with your GP, and ask whether a urologist (for erection problems) or an endocrinologist (for hormones) could help.

PFS is more than sexual problems. The criteria proposed in 2022 say that after finasteride, problems with thinking, depression and suicidality can occur with or without sexual difficulties. Tell your doctor about all of it.

Sumair was 21 when he used topical finasteride four times. Moral Medicine’s summary of his interview says a doctor first told him his symptoms were likely psychosomatic. A urologist later acknowledged PFS, but told him there was little that could be done.

Play video: Just 4 Doses of Topical Finasteride Changed His Life

Who should I see first if I think I have PFS?

Your GP. They decide whether to refer you to a hospital specialist.

Finasteride 1 mg for hair loss isn’t prescribed on the NHS, the UK medicines regulator says. Men get it from private clinics or, more often, online, so your GP may have no record that you ever took it.

For erection problems, the NHS says you can also go to a sexual health clinic.

The UK leaflet gives you the opening line. Its list of side effects includes “persistent difficulty having an erection after discontinuation of treatment”. It also asks you to “make a note of what happened, when it started and how long it lasted”.

So bring your dates, written down: “Finasteride 1 mg from an online pharmacy, March 2023 to January 2024. Low sex drive since February 2024.” If you bought it online, say so.

If your GP refers you, in England you have a legal right to choose the hospital in most cases, the NHS says. The GP picks a shortlist, so say what you’d prefer during the appointment.

Our free letter for your doctor puts the condition, the sources and your dates on one page. You can also show your GP the 2022 criteria. They are proposed criteria, agreed by a group of doctors and researchers, and no NHS guideline uses them yet.

For how to talk about it in the room, read how to approach your doctor about PFS.

What does a urologist do for PFS?

Urologists treat problems of the male reproductive organs, including impotence, says NHS Health Careers. Within urology, andrology covers “male reproductive and sexual health”, in the words of the British Association of Urological Surgeons.

Erection problems that keep happening can be a sign of a health condition that can be treated, the NHS says. So a specialist will usually look for other causes first.

Be ready for doubt. In a 2023 talk to urologists, Dr Maria Uloko, a US urologist, noted that PFS has a controversial status in her field. Her opening minute shows how the condition is discussed among specialists.

Play video: Common Drug-Induced Sexual Dysfunction in Men

Some specialists do recognise it. Connor, who lives in the UK, writes that his GP dismissed the idea of lasting side effects. A professor of andrology at a London hospital told him he recognised the condition, but could offer no help.

Should I see an endocrinologist?

An endocrinologist is a hormone specialist: the specialty covers “the effects of hormones on the whole body”, says NHS Health Careers. Whether you need one is for your GP to judge.

Your results may well come back normal. A 2016 study at a Boston hospital looked at men with lasting symptoms after finasteride. Their testosterone and DHT levels were the same as in men without symptoms. A normal test doesn’t mean nothing is wrong. Our article on finasteride and testosterone explains why.

Dr Michael Irwig, a US hormone specialist, was one of the first doctors to study men with PFS. Watch this 2012 film to hear, from an endocrinologist, how the men he interviewed described their symptoms.

Play video: Dr Michael Irwig on lasting sexual side effects of finasteride (extract)

What can I do?

These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Follow what the leaflet says.

Many people say it took time to be taken seriously. Bring the leaflet line. You can report it without a doctor agreeing.

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, write Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430).

Our reporting guide walks you through it

What else do people ask?

Is there a PFS specialist in the UK? We know of no NHS service set up for PFS. Some specialists recognise it, as Connor found. Others may not have heard of it. In 2024 the UK regulator said a patient card about these side effects would go in every finasteride pack.

Who helps with mood, sleep and cognition? Your GP, first. Many people with PFS describe low mood, poor sleep and problems with memory and focus. The leaflet says to stop finasteride and talk to your doctor if you get depression or suicidal thoughts. If you’re struggling now, the Samaritans are on 116 123.

What if my doctor says it can’t last? Show them the line in the official UK leaflet, under side effects of unknown frequency. It names erection problems that continue after stopping. If you’re new to all this, our guide on what to do if you think you have PFS covers the first days.

In the end, a urologist acknowledged Sumair’s PFS. If sex or mood have felt different since you stopped, see your GP with your dates, and report it whoever you see.

Sources

1. Propecia 1 mg film-coated tablets, patient leaflet, Organon Pharma (UK), Electronic Medicines Compendium, last revised May 2026. Section 4, “Frequency unknown”, lists persistent erection, sex drive and ejaculation problems after discontinuation of treatment. It adds: “It will help if you make a note of what happened, when it started and how long it lasted.” Sections 2 and 4: stop and contact your doctor if depression or suicidal thoughts occur.
2. Medicines and Healthcare products Regulatory Agency (MHRA), Finasteride: reminder of the risk of psychiatric side effects and of sexual side effects (which may persist after discontinuation of treatment), Drug Safety Update volume 17, issue 9, 29 April 2024. These side effects “are not well known by prescribers and patients”. Doctors are asked to monitor patients. A patient card goes in every pack.
3. MHRA, Finasteride: review of safety data and expert advice on management of risks, Public Assessment Report, 29 April 2024. Section 3.1: finasteride 1 mg is not prescribed on the NHS and is obtained from private hair loss clinics or, more often, online pharmacies.
4. NHS, Your choices in the NHS, page last reviewed 10 May 2023. Applies to the NHS in England.
5. NHS, Erectile dysfunction (impotence), page last reviewed 28 July 2023.
6. British Association of Urological Surgeons, Section of Andrology and Genito-Urethral Surgery: andrology is “male reproductive and sexual health”, including erectile dysfunction.
7. NHS Health Careers, Urology: urologists treat the male reproductive organs, including impotence; andrology is “male fertility and sexual health”.
8. NHS Health Careers, Endocrinology and diabetes: a specialism that “covers the effects of hormones on the whole body”.
9. Basaria S, Jasuja R, Huang G, et al. Characteristics of men who report persistent sexual symptoms after finasteride use for hair loss. J Clin Endocrinol Metab 2016;101(12):4669-80. Brigham and Women’s Hospital, Boston. 25 men with persistent symptoms, 13 finasteride users without symptoms and 18 men who had never used it. Testosterone and dihydrotestosterone did not differ among the groups. Cross-sectional, so it cannot show cause.
10. Healy D, Bahrick A, Bak M, et al. 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 agreed by expert consensus. Section 5: additional finasteride effects, including cognitive impairment, depression and suicidality, “can occur independently of any sexual difficulties”.
11. Uloko M. Common drug-induced sexual dysfunction in men, Perspectives in Urology: Point-Counterpoint, San Diego, 10 March 2023; the page’s summary notes PFS’s “controversial status in urology”; video published by Grand Rounds in Urology. This page plays an extract only, from 0:00 to 0:57.
12. PFS Foundation, Persistent sexual side effects of finasteride (Propecia) for male pattern hair loss, Dr Michael Irwig, August 2012. This page plays an extract only, from 0:00 to 1:45. His study: Irwig MS, Kolukula S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med 2011;8(6):1747-53.
13. Moral Medicine, Just 4 Doses of Topical Finasteride Changed His Life, interview with Sumair, 6 April 2023. The doctor and urologist lines come from the video’s description by Moral Medicine. His story on our site: Sumair’s story.
14. Connor, his own written account on our site, August 2024.