Neuroactive steroid levels are modified in cerebrospinal fluid and plasma of post-finasteride patients showing persistent sexual side effects and anxious/depressive symptomatology
Melcangi, Roberto Cosimo; Caruso, Donatella; Abbiati, Federico; Giatti, Silvia; Calabrese, Donato; Piazza, Fabrizio; Cavaletti, Guido
The Journal of Sexual Medicine · 10(10):2598-26032013
Summary (paraphrased)
Using liquid chromatography-tandem mass spectrometry on paired plasma and cerebrospinal fluid samples, the authors compared three men with persistent sexual side effects and anxious/depressive symptoms after stopping finasteride (prescribed for androgenic alopecia) against five healthy controls. In CSF, tetrahydroprogesterone, isopregnanolone and dihydrotestosterone were lower than in controls while testosterone and 17β-estradiol were higher; in plasma, dihydroprogesterone was lower and 5α-androstane-3α,17β-diol plus 17β-estradiol higher. The patients also reported muscular stiffness, cramps, tremors and chronic fatigue without any diagnosable muscular disorder, alongside a persistent neuropsychiatric pattern. The authors conclude that disrupted neuroactive-steroid levels outlast finasteride discontinuation.
Plain-language summary (paraphrased)
The first study to directly measure brain-fluid chemistry in PFS patients found their neurosteroid levels were still abnormal long after stopping finasteride — key calming brain steroids were low while testosterone and estrogen were elevated. This gave the first hard biochemical evidence that the drug leaves a lasting imprint on the brain.
Why it’s in the corpus
The first human CSF evidence that neuroactive-steroid disruption persists after finasteride withdrawal — the founding observation of the neurosteroid pillar of this corpus and the direct predecessor of the Caruso 2014 follow-up (RES-002).
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