Not medical advice. A living research archive of historical and continually changing sources, for research and personal reference only. Summaries are paraphrases — verify against the originals. Full disclaimer
Symptoms that continue, sometimes for years, after a medicine is stopped. The library covers three that share many features, reported side by side in a 300-case series from 37 countries (Healy et al. 2018) and given a shared set of proposed diagnostic criteria (Healy et al. 2022).
Persistent sexual, mental and physical effects after stopping finasteride (Propecia, Proscar), used for hair loss and enlarged prostates, and in some reports dutasteride. Most people tolerate these drugs; a small subset report lasting symptoms.
Sexual symptoms such as genital numbness, loss of libido, and erection or orgasm problems that persist after stopping serotonergic antidepressants (SSRIs and SNRIs). The cause is not known.
Persistent sexual dysfunction reported after isotretinoin (Accutane) and related retinoids. It is the least studied of the three: a systematic review found the evidence on retinoids' sexual side effects conflicting and of low quality, mostly about effects during treatment rather than after stopping, so causation can't yet be established.
Definitions follow the library's glossary. The proposed criteria also cover persistent genital arousal disorder after antidepressants.
A young field: case series, a handful of record-based studies, small laboratory studies and regulatory reviews. Hover a citation to see the record.
Eight records, in order: the shared picture first, then each condition, then the numbers and the regulators.
300 cases from 37 countries across antidepressants, finasteride-type drugs and isotretinoin: the case series behind treating these as related conditions.
The proposed diagnostic criteria for PSSD, PFS and post-retinoid sexual dysfunction, drafted by a multidisciplinary panel from the largest case collections.
A systematic evaluation of 250+ articles on finasteride and dutasteride: the broadest overview of PFS and its proposed mechanisms.
A recent systematic review of PSSD: how often symptoms persist, the proposed mechanisms, diagnosis and management.
The systematic review of sexual side effects after retinoids: conflicting, low-quality evidence, mostly about effects during treatment rather than after stopping.
The only attempt so far to put a number on PSSD risk: 4 of 866 exposed men (about 1 in 216), under a narrow records-based definition.
11,909 men in health records: persistent erectile dysfunction was more likely the longer they had taken finasteride or dutasteride.
The FDA's 2022 response to the PFS Foundation's petition, including the full history of US label changes.
Every record says what kind of source it is and how far it has been checked. Nothing is silently dropped: weak or withdrawn sources stay visible, and marked.
How sources were found and checked: methodology.
If this is happening to you
This library summarises research. It can't tell you what is happening in your case or what to do: decisions about starting, stopping or changing a medicine belong with a clinician who knows you. Patient organisations such as the PFS Network, the PSSD Network and RxISK offer information and community.
If you are thinking about suicide or feel unsafe, please contact your local emergency number or a crisis line now: in the US, call or text 988; in the UK and Ireland, call Samaritans on 116 123.
