Insights into the peripheral nature of persistent sexual dysfunction associated with post-finasteride, post-SSRI and post-accutane syndromes: lessons learned from a case study

Abstract

Purpose
Retinoids for acne, finasteride/saw palmetto for hair loss/BPH, and selective Serotonin Reuptake inhibitors (SSRIs) for depression, have all been implicated in severe, persistent sexual dysfunction that occurs after stopping these medications. The underlying mechanism of this post-drug syndrome is unknown, nor is an effective treatment available. The purpose of this investigation is to use a retrospective chart review to characterize a cohort of patients who suffer from post-drug syndrome and to determine if improvement in symptoms is feasible when focusing treatment on the peripheral nerves of the genitalia.

Methods
Three male patients seen in our urology clinic were sequentially treated with high frequency electrical stimulation and low intensity extracorporeal shock wave therapy for a total of 16 weeks. Symptom improvement was assessed using the International Index of Erection Function (IIEF), the Masturbation Erection Index (MEI), global response assessment scale, corneal confocal microscopy, the FirmTech® Ring to monitor nocturnal erections pre- and post-peripheral nerve treatment and von Frey filament testing.

Result
Mild-moderate erectile function improvement, mild penile sensitivity improvement, and mild nocturnal erection improvement were seen across all three patients. Peripheral neuropathy was noted in two patients via corneal confocal microscopy, however central symptoms remain.

Conclusion
The post-drug syndrome appears to consist of a peripheral component which may be treatable using our regimen, as we saw overall improvement in penile sensitivity and erections following treatments. However, patients were still profoundly affected by their symptoms post-treatment and thus there is an urgent need for additional research on this syndrome.

Full text

Vol.:(0123456789)
International Urology and Nephrology
https://doi.org/10.1007/s11255-025-04373-w
UROLOGY – ORIGINAL PAPER
Insights intotheperipheral nature ofpersistent sexual dysfunction
associated withpost‑finasteride, post‑SSRI andpost‑accutane
syndromes: lessons learned fromacase study
JacksonStachelek1· BernadetteM.M.Zwaans1,2· RoniShtein3· KennethM.Peters1,2
Received: 26 November 2024 / Accepted: 9 January 2025
© The Author(s), under exclusive licence to Springer Nature B.V. 2025
Abstract
Purpose Retinoids for acne, finasteride/saw palmetto for hair loss/BPH, and selective Serotonin Reuptake inhibitors (SSRIs)
for depression, have all been implicated in severe, persistent sexual dysfunction that occurs after stopping these medications.
The underlying mechanism of this post-drug syndrome is unknown, nor is an effective treatment available. The purpose of this
investigation is to use a retrospective chart review to characterize a cohort of patients who suffer from post-drug syndrome
and to determine if improvement in symptoms is feasible when focusing treatment on the peripheral nerves of the genitalia.
Methods Three male patients seen in our urology clinic were sequentially treated with high frequency electrical stimulation
and low intensity extracorporeal shock wave therapy for a total of 16weeks. Symptom improvement was assessed using the
International Index of Erection Function (IIEF), the Masturbation Erection Index (MEI), global response assessment scale,
corneal confocal microscopy, the FirmTech® Ring to monitor nocturnal erections pre- and post-peripheral nerve treatment
and von Frey filament testing.
Result Mild-moderate erectile function improvement, mild penile sensitivity improvement, and mild nocturnal erection
improvement were seen across all three patients. Peripheral neuropathy was noted in two patients via corneal confocal
microscopy, however central symptoms remain.
Conclusion The post-drug syndrome appears to consist of a peripheral component which may be treatable using our regimen,
as we saw overall improvement in penile sensitivity and erections following treatments. However, patients were still pro-
foundly affected by their symptoms post-treatment and thus there is an urgent need for additional research on this syndrome.
Keywords Post-drug syndrome· Finasteride· SSRI· Saw palmetto· Retinoid· Sexual dysfunction
Introduction
Retinoids for acne, finasteride/saw palmetto for hair loss/
BPH, and selective Serotonin Reuptake inhibitors (SSRIs)
for depression, all centrally acting agents, have known side-
effects of sexual dysfunction while taking these drugs. Like
most side-effects, they are expected to resolve after cessation
of the drug. What defines post-drug syndrome is a rapid and
severe onset of sexual dysfunction after stopping these medi-
cations. The sexual dysfunction symptoms include genital
numbness, a “disconnect” between the genitalia and the
brain, reduced nocturnal erections, anhedonia, and brain fog.
[1] The syndrome is understudied, the incidence is unknown,
and no effective treatments have been identified. Instead,
patients turn to robust on-line support groups that exist for
each of these drug-classes to learn more about this syndrome
and try to find therapies that may improve their suffering.
The underlying mechanism of this post-drug syndrome is
unknown, nor is it understood if this is a central or periph-
eral condition. The purpose of this preliminary investiga-
tion is to characterize three patients who suffer from post-
Accutane, post-finasteride, and post-SSRI syndrome and to
retrospectively determine if improvement in symptoms is
* Kenneth M. Peters
Kenneth.peters@corewellhealth.org
1 Corewell Health William Beaumont University Hospital,
RoyalOak, MI, USA
2 Oakland University William Beaumont School ofMedicine,
Rochester, MI, USA
3 University ofMichigan Medical School, AnnArbor, MI,
USA
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