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Post-Finasteride Syndrome but I Respond to TRT. What Can I Do?

Hey guys,
quick short story.

Used Finasteride to treat hair loss: ball ache and shrinkage, penile shrinkage, chest pain, cystic acne.
Stopped after 11 days. One month after woke up in the middle of night with severe palpitations, anxiety, insomnia, depression.

I have experienced a lot of weight gain in abdomen, double chin, pale skin, muscle loss, severe fatigue, impotence, black depression, memory issues, apathy, loss of body hair, beard stop growing, joint pain.

I have done a lot of exams (cortisol, acth, igf-1, dht, prolactin, fasting blood sugar…): they are all fine.

Total Testosterone was 4.0 ng/ml. Estradiol less than 20.0 pg/ml. Endo has refused to make a pfs/hypogonadism diagnosis because he thinks I have only a chronic fatigue syndrome so he prescribed me testosterone gel (trade name Testavan). 46 mg/day. After one year my symptoms have improved.

However due to a drug interaction (I used gemfibrozil to treat hypertriglyceridemia due to testavan) my total testosterone skyrocketed to 9.1 ng/ml and my symptoms almost recovered (no depression, no more fatigue, mental sharpness, erections every day, muscle tone, fat loss, more sebum and body hair) (symptoms not solved are flaccid penile shrinkage and visceral fat).

Removed the drug interaction, my maximum improvements almost disappeared and my last blood exam has revealed a 4.2 ng/ml of total testosterone. Endo however has refused to switch to trt injections.

What can I do? Do you think that my issues are only related to androgen deficiency/estrogen dominance?
Are trt injections (proprionate, cypionate, enanthate) so risky to try?

Now I’m 27 yo, I used finasteride at 22 yo but when I was 19 yo I have already some troubles with memory and erections and my total testosterone was 4.7 ng/ml.
Probably finasteride has messed up my fragile hormonal balance.

If you need more data, ask me.
BMI during the years:
Before finasteride - BMI 16.05
After finasteride (before trt) - BMI 21.91
During trt and gemfibrozil - BMI 17.74
Actually with trt - BMI 18.5
Despite a normal BMI my pot belly has remained.
Every advice is very appreciated.
Thank you.

If you already know higher T significantly improves things for you, then I’m not sure what you’re asking? Do you have the option of switching to injections? What are the normal ranges for the values you’re posting? The values don’t mean much without the ranges.

Thank you for your reply.
Total testosterone range 1.9 - 7.9 (ng/ml)
Estradiol range 20 - 47 (pg/ml)
I have no way to obtain trt injections without prescription.

I personally only would consider injections. If you can’t do injections then stick to gel. Doesn’t sound like any other option other than changing your doctor.

Thank you for your reply.
For endo values over 300 ng/dl are not correlated with androgen deficiency so he refuses to prescribe me trt injections. In his opinion, gel mimics better hormone physiology.
However finasteride has given me literally a chemical castration with penile shrinkage, balls shrinkage and upper muscles atrophy (especially sternocleidomastoid muscle, trapezius, latissimus dorsi muscle).
I have already visited several endos and urologists but only this endo has given me a testosterone prescription.
Seems that the problem is easily manageable with a testosterone replacement but it’s almost impossible to obtain injections without a proven androgen deficiency.
What do you think? Can injections give me some estrogenic issues like gynecomastia and water retention even at therapeutic dose?

Have him test you again, without having used the gel. Im sure youve shut down already. Have a sleepless night drinking or something before your blood test, and you should be in the gutter. At 27, I would rebudget myself to pay the miminum of $150 a month or get UGL T. Where do you live?

You presumably used the internet to find this forum. That same tool can be used for many, many other things. Just saying.

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I’m from Italy.
One month therapy about 40 €.

Do you think trt injections are a good idea in my condition?
Or can make the situation worse?
What about serious sides like polycythemia and lipids panel alteration?
Are they manageable?
What is the rate of liver diseases with trt injections?

I’m sorry for asking you so many questions but I don’t know almost nothing about trt.
Every advice is very appreciated.
Thank you.

The first is somewhat overblown and the second is usually improved by trt.

Absolutely. Everything is manageable, assuming you’re not the tiny tiny minority who has some weird complications.

Somewhere in the neighborhood of zero. Your liver doesn’t get shot by trt, it gets shot by all the other stuff you do in your life. You’re Italian, so I’m assuming your diet isn’t a bunch of sugars and refined carbs. I also assume you’re not drinking heavily and regularly. Now if I’m wrong then you need to worry about your liver anyway, trt or not. But for those who eat well and don’t abuse alcohol or oral steroids the liver risks are almost nonexistent.

Don’t be sorry. This place is here for people to ask questions and learn. There’s no shame on not knowing something. The only shame is I’m not trying to learn.

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Thank you very much for your kind reply!

I think the first try for pfs guys should be a temporary course of hcg.

How long did it take the cream to start improving your symptoms? You said you improved over a year. Were the improvements linear over time or quite sudden once you started?

Were you applying the cream to your scrotum? I’m not an expert on PFS, but I’ve heard that creams often work better than injections for some given that skin, especially of the scrotum, contains a high density of 5ar — the enzyme that is inhibited by fin. Thus, you would convert more T -> DHT

Is your penile shrinkage only while flaccid or while erect too?

I experienced many of the same symptoms when I developed PSSD from antidepressant use, so I’m curious about your testament.

Best of luck!

I have already tried in the past a course of hCG injections 2000 ui x 2/week for 16 weeks.
Only minor improvements like sleep, libido.
Nuts didn’t grow despite hCG. (each nut volume 8 ml after finasteride)

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Some improvements were very quickly like muscle tone, mood and libido (also roid rage).
However the effect slowed down very quickly (androgen receptor?).
Fortunately the improvements in body composition, mood, memory, stamina, sleep and libido appeared after some months.
Major issues are flaccid penile shrinkage (urologist confirms no issue in penile tissue so probably it’s a pelvic floor dysfunction) and visceral fat (decreased a lot but still here).
The incredible fact is that penile shrinkage appeared two hours after the first pill of finasteride so during the treatment and no after the withdrawal (seems literally a body shutdown).
I put gel on my shoulders and upper arms…why scrotum? It’s not a formulation for genitalia.
By the way, I have also andractim gel (by authorized pharmacy) but not used yet to avoid drug interaction…do you think can be useful?
I have read opposite opinion about dht…for some it’s only a trash hormone, for others it’s useful to balance estrogenic effect (like water retention, visceral fat and gynecomastia).
In the andractim leaflet common sides are increased red blood count and hematocrit elevation so maybe it’s better to avoid drug interaction.

There’s a cream that some people use that IS ok to use on scrotum. Positives are better absorption and higher DHT, for those that respond normally to that.

I too experienced this from PFS. Did you get your FSH checked? Mine was very high, I suspect the finasteride killed the Sertoli cells that produce sperm. My ejaculate volume reduced significantly and did not recover after 3 months of HCG treatment.

Did you end up perusing TRT? I would be interested to here how you are going.

I am currently pulling an allnighter to try crash my testosterone into the gutter to try get prescribed TRT. Also consuming sugar before your blood test is a good way to crash your levels:

The authors found that the glucose solution decreased blood levels of testosterone by as much as 25 percent

Update: All nighter successful. I feel dreadful. I hope this works.

A quick update: My endo has finally prescribed me a 2 months cycle with testosterone propionate injections because from my last blood test my T was 3.3 ng/ml and E2 was 13 pg/ml (both under physiological range)
Other values (all perfect) before injections:
Fasting blood sugar 90 mg/dl
TC 156 mg/dl
HDL 52 mg/dl
LDL 77 mg/dl
TG 108 mg/dl
SHBG 25.1 nmol/l
Protocol TESTOVIS (testosterone propionate) 50 mg twice a week
Price in Italy 2,50 € for one packet with 100 mg/2 ml x 2

Result: Insane responder for first 10 days. Confidence, sharp mind, stamina, muscle tone (deltoids, biceps, chest, latissimum dorsi, trapezius, legs, pelvic muscles (basically all skeletal muscles), penis growth, strong masturbation 3 times a day, huge appetite, body hair growth, oily skin, masculine face, deeper voice, flat belly (muscle tension), no constipation, insane body odor, euphoria, restorative sleep… Recovered from PFS and even more better than pre-PFS.
Then unfortunately the situation has come literally to baseline.
I don’t know the reason why one responder could become non responder in just 10 days.
Btw I have checked the situation with blood test and here the result:
T >15 ng/ml
E2 49 pg/ml
SHBG 27.2 nmol/l
Basically insane level but poor response.
Then I have tried to manage the E2/T ratio with 0.25 mg anastrozole at the time of injection (despite E2 is in perfect range) with poor result (brain fog, fatigue, insomnia, nightmares, strong anxiety) so I have removed the AI.
I have used anastrozole to flush out the water in my abdomen without success and only nasty side effects.
The massive amount of muscle tone in the first 10 days is basically fluids in the muscles.
Another thing is the strong body odor disappeared at the same time T stop works.
The male pheromones are basically all 5 alpha reduced metabolites so it seems a 5AR shutdown by a ghost inhibitor (or maybe by a problem in steroid pathway).
Can be an issue with adrenal glands or kidney?
Actually I start a drug with potassium chloride 600 mg/day to verify a possible electrolyte imbalance.

Any advice from the community is very appreciated.
Thank you

Give it two months before you start to modify things. It usually takes that long to get the benefits of try. I would argue that the changes you felt immediately after starting were placebo effects. You may also need to go higher on your dosage. We just don’t have enough time to say for certain.

Thank you for the reply.
I don’t think it’s a placebo effect because my parents and my friends have confirmed the dramatic improvements.
About higher dosage (over therapeutic) it’s only dangerous. My HT and BP have already increased. My T is over 1500 ng/dl (lab don’t measure exactly over this range so maybe it could be 1600-1700 ng/dl). I will continue the protocol prescribed by the endo but I don’t expect much.
In your opinion can be useful add HCG to TRT? (to preserve steroid pathway)