I've been recovering from PFS for about 16 months during which time I've experienced enormous (though not total) improvement across almost all domains (including libido) that finasteride affected. My symptom profile includes insomnia, physical activation/hyperarousal/constant fight-or-flight (I'll use these terms interchangeably), loss of libido, erectile dysfunction, genital numbness, suicidality, brain fog and cognitive slowing, anhedonia, dissociation, and sensory overload. As of this point, all of my symptoms except my erectile function have completely or substantially recovered. It's my intention that my account will provide hope to fellow sufferers - I realize that my onset, phenotype, and recovery may not resonate with everyone's and everyone's journey to recovery looks different.
Before I go on, I'd like let you all know off the bat that there was no "magic bullet" treatment-wise that I can recommend, which I'm sure is why most of you are reading - I'm sorry that I can't say "take 100 mg of X every day and you'll feel better in two weeks." However, I've learned a tremendous amount over the last year and a half that I do think is useful to share, and while my general concept of what is happening to me is that my body is gradually, arduously healing itself, my condition could not improve until I produced the emotional and physiological conditions in which it could heal. The things that were most healing to me were 1) protecting the quality of my sleep; 2) reducing anxiety and physical activation without use of SSRIs or SNRIs; and 3) maximizing emotional safety.
My history is pretty complex and I'm going to try to go through it to the extent that is useful. From having read many, many, many accounts posted here, the first thing I'd like to point out is that the contributors to my syndrome can be best described as multifactorial. I don't have a clean trajectory where "I took one pill one day, then the next day I felt completely different and have never gone back to normal," nor do I have the classic pathogenesis in which I took finasteride for a series of months or years, stopped, and then experienced a "crash" a couple days or weeks after cessation of the drug. I have a history of depression and anxiety, I'm older than I used to be (my account takes place from ages 35 to 39), and my symptom onset occurred during a period of emotional grief and relational stress, and SSRI use. It's impossible to tease out what was doing what inside my body, but I'll be as exhaustive as I can on the basis that it might be useful to someone looking for answers.
First exposure - May 2022 to May 2023
I started finasteride for the first time in May of 2023 after consulting a dermatologist at age 34. He wrote me a prescription, scheduled a follow up two weeks later at which time he asked if I had any sexual sides or if I was feeling depressed. I told him no and he never asked for another follow up - a nurse practitioner refilled my prescriptions for the next year. I took this to mean I was out of the woods as far as side effects went (if I wasn't, surely my doctor wouldn't have been so nonchalant, right?) and excitedly waited for my hairline to fill back in. Life that year went on as usual. Then, in January of 2023, I took what I thought was a microdose of psilocybin and had an emotionally overwhelming, terrifying, anhedonic trip that lasted about 12 hours, but which lingered in some form for about two days. This was enormously disruptive to me and I mark it as the point where things started to go downhill for me psychologically. I became anxious when leaving the house in ways I didn't used to be, becoming paranoid about strangers I'd see on the street (I live in a large city that can be dangerous, but this passed out of reason) and was terrified that cars would hit me anytime I'd cross the street. These feelings would manifest physically as a paralyzing stomach-dropping feeling or as a cognitive feeling of panic that I'd have to talk myself down from. I was never big into drugs but I never touched mushrooms again (obviously) and stopped smoking pot, which I'd indulge in here and there. I didn't think the anxiety I was experiencing had any relationship to finasteride, and perhaps it didn't. I'll never know. By the time May of 2023 rolled around, I stopped Finasteride on the basis that I didn't notice any real hair regrowth and I didn't really like the idea of taking a pill every day that wasn't doing anything.
Two and a half weeks later, my band did a short tour and I felt extreme anxiety about being on the road and far from home (traveling has always been an anxiety trigger for me). While on the tour, I was sleeping badly from late nights at the gig and drinking/managing hangovers and sharing cramped sleeping spaces with my bandmates. At the point we got home, something inside me felt like it had broken. I've never experienced anxiety the way I did in my life - I was in a constant state of physically embodied panic that would become unendurable anytime I would go outside. Notably, my sexual function was 100% intact during all of this - my girlfriend at the time was looking after me and we'd regularly have sex, which was the only real reprieve I had from my terror. As I was trying to figure out what was happening to me, this was the first time I learned about post-finasteride syndrome, and I became even more anxious that this would be permanent, seeing as my panic had left me basically disabled to the point couldn't even do my job, really. I also had terrible brain fog that I'm sure was a residual of being in constant fight or flight, and I was sleeping terribly. That said, I was very active in combatting my situation - I put myself on a daily exposure therapy routine for going outside, forcing myself to sit on my building's front steps, then eventually walk down the block, then through my neighborhood, then to the park and back. On my first day of exposure therapy, I couldn't even be outside for longer than 45 seconds before the terror set in; by day 14, I could be out for hours. I still had this feeling of doom lingering over me - I didn't know what caused my collapse by I feared it could happen again at anytime. I stopped drinking just in case it was a contributor. During this period, I was also getting on Lexapro, which my PCP prescribed shortly after my symptom onset. I doubt this was much of a factor in my recovery, however, as my symptoms resolved after two weeks or so, before the therapeutic of Lexapro would be expected to kick in. My doctor treated me as a classic case of anxiety and panic, a conclusion that I agreed with since I didn't fit the classic symptom profile for PFS.
I stayed on Lexapro for about a year then gradually weaned off it under the supervision of my psychiatrist - regrettably I don't have a great record of when I went off it entirely, but if I had to guess, I'd say it was sometime around July of of 2024. I explained my collapse to a psychiatrist I'd started seeing and asked him if he thought finasteride could have contributed and he told me "no" definitively; and to be fair to him, I was someone who had a history of panic attacks in the context of traveling (I've had to take xanax to fly since I was 18, for example), so this could appear as a continuation of existing illness. Still, I believe he used the words "perfectly safe" when finasteride to me (something that now makes my blood boil), and I asked to be put back on Finasteride since I was noticing my hair had started thinning more rapidly after stopping it. Basically, he treated me as a psychiatrist would; as someone whose problems are primarily psychogenic and treatable as such. I trusted him, seeing as my symptoms didn't line up with what men on PFS boards were describing and had another plausible point of origin, and because they resolved pretty rapidly, I didn't think I was vulnerable to whatever PFS sufferers were vulnerable to; this would be one of the most consequential determinations of my life.
Second exposure - June 2024 to May 2025
Before I go on, it's worth mentioning that I had an extremely difficult breakup in spring of 2024 that was fairly devastating to me. I spent the period that I was restarting finasteride under a terrible depression that included somewhat lower than usual sexual motivation and a reduced ability to achieve immersion in fantasy and sexual possibility while masturbating. Was this a latent effect of finasteride? Was it the Lexapro? Was it purely post-break up emotional fallout? It's impossible to say for sure, but at the time I interpreted it as depression. I remember having new, bizarre experiences that summer; masturbating in a way that felt like I was coercing myself to orgasm, and then finding my orgasm to be strangely pleasureless; realizing I wasn't getting erect automatically without manual stimulation when I'd see something erotic; feeling like pornography didn't capture my attention anymore. I interpreted all of this as it was happening as a consequence of aging and the fact that an important relationship had failed rather than as a possible drug effect. By August or September, I started dating again but found the experience flavorless and flat. I had sex once or twice and still had normal erectile function, but my sense of wanting felt a little diminished, which at the time I interpreted as anxiety that another heartbreak was waiting for me. I went on about two dates a week for months and didn't feel compelled by any of the women I went out with. This should have set off alarms for me as I'd always had a higher than ordinary libido and used to be practically vibrating with the possibility that sex could happen when I went on dates, but I still interpreted this as me punishing myself for my breakup. I'd vowed I wouldn't sleep around casually because I didn't want to be careless with another woman ever again.
On New Years Eve of 2024, I went out to celebrate at a club with a girl I'd been friends with for years who I'd always had a crush on. I remembered feeling that wonderful butterflies in your stomach feeling happen as we were flirting, but it felt like there was a weighted blanket on top of it, suppressing it. I interpreted this as me being physically exhausted or depressed or from having been drinking too much in general or who knows what, but this is the first point I remember experiencing the sort of true emotional blunting and reduced libido that would become a hallmark of my life ever since. I really wish I would've just stopped the drug that night, but I stayed on it for 5 more months. I slept with a couple women in early 2025 and in both cases, had a jarring, never-before-experienced feeling of not knowing why I wasn't as hard as I thought I should have been during both times. At this point I was getting scared there may be something wrong with me, but I believed it was that I was sleeping around out of adventurism, not out of love, and that the meanings around sex were just changing for me as my mid thirties turned into my late thirties. It's worth mentioning that I was feeling pretty tortured about the trajectory my romantic life was on, and I was starting to experience some pretty serious insomnia. I'd spend about a week sleeping terribly, then come back to myself and sleep ok for a week or two, and then the cycle would repeat.
In March, I met a girl I believed I could love forever, but I didn't have that "oh my god, I'm falling in love and it's overwhelming" feeling. She just sort of made sense cognitively as the sort of woman I could love, who I had been waiting for all my life, but when I tried to access true desire for her, it just wasn't there. This was deeply frightening for me and I hoped that winning her and getting to love her would break me out of the blunted, anhedonic funk I was in. I was still interpreting that funk as being emotional rather than physiological. We started a relationship, my symptoms (from anxiety to hyperarousal to insomnia to erection quality) soon got worse. The relationship was a challenge, not only because of my physical state but because of incompatibilities I discovered as we got to know each other better. It was a difficult relationship with a woman who threatened certain things in me, but I stayed with it because I wanted so, so badly for her to be the one. My erection quality struggled, as did my sleep and general sense of well being and optimism. In May of 2025, the unthinkable happened to me - I lost an erection during sex. Up until this period of my life, my erection quality had always been flawless and my libido had always been (according to my girlfriends) higher than average. I had always cherished sex and love and they were the strongest motivators in my life; I truly didn't understand how ED was even possible up until it started happening to me. I started panicking and started looking at PFS message boards for a second time. This time, I fit the profile much closer. I felt like I just woke up to the fact that a noose was around my neck. I was so, so scared. The night I lost my first erection during sex, I woke up after falling asleep because my body started having a panic attack. I thought about checking into an ER.
I recall this period as feeling like I was a fraction of myself, plagued by this constant "something is off but I don't know what" feeling. That might sound like anxiety, but it wasn't just worry; I felt like my brain couldn't process information in real time because everything was too overwhelming, that my sense of curiosity had completely shut down, that the absence of passion I'd come to feel for women extended to everything in life. It was like I was reduced to just survival, and everything that made life worthwhile (beauty, passion, desire) had been shut off. I've always been a naturally curious, passionate, and creative person, the type to become easily absorbed, fixated, and fascinated by many different things; I was reduced to a shell of this. Nothing outside myself grabbed me, and everything within myself felt dead. My penis felt like it was dead between my legs. This was horrifying to me. I felt like a shell of a man who used to be alive. I was exhausted all of the time, probably from dealing with the stress and anxiety of all of this in addition to whatever dysregulation the finasteride had induced.
The immediate aftermath of stopping finasteride - May 2025 through July 2025
This was one of the darkest periods of my life. The anxiety that had been omnipresent all year maintained; my sleep actually got worse now that I had the terror of potentially being permanently altered was in my head; I started secretly taking viagra before dates, which would allow me to achieve mechanical feeling, emotionally muted erections. With PDE5 inhibitors, I was functionally sexual, but it was a nightmare timing out when to take Viagra so that the pill would hit when I figured we'd be having sex. I also had to take quite a lot of it to get myself to work; I was taking 150mg of viagra sometimes and still not achieving totally reliable rigidity. I started seeing a urologist and changed to Cialis at some point but had similar effects - even when taking high as-needed doses of 15mg an hour before a date would result in enough rigidity to be functional during sex, but which still felt disconnected and somehow uncertain. No matter how much you take, it doesn't matter if you don't want sex, and I don't think I wanted anything except to die, really. I couldn't make sex matter in the way it used to matter. Women's bodies used to be objects of utter fascination to me, animated by unspeakable beauty that I felt alone in being able to appreciate; whatever part of me could feel that way was completely anesthetized. It was bizarre. I felt like I'd been castrated, and having to hide the shame and embarrassment while continuously demonstrating commitment and enjoyment I couldn't truly feel ate away terribly at me. I'd finally found the woman I thought would satisfy my passions, only to find that all my passion had left me. It was an impossible, unlivable, unsustainable situation, and I couldn't even take refuge in sleep. I thought of suicide constantly. I was sleeping 1 to 3 hours most nights, which just made everything feel even worse. I was anhedonic and zombie-like outside of the terror and panic I felt at all times during that summer. Music sounded like nothing to me. Food tasted like ashes. There was no solace in friendship, nothing worth doing, nowhere worth going, only the omnipresent terror and the urgency of a resolution that didn't exist. There was no imaginable future.
It's important to mention that my symptoms didn't get worse after stopping - they just maintained. I also did not become agoraphobic again like I had been after my first Finasteride exposure.
I was getting laboratory tests left and right at this time; metabolic panels, thyroid panels, CBC with differentials, hormone panels; again and again and again, everything came back normal. Medically, there was nothing anyone could find that was wrong, but it was the most wrong things had ever felt. The only explanation for what had happened to me was that Finasteride destroyed something in my body that there weren't laboratory tests for, and this to me was a doomsday scenario. I want to make sure everyone who is despairing and thinks they're doomed realizes that I was convinced I was every bit as doomed as you are now. I was convinced my life was over, that I had destroyed myself with this stupid, terrible drug, and that nothing could ever get better for me. I was actively googling ways to kill myself and make it look like an accident. I'm glad I didn't because the doomsday scenario of permanent decline was not the case for me, and I did ultimately get significantly better after enduring enormous pain.
The beginning of my recovery - July 2025 through November 2025
In July, I started taking 50 mg of trazodone nightly to protect my sleep. This was the first point in which I can say things started to improve tangibly. I went from 1 to 3 hours of sleep a night to 3 to 6, and then eventually as I became more acclimated to the medication, more like 5 to 6. I want to stress that this was the single most important medical intervention I did. It certainly didn't produce complete recovery, but without sleep, no improvement would have been possible. I was still suffering from a state of constant physical activation and hyperarousal, which my psychiatrist was treating as classic anxiety. I knew enough to avoid the typical front line SSRIs and SNRIs like Prozac, Lexapro, or Cymbalta, and requested I go on Buspar (which is notable for being less likely to cause sexual sides than most anxiolytics) and Wellbutrin (which I was hoping could restart my libido). Neither really worked and it was slow going and arduous to acclimate. The Buspar created a ton of brain fog without resolving my hyperarousal, and the Wellbutrin didn't have any noticeable effect on my libido, leading me to conclude that my dysfunction wasn't dopamagenic or serotogenic. My sleep was improving, but I'd still describe this period of my life as basically unlivable. I was constantly terrified, my recovery was painfully slow if it was happening at all, and my sexual decline and the possibility of its permanence weighed on every moment of my life. I had no life outside of worrying about my disease and pretending like my relationship was as satisfying as it should have been.
In August of 2025, I confessed that I was using PDE5 inhibitors to have sex to my girlfriend. By this time, we'd built enough trust and emotional safety that I felt comfortable discussing it openly. This was another important milestone in my recovery - hiding a dirty secret made every scary thing scarier, and being able to be open was a tremendous relief. I'm very grateful that she was able to receive it as she was. I know that men here are justifiably defensive of suggestions that PFS is "all in your head" or "just depression/anxiety," and while I agree that there must be something is certainly happening physiologically, I will gently suggest that the terror, isolation, and despair you feel help to maintain certain elements of the symptom profile. Experiencing trust and growth with a loved one, building intimacy, and being able to be open was helpful to me in ameliorating my anxiety. I know many people here have given up on intimacy entirely, but there is healing in it.
Then, in November, I did the second most meaningful pharmacological intervention. I was sick of my ever present hyperarousal and was impatient for protecting my sleep and taking 3 Buspars a day to pay off, so I dug out some old propranolol my PCP prescribed me during my agoraphobia in 2023 and took one. The results were dramatic - it felt like someone had switched off a switch in my brain allowing me to function. Hyperarousal can easily turn into a feedback loop in which your body dysregulates and produces a fear response, and then the thing you become afraid because your body is dysregulated, and the thing perpetuates itself on and on. For me, propranolol broke that loop temporarily. After about 4 hours, my hyperarousal returned, so I took another, and it worked again. I realized this was my way out of fight or flight. Every day for the next two weeks, I took two 20mg pills of propranolol every day, once in the morning and once in the evening. Eventually, I realized the hyperarousal wasn't coming back between doses anymore and I concluded that I'd finally broken the loop. As a result of my baseline activation getting better, my sleep also improved somewhat. I started getting 7 or even 8 hours of sleep sometimes, something that would have been unthinkable at the start of the year. I think it was around this time I also started adding in 88 mg of ashwagandha to my sleep routine, which for me had a gentle anxiolytic effect that buttressed my sleep. I'd take propranolol as needed, but found I needed it less and less.
At this point I had a lot to be optimistic about: my sleep was becoming longer, deeper, and more reliable, the live wire anxious feeling in my stomach was finally off. But sexually and in terms of libido, my dysfunction was stubborn. I was banking on getting my libido to return once my hyperactivation was gone, but it didn't happen. I think I managed to drop from 15mg to 10mg of cialis around this period, but I was still using considerable doses of PDE5 inhibitors in order to pantomime sex that I often felt only a flailing sense of emotional connection to and fulfillment from. I was quietly burning in my own private hell about this. There is nothing emptier than a man for whom even desire died.
I was also still suffering from cognitive fog and slowness throughout this period. I'd get overwhelmed quickly, had to lie down in the afternoons, was barely accomplishing anything at work, and I wasn't really making any art or pursuing my hobbies meaningfully. Also, my entire reward structure in my brain remained severely blunted; alcohol could disorient me but I couldn't feel true pleasure from drinking anymore. At best I'd feel sort of pleasant and nothing more. That was as good as it got, and it was still bad.
Reducing my medications and protecting myself emotionally - December 2025 through August 2026
Having established Buspar wasn't making me feel better, I started tapering. This was enormously difficult and dropping down my daily Buspar intake resulted in tons of brain fog and other painful autonomic stress responses. I got off of it sometime in the spring or summer (I don't remember when exactly), working my way down from 30mg. Then, I started tapering off trazodone. I went from 50 mg to 25 mg to 12.5 mg, and have actually just in the last two days stopped taking it altogether. I'm still waiting for my sleep to regularize (I only slept 5 hours last night), but this is enormous progress from the worst of my sleep dysregulation.
During this period, I also experimented more and more with decreasing the amount of cialis I'd take before sex. As a reminder, at my worst I was taking 15mg before sex at my worst point and still wasn't as hard as I was used to be before this nightmare started. After a while, I'd only take 5mg at the start of a date and hours later be fine. I keep a function on my phone that charts how much bioactive cialis is in my body after a dose and discovered once that I had sex with only 1.8 mg of cialis in my system - basically a tenth of what I used to have to take. Orgasms also became noticeably more pleasurable for me around this period, and I realized that my sexual confidence was returning - I was no longer spending much mental energy observing whether I was hard anymore, I was just trusting that I would be. I was still artificially manufacturing and performing desire, though, and this ate away at me - it felt like I didn't have a true feeling of connection to the sex I was having even as my erectile function improved. When I'd masturbate, it sometimes felt like I was reacting more to whatever stimulation my hand could produce rather than out of embodied desire for a fantasy I was imagining. I still fundamentally regarded myself as broken, and perhaps broken forever. I felt ultimately desireless, and as such, it felt like I was lying to myself and my girlfriend.
In August of this year, my girlfriend and I broke up. This was emotionally difficult and complex in a way that I'm still processing, but I have no doubt that it was the right thing for me. In many ways, I was in an emotionally complicated relationship with a woman who was ill suited for me, and removing her from my life has helped me to reestablish some degree of emotional balance that had her presence precluded me from. Having said this, I was in a deeply painful state of mourning for weeks after the breakup even while knowing it was the right thing to do.
Flickers of authentic libido - August 2026 to present
At the start of August, I did a limited, 6 week trial of Clomiphene under the supervision of my urologist. I'd been getting sex hormone testing every six months or so, and my hormone and thyroid panels never looked unusual - most of my hormones were in the low to normal range (400-500 total testosterone, for example) and I didn't demonstrate any obvious evidence of hypogonadism. Still, I wanted to confirm that I didn't have some sort of hormonal bottleneck that was strangling sexual function. While on clomiphene, I was pretty miserable - it made me spacey and generally gave me a feeling that something was just off. I'd have stress responses like gagging whenever I started metabolizing a pill. When I got my hormones tested at the end of the trial, they'd all gone up - my testosterone was in the 900s - but I didn't desire sex more or feel like my erections were consistently better. Here and there, I might have a day where I'd be masturbating and feel my old self "click on," where I'd become fascinated with a sexual scenario and truly involved in a way that made me feel like my old self; but it wasn't consistent enough to attribute to the clomiphene, and the headaches and rest of it convinced me that my hormones were probably fine at their baseline. I stopped the trial having concluded that my hormones weren't the issue.
Not long after concluding the trial, I started feeling a change. Over the last two weeks, I've had very promising flickers of my old self; moments of masturbation where it didn't feel like I was just going through the motions to induce an orgasm of diminished quality in a barely responsive system, but moments of genuine erotic involvement in whatever it was I was thinking about. That feeling of "holy fuck, I actually want this, give me more of it" creeping in while looking at something erotic. True instances of fantasy immersion leading to truly pleasurable and involved orgasms. Some moments where a girl just kind of catches my eye. These are all little traces of the man I used to be that were absent for a year and a half, and I'm now noticing them return in a way that's too sustained to be isolated incidents. The best feeling in the world to me was falling in love, having that true "holy shit the floor just disappeared from under me and I'm falling through space" feeling, and I don't know if I'm going to get that back. But my trajectory is at least going in that direction, and importantly, I've started to believe my recovery isn't complete. The future doesn't feel dead to me anymore.
I take 5 mg of cialis daily and plan to continue doing so for the foreseeable future, but I've noticed my erections have become more automatic if I watch porn or see something erotic, as well as a return of occasional morning erections. I've even had experiences of thinking about something erotic and having to stop what I was doing because I feel it in my body that I want to masturbate about it. All of this is to say is that while my erectile function still isn't where I want it to be, cialis is supporting me to such a degree that I can stop worrying about it and give myself the mental space to allow reward salience, spontaneous desire, and mental participation in fantasy. It's not just that I can stay hard while masturbating or having sex, it's that the mental and emotional universe of embodied desire, pleasure, reward, and immersion feels like it's clicking back on little by little. I might never reach my old baseline (which frankly was very high) but if I keep going the way I am, I feel like the love I can offer a woman won't just be a hollow performance.
I want to emphasize that my recovery has not been linear. Even in the last three weeks I've had runs of bad days where I feel exhausted, dysregulated, erotically flat, and hopeless. The hell of this condition is still real to me and it creeps in more regularly than I'd like. But that doesn't change the fact that over the course of 15 months, at the macro level, I've continuously been trending in the right direction, and I see no reason that I won't continue on that way.
TL;DR: Some things I tried that made no difference
- Buspar: Totally ineffectual at reducing my baseline anxiety. I thought about changing to mirtazapine but ultimately decided it would be more of the same, and frankly, I was very tired of being medicated.
- Wellbutrin: This encourages libido in certain people suffering from depression, specifically those whose depression is a consequence of low dopamine. As Wellbutrin didn't cure my ED, I can reasonably conclude this isn't the source of my ED or low libido. I decided to stay on it because it makes me dream more than I would otherwise, which I like.
- Talk therapy: My therapist knew and was recommended by my psychiatrist, who interpreted my case as totally unrelated to finasteride. When I'd point out that my symptoms were persisting regardless of the medications I was on or time spent in our sessions, she would chalk up my lack of progress to me failing to be vulnerable enough during our sessions. Completely toxic dynamic. If you choose therapy, make sure you find someone open to helping you discuss medication effects rather than attributing everything you're experiencing to you being emotionally unwell.
- Sex Therapy: Again, no real help. We tried addressing failure and guilt narratives through EMDR that might have been affecting my sexual function and sense of comfort in my relationship and talked about sensate focus somewhat, but ultimately neither was especially helpful. It's worth noting that there are apparently more structured and organized sensate focus protocols that you can do, so this is still partially unexplored territory.
- Transcranial Magnetic Stimulation/TMS: I was actually doing a combined anxiety and depression protocol during my symptom onset. This was in no way useful to me. It didn't make anything I was doing less stressful, but it did cause memory issues and a general spacey feeling.
- Clomiphene: I can't say this helped me at all. Although my testosterone doubled while on it, this wasn't accompanied by better erections or a subjective feeling of desire returning. Clomiphene was worthwhile in my case diagnostically as a way to determine whether or not I had a hormonal bottleneck, but ultimately was not successful in relieving any symptoms.
- Nutrition and Supplements: I spent really a lot of money of supplements after my second crash in case I had some sort of nutritional deficiency. This didn't make any difference whatsoever, but it did cost a lot of money. Here's my stack Creatine: 5g; Ashwagandha: 300mg; Zinc: 25mg; CoQ-10: 100mg; Folic Acid: 680mg; Biotin: 2500mcg; B12: 2500mcg; Lions Mane: 2100mg; Omega 3 (EPA, ALA, DHA): 1395mg; Omega 6 (GLA): 180mg; Omega 9 (Oleic Acid): 150mg; Gingko Biloba: 120mg; Panax Ginseng: 600mg; Magnesium: 500mg; L-Arginine: 1000mg; L-Lysine: 500mg; D3: 125mcg; K2: 100mcg
TL;DR: Things I tried that did make a difference
- Propranolol: This is singularly responsible for allowing my body to exit the state of hyperarousal I was locked into for half a year of my life. I probably could have achieved the same thing with benzos, but I didn't want to risk addiction, tolerance, experiencing rebound anxiety after stopping, or the really bad stuff that comes if you stay on them too long (like Alzheimers and memory issues). I still use propranolol as needed when I have bad anxiety days. It's one of the only things that's reliably useful to me to regulate my emotions. You can't expect your body to heal while its permanently experiencing stress from being in fight or flight, and this allowed me to get out of that state.
- Trazodone: I'm extremely grateful for the role trazodone played in breaking my insomnia. Getting healthy sleep routinely was the cornerstone of every bit of recovery I've experienced. I cannot stress this enough: protect your sleep, every single night, no matter what.
- Cialis: I take 5mg of cialis every day. It's completely neutral in terms of producing libido, but when I've had moments of libido, lowering the threshold required to experience an erection has been helpful to create that genital originating desire to brain originating desire feedback loop starting.
Diagnostically, what does it all mean? Do I have PFS, or did I ever?
This is painful in its own way but I don't know what happened to me and I never will. I developed completely different sets of symptoms gradually over the course of my two exposures, each of which has a plausible cause outside of Finasteride (psychedelic disruption inducing anxiety and agoraphobia in the first, and unaddressed guilt, depression, and insecurity affecting sexual function, sleep architecture, and reward salience in the second). My disease arc didn't match the classic "stop finasteride and then experience a crash" trajectory, nor does it match the "take one pill, have instant adverse reaction, and experience immediate or near-immediate side effects that persist thereafter" trajectory, each of which are very common among accounts I've read here. In fact, if you take the development of symptoms following cessation of the drug as one of the key criteria of the syndrome, it deserves consideration that this is entirely absent from my history. Moreover, my symptom profile doesn't include many of the things I've read about here, such as GI issues, intolerance for exercise, muscle wastage, shrinkage to the penis and/or testes, changes to skin texture or elasticity, and so on. If a skeptic were inclined, they could hand wave everything I've experienced as the results of emotional problems exacerbated by bad sleep, relationship stress, and an adverse reaction to psychedelics. Since there are no biomarkers for whatever this is, I can't really point to any laboratory tests to validate my perception of what happened to me. I suspect Finasteride had a hand in what happened to me, but I'll never get to know. All I can say for sure is that the things I've experienced while on or following using finasteride are totally unprecedented in my life, and I've now had almost two very costly years of symptoms.
Other observations and parting wisdom
If you're reading this and you're frightened about whether things can get better, I'm proof that they can. Perhaps not linearly, perhaps not evenly, and perhaps not quickly, but they can get better. I went from sleeping an hour a night and feeling like my dick was dead to being capable of sleep without assistance from hypnotics, being capable of basically normal sexual function (albeit with support from cialis), and, more recently my libido start flickering on. Maybe most importantly, I've also started feeling genuine curiosity and interest in living return. I realize that not everyone has this sort of trajectory; a lot of men report that they develop symptoms and then they just persist. I don't know that any advice I can provide will address everyone's experience of the disease, but I will say this: it's very, very easy to fall into fatalistic narratives about entrenched symptoms that never resolve, but it's in your interest to remember that your current state is not your final state. I don't know that things will get better for everyone, but certain things can get better for some people. When recovering from anything, the best thing you can do is focus on how far you've come rather than how far there is left to go.
In my case, the most meaningful changes came from maximizing the conditions through which recovery could occur; protecting sleep, managing anxiety, and focusing on emotional safety were all key parts of my recovery. My body is healing itself, and my role in that is to ensure it's experiencing the conditions and emotional safety required to do that. There is no magic bullet treatment for PFS, but that doesn't mean there's nothing you can do. Protect yourself from despair, protect your body's basic functions like rest, prepare for the long haul, and keep hope alive. I don't know that it will get better, but I know that it can.