Mechanistic Insight and Management Recommendations for Persistent Genital Changes after Finasteride or SSRI Discontinuation

Mechanistic Evidence

• Finasteride inhibits 5α‑reductase, preventing the conversion of testosterone to dihydrotestosterone (DHT) and disrupting neurosteroid production; this endocrine alteration is proposed to underlie persistent sexual dysfunction in patients who have stopped finasteride therapy. 1

Clinical Management Recommendations

• In individuals with ongoing genital anesthesia, reduced libido, or erectile dysfunction after discontinuing SSRIs or finasteride, clinicians should refrain from prescribing additional serotonergic or anti‑androgenic medications, as these agents may worsen the persistent symptoms. This guidance reflects expert consensus and guideline‑type recommendations. 1, 2