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Alan R. Jacobs MD PCAlan R. Jacobs MD PC
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A potentially new treatment for post-finasteride syndrome

March 2, 2022 Post-finasteride Syndrome

It is known that post-finasteride syndrome (PFS) patients suffer from treatment-resistant depression and anxiety. Researchers have found low levels of neurosteroids, including allopregnanolone, in the cerebrospinal fluid of post-finasteride syndrome patients.  

Palmitoylethanolamide (PEA) is a substance naturally produced in many cell types in our bodies, including in very high concentrations in our brains.  Over 60 years ago PEA was found in egg yolks and peanuts and determined to have anti-inflammatory and neuroprotective and analgesic properties.

By the mid-1990’s PEA’s mechanism of action was discovered and linked to its ability to induce the brain biosynthesis of neuroactive steroid hormones, including allopregnanolone.  In mouse models PEA increased brain allopregnanolone levels and reduced anxiety-like and depression-like behaviors.  This improvement was blocked by finasteride, which blocks the synthesis of allopregnanolone.  

PEA molecule
Photo courtesy of ResearchGate.net

It appears promising that treatment with PEA, by increasing allopregnanolone levels in PFS patients’ brains, could improve mood and reduce anxiety.  PEA has been studied in 40 clinical trials involving 6000 subjects over the years and has shown a quite favorable risk/benefit ratio.  

Doses have ranged between 1200mg and 3600mg per day without significant side effects.  30 mg/kg doses have been studied in children.  

In the near future oral allopregnanolone analogs will be available to use in attempting to treat PFS patients.  In the mean time ultra-micronized PEA can be obtained from Amazon for a reasonable cost.

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