Biggest finasteride study ever proves Post-Finasteride Syndrome is FAKE!

Summary

The Haircafe presenter argues that a large follow-up analysis of the Prostate Cancer Prevention Trial found no evidence of a higher rate of diagnoses associated with post-finasteride syndrome (PFS) among men who took finasteride than among men who took placebo.

The video’s title is stronger than the study’s stated conclusion: the study found no evidence of PFS in its data, rather than proving that PFS can never occur.

Study discussed

• The original trial randomized men to receive finasteride at 5 mg daily or a placebo. The presenter notes that 5 mg is five times the usual 1 mg hair-loss dose.
• In the later analysis, researchers reviewed Medicare records for 14,239 participants. Average follow-up was about 20 years, totaling 267,983 person-years.
• The presenter says the analysis found no significant difference between the groups in common diagnoses such as depression, erectile dysfunction, fatigue, or muscle pain and weakness.
• In the placebo group, reported erectile dysfunction, reduced ejaculate volume, and lower libido more than doubled after participants began taking the placebo. The presenter highlights this as evidence that expectations can affect symptom reporting.
• The presenter argues that PFS is difficult to assess because reported symptoms and their timing vary widely. The study authors’ stated conclusion, as quoted in the video, is that conditions attributed to PFS cannot be linked to finasteride without a properly designed, sufficiently powered study.
• The presenter proposes a prospective trial comparing people who stop finasteride with a control group, with symptoms tracked afterward. He suggests it might require 5,000–10,000 participants.

Advice and takeaways presented

• For people concerned about finasteride: The presenter advises viewers not to rely on online claims and recommends finasteride or dutasteride for hair loss. This is his opinion, not individualized medical advice. Anyone considering or using these medicines should discuss their risks and benefits with a qualified clinician.
• About side effects: The video acknowledges decreased libido, erectile dysfunction, and reduced ejaculate volume as possible adverse effects, while also noting potential prostate-related benefits.
• For managing online information: The presenter recommends reducing smartphone use or switching to a basic “dumb” phone, arguing that this may limit exposure to misinformation. He also points viewers to a related video on the topic.
• For further reading: He says he chose not to make a video about minoxidil and topical diazoxide, but wrote a Substack article instead.
• On the video’s tone: The presenter uses strongly dismissive and insulting language about people who report PFS. That rhetoric is separate from the study results and should not be treated as scientific evidence.

Presenters and sources mentioned

• Presenter: Haircafe; the presenter refers to himself as Kevin.
• Main study: Till et al., “No Evidence of Post-Finasteride Syndrome in 267,983 Person-Years of Follow-up in the Prostate Cancer Prevention Trial” (2026).
• Other research cited or discussed:
  • Thompson et al. (2003) on the Prostate Cancer Prevention Trial
  • Goodman et al. (2019) on long-term prostate cancer mortality
  • Mondaini et al. (2007) on nocebo effects
  • Ganzer et al. (2015) on reports of persistent symptoms
  • Trüeb et al. (2019) on a reported PFS case
• Other references: A Peter Attia interview, the presenter’s PFS and placebo-effect video playlists, and his Substack article about minoxidil and topical diazoxide.