I speak as a 5-AR hyperresponder who had “post finasteride syndrome” before there was a term for it. My crushed DHT from propecia left me depressed and libidoless for weeks. Very frightening when you don’t understand the mechanism.
However, while crushed DHT levels absolutely cause those systems, just like low E2 or Test levels cause symptoms, I don’t believe in PFS as a permanent effect like the reddit fearmongers do. The residual effects are psychosomatic. This has been studied to death and I’m convinced there’s no permanent damage.
Once you stop and DHT rises again symptoms disappear.
BUT, Dutasteride’s extremely long half life means if you mistakenly drive DHT too low, like with an overdose, it takes a long time for levels to recover. What takes a few weeks at most with Finasteride, could be 2-3 months with Dutasteride.
If you’ve never used a 5-ar inhibitor, no need to be anxious, just start with a very small dose and slowly titrate. If you start to feel depressed, just back off to the dose that was ok.
With Dut 1/4 tab, 0.125mg, 2x week is safe. After 2 weeks increase to .25mg 2x, two more weeks, .50mg 2x, two more weeks then 3x. Etc.
Better yet get a baseline DHT blood test so you can monitor how low you can go and still feel good. Easy to recover from any downturn if you catch it early, and still protect your hair. I think all the unnecessary suffering and drama around these meds would be a non issue if monitoring DHT was the norm, just like monitoring Test levels is with TRT.