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The enzyme steroid 5α reductase (S5α R) catalyzes the conversion of Δ⁴-3-ketosteroid precursors--such as testosterone, progesterone and androstenedione--into their 5α-reduced metabolites. The 5α-reduced metabolite of testosterone, 5α-dihydrotestosterone (DHT), is the most potent androgen and stimulates prostatic growth led to the development of S5α R inhibitors with high efficacy and tolerability. Two of these agents, finasteride and dutasteride, have received official approval for the treatment of benign prostatic hyperplasia and are being tested for prevention of prostate cancer. Over the last decade, converging lines of evidence have highlighted the role of 5α-reduced steroids and their precursors in brain neurotransmission and behavioral regulation. Some preliminary data suggest that S5 R inhibitors may elicit therapeutic effects in a number of disorders associated to dopaminergic hyperreactivity, including psychotic disorders, Tourette and impulse control disorders. In the past year, we tried finasteride (5mg/day) in 5 male and 1 female adults with severe tics that resist to neuroleptics and other medicines for more than 10 years.  Their tics reduced significantly within 1 to 4 weeks in 4 patients including the female one. These 4 patients maintained finasteride well for 6 to 12 months. The 3 males had no abnormal erection, ejaculation, libido, gynecomastia , and any malignancy. The only female had no health problem too. Regular liver ultrasound examination and blood checkup for CBC, PT/APTT, AST, ALT, Bilirubin(T/D), ALK-P, albumin and globulin every 3 months did not show any abnormal changes. Finasteride deserves a further evaluation of clinical efficacy in Tourette disorders.

5α reductase; Finasteride; Testosterone; tic; Tourette disorder