In Aprilthe FDA issued a warning on finasteride. It has been reported that DHT has a favorable effect Libido proscar sexual function and the cardiovascular system without any adverse effects on prostate. Medical therapy for benign prostatic hyperplasia: Sexual dysfunction and impact on quality of life. Fertil Steril. Advanced Search Users Online: Scroll to Accept. MediLexicon, Intl. A large prospective study in as many as 17, patients was conducted to look into the effects of finasteride and other covariates on sexual dysfunction as part of the analysis of The Prostate Cancer Prevention Trial PCPT. Libido proscar I 5AR, is present in the sebaceous gland, while type II 5AR is found on the outer root Libido proscar of the hair follicles and dermal papillae. We may share your information with third-party partners proscad marketing purposes.
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Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
- Generic Name: finasteride Dosage Form: tablet, film coated.
- Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
- Discussion in ' Dealing with Side Effects ' started by proscarred2 , May 2,
Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects. This article critically examines the evidence available and makes recommendations as to how a physician should counsel a patient while prescribing the drug.
Some of the commonly faced questions by a physician while treating a patient of pattern hairloss are about the possible sexual side effects caused by finasteride. Reports in the press, internet sites, and misinformation by practitioners of alternative medicine, all have contributed to this image of the drug, and has lead to apprehension in the minds of patients.
Often even dermatologists seem to hesitate to prescribe the drug on a long term basis. This article examines this subject in the light of evidence available. Pattern hair loss in males is androgenic in etiology. Antiandrogens such as finasteride are therefore useful in the management of the condition.
Androgens, especially testosterone increases the libido. Any drug which interferes with the action of androgens is therefore assumed, by the lay person, to induce impotence.
However, the precise role of androgen in penile erection needs to be fully elucidated. In addition to androgens, visual, olfactory, tactile, auditory, and imaginative stimuli influence the libido.
The penile erection is mainly under the control of parasympathetic nervous system. Ejaculation and detumescence require an intact sympathetic system. The androgens testosterone and dihydrotestosterone DHT have somewhat different actions.
It exists in two isoenzyme forms. While type I is predominant in liver, type II is predominant in prostate, seminal vesicles, epididymes, hair follicles, and liver. Type I 5AR, is present in the sebaceous gland, while type II 5AR is found on the outer root sheath of the hair follicles and dermal papillae.
At all these sites, the testosterone is converted to DHT. Finasteride is a specific and competitive inhibitor of Type II 5—AR, and has therefore a selective action on hair follicles. This explains why relatively small dose of finasteride may be adequate therapeutically. The bioavailability of finasteride is not related to food intake.
Finasteride is extensively metabolized in liver by Cytochrome P 3A4 enzyme subfamily and excreted both in urine and feces. A number of studies have looked at the problem of side effects caused by finasteride. These effects occurred early in the therapy and returned to normal on stopping or over a time on continuous use of the drug. The only causal relation between finasteride and sexual adverse effects is decreased ejaculatory volume because of predominant action of DHT on prostate.
A comprehensive review of a total of 73 papers on medical therapies for BPH was conducted, with a focus on the effects of different pharmacological agents on sexual function. The role of nocebo effect in the causation of ED due to finasteride has been investigated. In this study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED, when compared to the group without information.
Two studies in and showed that the incidence of these side effects with finasteride therapy was generally comparable to that observed with the treatment with placebo,[ 8 , 9 ] and there was no evidence of dose dependency or increased incidence with longer therapy out to 12 months.
In addition, the side effects ceased in patients even when they continued to receive finasteride. The incidence of side effects were comparable to that of placebo both at one year and at 5 years. A large prospective study in as many as 17, patients was conducted to look into the effects of finasteride and other covariates on sexual dysfunction as part of the analysis of The Prostate Cancer Prevention Trial PCPT.
Finasteride increased sexual dysfunction only slightly even at 5 mg dosage which is much higher than the 1 mg administered in pattern hair loss and its impact diminished over time. A recent review of the available literature too arrived at similar conclusions.
The study revealed that the subjects reported new-onset persistent sexual dysfunction low libido, ED, and problems with orgasm associated with the use of finasteride. The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date.
However, there were many limitations in the study, such as small number of patients, selection bias, recall bias for before finasteride data, and no serum hormone analysis. An important earlier study by Mella et al ,[ 14 ] conducted a systematic review of twelve randomized trials evaluated the efficacy and safety of finasteride therapy in male patients.
Moderate-quality evidence was found for an increase in erectile dysfunction RR, 2. A number of isolated case reports have also been published on the effect of low dose finasteride on DNA changes in sperms,[ 15 ] on motility, and sperm counts. Significantly, these parameters improved after stopping the drug. Another small study[ 17 ] reported three cases of young men, who had used finasteride for five years, investigated for male Infertility.
Semen quality was investigated by light microscopy to evaluate sperm concentration and motility, sperm morphology by transmission electron microscope TEM , presence of Y microdeletions by PCR, and meiotic segregationby fluorescence in situ hybridization FISH. TEM analysis revealed altered sperm morphology consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies. One year after the men had stopped the use of finasteride without receiving any other treatment, a recovery of spermatogenetic process was observed.
Motility and morphology improved whereas the meiotic pattern did not change. Traish[ 18 ] conducted a review of different published studies and concluded that altered sexual functions such as erectile dysfunction and diminished libido are reported by a subset of men receiving finasteride, raising the possibility of a causal relationship. The review suggested discussion with patients on the potential sexual side effects and possible alternate treatments before administration of the drug.
The taskforce posted their initial update on the subject as follows:. Reports of persistent sexual side effects have come from a variety of sources with some internet sites attracting individuals claiming to have sexual and psychological issues related to finasteride. While continued difficulty having erections after discontinuing finasteride has been reported in post-marketing surveillance the incidence of this problem remains unknown.
Also, little data is available concerning the medical and psychological work-up of these patients to exclude other potential causative factors. At the present time, the mechanism of interaction between the brain, 5 alpha-reductase metabolism, and hormones on sexual dysfunction is speculative and poorly understood.
Clearly, this is a complicated issue, which overlaps with other disciplines in medicine such as Endocrinology, Urology, and Psychiatry. We hope to participate in a multidisciplinary forum to further evaluate this topic. Millions of patients have benefitted from finasteride with no side effects at all, or minimal and reversible side effects. It is important for the medical community to verify anecdotal reports and if necessary, conduct further studies so that accurate information may be given to our patients to enable them to make informed choices regarding the use of this medication.
Thus, the evidence available about the safety of the drug can be considered as questionable, but cannot certainly be ignored. The matter needs further systematic investigation and documentation. However, there is no doubt that to the lay man the prospect of impotence while taking a drug for hairloss is daunting, however theoretical and small the risk may be.
The drug brochures mention the possibility of the side effect and the patient is often unable to distinguish between the effects of 1 mg and 5 mg. Several websites give a rather unfavorable opinion about the side effects, contrary to the evidence presented above. Several blogs also discuss the side effects, and individual and anecdotal experiences are highlighted and often exaggerated.
Any patient who reads such reviews is understandably apprehensive, and therefore may stop therapy with in a few weeks of starting or, in other instances, do not start the treatment at all.
Losing potency for gaining hair is not an attractive proposition, however remote that possibility is! In view of this, it is very important to properly counsel patients about the treatment. In particular, the following facts need to be stressed:. The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem.
Several studies have shown its safety over long duration of administration. The dosage given 1 mg is small and unlikely to cause side effects. Even in those cases where side effects were reported, the changes were found to be reversible. There are very few effective alternatives to the drug and it is therefore important for the patient not to stop the drug unless he experiences any side effects.
The treating physician should provide full information about the drug to enable the patient to make an informed decision. It is better to avoid the drug for any patient who has prior history of oligospermia, infertility, particularly if he is newly married and is trying to raise a family. As discussed earlier, there is sound rationale for such regimens.
Plasma half life of finasteride is hours and tissue binding is days. While 0. Efficacy has been demonstrated for all end points for finasteride at doses of 0. The value of such a regimen was shown in a preliminary study. Source of Support: Nil.
Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian Dermatol Online J. Venkataram Mysore. Author information Copyright and License information Disclaimer.
Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
Keywords: Androgenetic alopecia, finasteride, sexual side effects. In particular, the following facts need to be stressed: The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem.
Its effects are proven. Anitha B, Dermatologist, Venkat Charmalaya, for correcting the draft. Psychological effect, pathophysiology and management of androgenetic alopecia in men. Mayo Clin Proc. Sawaya ME. Antiandrogens and androgen inhibitors.
The androgens testosterone and dihydrotestosterone DHT have somewhat different actions. The following additional adverse events have been reported in postmarketing experience with Proscar. Medically reviewed by Drugs. The seminal plug is essential for normal fertility in rats and is not relevant in man. It exists in two isoenzyme forms.
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Or, is it something that may just continue forever? I recently asked my doctor for some blood work to be done. They have a lab there that I'm supposed to get a discount with as a patient. But, he's an old timer D. Has anyone any recommendations? Thank You. Wuffer Experienced Member. If you believe Propecia caused these side effects, I would check out propeciahelp. From what I have seen, there isn't much available in terms of treatments, but I just checked and saw they are conducting some new in-depth studies on this phenomenon.
I personally experienced sexual problems in conjunction with some severe anxiety during the first month or so on finasteride. In fact I was basically not able to have sex for quite a while, and it caused some major relationship issues with my girlfriend at the time.
After realizing this, I was able to stop these bad habits and basically get out of my own head. I am NOT saying your problem is because it is in your head, because finasteride may definitely be the cause.
However, libido lies entirely between the ears, and there is a strong mental component involved in feeling sexual desire. Even men suffering from conditions such as hypogonadism severe decrease in Testosterone production often respond well to sexual counselling.
In addition to this, focus on things that are proven to increase libido. Regular, intense cardio and weight lifting are the two biggest. This sounds like obvious stuff, but in combination it can have a huge beneficial impact. Best of luck. I rarely reply to these posts because what works for one person could be a waste of time for another, but I'll let you know about my experience in case you'd like to apply parts of it to you own situation.
I started finasteride at 20 and took it until I realized something was wrong when I took an attractive lady to my hotel room in Las Vegas and couldn't get hard. After that night, I began to slowly decrease my dosage until I came off completely, and ended up with a massive post-finasteride crash.
Not great but much better than 0. Here's what helped me: I started exercising everyday, and by exercising I don't mean playing tennis. I mean going to the gym and lifting heavy weights with few repetitions To get your testosterone boosting you need to lift low reps and high weight.
I feel hornier in general after going to the gym for a week, and my general disposition improves. For an extra boost of wellbeing I jog for minutes whenever I can. Another benefit of this is that you will start to look good, getting attention from women, and that itself can make u hornier.
Processed food, fast food, foods high in saturated fats, high sugar, high salt, soda, etc. I drink a lot of water, a lot of water and green tea, lean meats red meat only once a week , fish, brown rice, sweet potatoes, etc.
I stopped drinking, I stopped partying until 3am, I stopped smoking weed, etc. I try to wake up early and sleep early, and I try to be consistent so that my body knows when to rest and when to work.
I take a multivitamin for men, fish oil, Vitamin A for my skin and thats about it. I try to stay away except for the green tea from drugs that claim to lower DHT or be Anti-Androgens because that would be obviously counter productive to my recovery. This is difficult as you might seem like you are willingly letting go of your hair, but you have to make a decision on what you want, cause if your the type of person that is suffering from 0 libido from finasteride, you probably can't have both your hair and your libido, some men can keep a balance, others have to choose.
I incorporate ginger in my diet as its a potent anti-inflammatory and I use minoxidil on my hairline, thats about all I do for my hair besides staring at it in the mirror all day. In the last 6 months my libido has recovered substantially as a result of these changes, and I think if you can incorporate any of these you are helping yourself.
Hope that helps, don't give up on yourself. I exercise, have a good diet, rarely drink, don't smoke, and I feel really healthy I know I was worried before I even popped the first Propecia tablet, and I felt my libido diminish slightly even then! Because of this, I honestly believe that a lot of the libido stuff is in the mind for many people Good luck everyone, hope your desire to shag comes back!
I lost a little bit of my libido in the first week and I am only on week 2 and just want to hump everything! Chris87 Established Member. This can't happen, it's all in your head. My libido is shot aswell. And stop with this "it's all in the mind" bullcrap. WTF, that's such bullshit. I guess the random ball-ache is all in the mind too? Obviously the drug is strong enough on its own to chemically cause serious damage to ones libido and proper functioning of the dick I chose my thumb primarily for its girth and my ability to mask boners by giving thumbs ups.
ProscarParanoia New Member. I finally decided to give finasteride a try after extensive research on side effects, success rates, etc. Felt side effects right away. Penis is slightly numb, hard to maintain an full erection, difficulty with arousal ie physical stimulation needed , slight ball ache. I thought I should wait this out, maybe the body was just getting used to it. Side effects have persisted. Proscar Uses. Proscar Dosage. Proscar Drug Interactions.
Proscar Warnings and Precautions. Propecia and Proscar. Proscar and Pregnancy. Proscar Overdose. Generic Proscar. Proscar Alternatives. This site does not dispense medical advice or advice of any kind. Site users seeking medical advice about their specific situation should consult with their own physician.
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Does Finasteride Lead to Permanent Sexual Side Effects? | The Dermatologist
In adults, DHT acts as primary androgen in prostate and hair follicles. The only FDA-approved dermatological indication of finasteride is androgenetic alopecia. But, apprehension regarding sexual dysfunction associated with finasteride deters dermatologists from prescribing the drug and patients from taking the drug for androgenetic alopecia. Testosterone, through its humoral endocrine and local paracrine effects is relevant in central and peripheral modulation of sexual function than locally acting DHT.
Several large population-based long-term placebo-controlled studies, using International Index of Erectile Function-5 questionnaire and objective method Nocturnal Penile Tumescence to assess the erectile function have demonstrated no clear evidence of the negative effect of finasteride on erectile function.
Reduction in ejaculatory volume is the only established causal relationship between finasteride and sexual dysfunction. Though finasteride causes significant reduction in all the semen parameters except sperm morphology, they did not fall below the threshold levels to interfere with fertility.
Therefore, the sexual adverse effects associated with finasteride should be viewed in relation to normal prevalence and natural history of erectile dysfunction in the population, age of the patient, other confounding factors and also nocebo effect.
The impact of finasteride on the prevention of prostate cancer has been discussed extensively. Finasteride is found to be effective in significantly reducing the incidence of low-grade prostate cancer. But the paradoxical increase in high-grade cancer in the finasteride group has been attributed to increased sensitivity and improved performance of prostate specific antigen levels to detect all grades of prostate cancer. Androgens, otherwise known as sex hormones, are essential for the development of external genitalia, testes, and maintenance of spermatogenesis and secondary sexual characters.
Testosterone and dihydrotestosterone DHT are the main biologically active forms of androgens. Testosterone is synthesized by both gonads and adrenal glands. In the testes, testosterone is synthesized by the Leydig cells in response to stimulation by lutenizing hormone. It exists in two isoenzyme forms. Type 1 is predominant in the sebaceous glands and liver, and Type 2 is predominant in the prostate, seminal vesicles, epididymes, hair follicles and liver.
The average peak plasma concentration has been found to be 9. The bioavailability of finasteride is not related to food intake. Finasteride is extensively metabolized in the liver by Cytochrome P 3A4 enzyme subfamily and excreted both in urine and feces.
The FDA-approved dermatologic indication is male pattern androgenetic alopecia. Other dermatologic uses include hirsutism, acne vulgaris, and hidradenitis suppurativa. Various adverse effects of finasteride include sexual dysfunctions; hypersensitivity reactions such as rash, pruritus, urticaria, and swelling of the lips and face; breast tenderness and enlargement; severe myopathy and testicular pain.
It is also known to have teratogenic effects in animals. To understand the impact of finasteride on sexual function, it is important to know the normal physiology of male sexual function and the role of testosterone and DHT in erectile function. Male sexual function normally requires intact libido; the ability to achieve and maintain penile erection; ejaculation; and detumescence.
Androgens, especially testosterone increases the libido. A variety of visual, olfactory, tactile, auditory and imaginative stimuli can also influence the libido. The penile erection is mainly under the control of the parasympathetic nervous system. The nitric oxide released from the non-adrenergic, non-cholinergic autonomic fibers causes relaxation of smooth muscles in the penis, leading to increased flow and accumulation of blood in the lacunar network of corpora which are converted into non-compressible cylinders resulting in erection.
The nitric oxide is synthesized in the cavernosal tissue of penis by nitric oxide synthetase. Ejaculation and detumescence require intact sympathetic system. The integrity of structural and cellular components of the penis, and veno-occlusive mechanism is essential for normal erectile function. In animal experiments on castrated rats, the importance of testosterone in normalizing erectile function and nitric oxide synthetase activity has been demonstrated. However, in elderly males, normal testosterone levels appear to be important for erection.
DHT is a paracrine hormone exerting its action in the tissue of origin. Thus, the testosterone, through its humoral endocrine and local paracrine effects is relevant in central and peripheral modulation of sexual function than locally acting DHT.
Review of the literature on ED in men taking finasteride revealed the incidence of ED to be between 0. However, randomized controlled studies reported ED to be between 0. Therefore, large population-based long-term placebo-controlled clinical studies using a validated questionnaire and objective method of assessment of sexual function are required to establish the causal relationship between finasteride and ED.
In a study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED when compared to the group without such information. Several placebo-controlled studies have evaluated the efficacy and side-effects of dutasteride 0. The ED has been reported to be significantly higher in the dutasteride group than in the placebo group 6.
However, by the end of two years, the prevalence of ED was similar in both the groups 1. Therefore, ED occurring during finasteride therapy should be viewed in terms of normal prevalence and natural history of ED in the population, age of the patient, other confounding factors, and also the nocebo effect. The effect of finasteride on ejaculatory volume and other semen parameters has not been reported in detail in the literature.
The ejaculatory dysfunction associated with finasteride ranges from 2. The individuals received any one of these drugs for one year and semen analysis was performed at 26 weeks and 52 weeks of treatment, and also after 24 weeks of follow- up. The finasteride group showed statistically significant reduction in sperm count However, at 52 weeks of treatment and after 24 weeks follow-up, the reduction of all the three semen parameters from the baseline was no longer statistically significant.
But there was no significant change in sperm morphology anytime during the study. However, marked sensitivity of some individuals to finasteride may result in substantial reduction in semen quality leading to infertility.
Therefore, finasteride should be considered as a possible etiological agent while evaluating men for infertility. Recovery of semen parameters towards the baseline at 52 weeks of treatment and after 24 weeks of follow-up in the presence of significant decrease in DHT levels In these patients, the prostate and seminal vesicles were atrophic with resulting low semen volume. Thus the only causal relationship between finasteride and sexual dysfunction is low semen or ejaculatory volume.
Prostate cancer is one of the common causes of cancer deaths in men. The management of prostate cancer should be focused on early detection and treatment. The prostate epithelial cells and the stromal cells express androgen receptors and depend on androgens for growth.
PCPT compared the ability of finasteride 5 mg versus placebo in reducing the risk of prostate cancer. The study reported that finasteride prevents or delays the appearance of prostate cancer, thereby decreasing the overall incidence of prostate cancer. Significantly, it was also found that there was an increase in the incidence of high-grade prostate cancer with finasteride compared to placebo. This may be due to the finasteride induced alteration of intraprostatic androgen levels leading to morphologic changes in low-grade tumors.
Selective inhibition of low-grade tumor by finasteride may also be another explanation for the increase in high grade cancer. The analysis of the PCPT study demonstrated that finasteride significantly increased the sensitivity of PSA levels in the detection of all grades of prostate cancer when compared to placebo.
Thus increased incidence of high-grade prostate cancer in the finasteride group has been attributed to improved performance of PSA screening in detection of prostate cancer. However, there is a concern over chronic use of finasteride and development of prostate cancer. Through its effect on hormonal estrogens vs. In many studies it has been shown that the prostatic hyperplasia and cancer develop frequently in the hormonal milieu of estrogen excess over androgens.
This hormonal imbalance is normally seen in aging males. Finasteride increases the circulating levels of testosterone which is peripherally aromatized to estrogens.
Thus the use of finasteride in older males further shifts the hormonal balance towards estrogen excess. The expression of aromatase is also up-regulated in prostatic hyperplasia and cancer. Finasteride alters the immune surveillance of cancer in aging males and may predispose them to the risk of prostate cancer.
The supplementation of DHT, a non-aromatizing androgen, restores the estrogen-androgen balance by decreasing the plasma levels of estradiol and testosterone. It has been reported that DHT has a favorable effect on sexual function and the cardiovascular system without any adverse effects on prostate. Although a relationship has been established between finasteride and sexual dysfunction in the literature, the analysis of the role of androgens in male sexual function and the evidences from large population-based long-term placebo-controlled studies using validated questionnaire and objective method for assessing sexual function suggested no substantial evidence of ED in men receiving finasteride.
Low ejaculatory volume is the only causal relationship between finasteride and sexual dysfunction. Finasteride has been an effective drug in preventing low-grade prostate cancer but its role in increased incidence of high-grade prostate cancer has been attributed to better performance of PSA screening in prostate cancer detection. So, as dermatologists, we should be aware of the potential risks and benefits while treating baldness in young men with long-term finasteride.
Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Cutan Aesthet Surg. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. Arun C. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Keywords: Finasteride, prostate cancer, sexual function. Normal male sexual function Male sexual function normally requires intact libido; the ability to achieve and maintain penile erection; ejaculation; and detumescence. Role of androgens in erectile function The integrity of structural and cellular components of the penis, and veno-occlusive mechanism is essential for normal erectile function.
Erectile dysfunction Review of the literature on ED in men taking finasteride revealed the incidence of ED to be between 0. Ejaculatory dysfunction The effect of finasteride on ejaculatory volume and other semen parameters has not been reported in detail in the literature. Canguven O, Burnett AL. J Androl. J Clin Endocrinol Metab. J Med Sci.