Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss

Abstract

Introduction Finasteride has been associated with reversible adverse sexual side effects in multiple randomized, controlled trials for the treatment of male pattern hair loss (MPHL). The Medicines and Healthcare Products Regulatory Agency of the United Kingdom and the Swedish Medical Products Agency have both updated their patient information leaflets to include a statement that “persistence of erectile dysfunction after discontinuation of treatment with Propecia has been reported in post-marketing use.” Aim We sought to characterize the types and duration of persistent sexual side effects in otherwise healthy men who took finasteride for MPHL. Methods We conducted standardized interviews with 71 otherwise healthy men aged 21–46 years who reported the new onset of sexual side effects associated with the temporal use of finasteride, in which the symptoms persisted for at least 3 months despite the discontinuation of finasteride. Main Outcome Measures The types and duration of sexual dysfunction and the changes in perceived sexual frequency and sexual dysfunction score between pre- and post-finasteride use. Results Subjects reported new-onset persistent sexual dysfunction associated with the use of finasteride: 94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm. The mean number of sexual episodes per month dropped and the total sexual dysfunction score increased for before and after finasteride use according to the Arizona Sexual Experience Scale (P <0.0001 for both). 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. Study limitations include a post hoc approach, selection bias, recall bias for before finasteride data, and no serum hormone levels. Conclusion Physicians treating MPHL should discuss the potential risk of persistent sexual side effects associated with finasteride.

Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride

“…More than two-thirds of our respondents reported increased lethargy, feelings of listlessness, and lack of motivation. Several studies refer to symptoms of lethargy in men who have taken finasteride for either benign prostatic hypertrophy or MPHL, although whether the lethargy is related to the use of finasteride or to a preexisting psychological condition remains unclear (Irwig & Kolukula, 2011;Traish et al, 2011).…”

“…In a recent study, researchers sought to characterize the type and duration of persistent sexual adverse effects associated with the use of finasteride for MPHL. The researchers conducted standardized interviews (N = 71) in a group of otherwise healthy men (age 21-46 years) who reported new symptoms that endured for at least 3 months after stopping the medication (Irwig & Kolukula, 2011). The mean duration of finasteride use in this sample was 28 months; 94% reported low libido; 92%, erectile dysfunction, 92%, decreased arousal; and 69%, difficulty achieving orgasm.…”

Risk of erectile dysfunction associated with use of 5-α reductase inhibitors for benign prostatic hyperplasia or alopecia: population based studies using the Clinical Practice Research Datalink

“…Though benign prostatic hyperplasia itself is an independent risk factor for erectile dysfunction, 1 evidence suggests that 5-α reductase inhibitors may independently increase the risk of adverse sexual side effects, [2][3][4][5][6][7][8][9][10] potentially through induction of androgen deficiency by inhibition of 5-α reductase and reduction in available 5-α dihydrotestosterone. 11 Further, these adverse effects may be persistent or irreversible even when treatment is discontinued.…”

“…13 Of particular concern is that many reports of sexual dysfunction were in previously healthy young men using finasteride 1 mg for alopecia. 9 Increasing patient activism, including establishment of a research foundation for "post-finasteride syndrome," is indicative of growing alarm and the need for awareness and research on long term complications of 5-α reductase inhibitor use. 14 Finally, assessment of the safety of 5-α reductase inhibitors for benign prostatic hyperplasia and alopecia is warranted owing to the…”

Efficacy and Safety of Thermobalancing Therapy in Men with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia was Confirmed by Clinical Trial

“…Dr. Irwig has confirmed persistence of erectile dysfunction after discontinuation of treatment with Propecia (finasteride). That is why a watchful waiting stage for BPH is recommended (14) . The data above shows that in the etiology and pathogenesis of BPH vascular factor plays a decisive role, also BPH medications and surgeries are not safe and interfere men's quality of life.…”