Finasteride and permanent impotency and erectile dysfunction!

Question

I am a 32 year-old male and was prescribed 1mg Propecia for male-pattern hair loss. I do not mind having a typical low libido but reading the frequency of incidences of people that experienced permanent ED and impotency is frightening and I am reluctant to take this medication. I am wondering if doctors had patients with such permanent and irreversible problems while on Finasteride?

Jason Emer, MD · Answer

Theassociation between finasteride and permanent erectile dysfunctionhas a very low incidence and is only recently reported. Best coursefor reversing hair loss is a combination therapy of progesterone, PRP,hair transplant, finesteride. Please see an expert. Best, Dr. Emer

Jeff Rapaport, MD · Answer

In my opinion the incidence of post finasteride syndrome is low, approximately one percent. I believe that for the majority of patients Propecia is safe. I would recommend starting the medication and if you're developing any problems stopping the propecia. Should this still be of concern, platelet rich plasma can increase hair growth, decrease hair shedding and increase thickness  of the hair shaft. It is natural and without systemic side effects. Good luck .

William Woessner, MD · Answer

I have read of such patients, although I have never had a patient with permanent problems from Propecia. My advice to you is, however, to not take the Propecia because your mind is already negative towards it, therefore it may be impossible to tell which sides are psychological and/or physical. Better to er on the side of caution. Be sure to use Rogaine twice per day.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You state you’re 32-years-old, received a prescription for finasteride 1 milligram once a day, and you are concerned about having a lower libido and long-term erectile dysfunction and sexual dysfunction related to finasteride. You are asking about the relative risk for taking finasteride.
I can share with you my experience with patients I’ve treated since the introduction of finasteride. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. Hair transplant has been a part of my practice for many years, and I’m the founder of TrichoStem™ Hair Regeneration Centers where we developed a non-surgical alternative to hair transplant, and an alternative to finasteride, so I’ll go over that history a little.
To answer the question about long-term erectile dysfunction and sexual side effects, I think you’ve touched upon a very controversial topic. With the exception of a small group of people who made this claim, and there has been a lot of momentum in the fear of taking finasteride. It has reached a point where people who come from all over the world to us for our Hair Regeneration treatment won’t take finasteride. Some categorically refuse to take it, or they’ve taken it and developed side effects. Our patients who experienced side effects did get better after they stopped taking the drug. 
When you describe long-term sexual side effects in spite stopping the drug, I think this remains unresolved. I find it difficult to explain how a pharmacologic process when the drug is stopped can continue. How are there permanent changes that affect sexual function? There are certainly a lot of opinions about it from the central pathways of the brain, etc., but I think that it remains to be determined. Given the number of people who take more than 1 milligram of finasteride in a drug used for benign prostatic hypertrophy called Proscar which is 5 milligrams of finasteride, and another drug dutasteride that is also a DHT blocker, I think from the medical perspective, the relative risk is very low. 
I can tell you from studies done about compliance with these drugs, there is a real issue about taking finasteride consistently. Those studies show they’ll take it for the first year, and then not take it for the second year, or just taper off with time, which I’ve seen in our practice. Clinically, our patients will say they took it, but weren’t sure if it was working. They weren’t sure if they were feeling right, and just stopped taking it. Often, they just weren’t sure it was working, so they stop altogether, or just didn’t get around to refilling their prescription - there’s a long list of reasons. 
The point I’m making is there is an alternative to finasteride which may be of interest. We were using something called Acellular matrix to help heal people undergoing transplants to improve the survival of the grafts and the healing of the donor area. A side effect was thinning hairs got thicker in a lot of different patients. So, I took it upon myself to develop a system and process we ultimately called Hair Regeneration. It has become quite a relief for people who don’t want to take or can’t take finasteride. It is important to note that finasteride helps 60% of men, and doesn’t work for 40% of men. Also, finasteride slows down the progression of hair thinning, but it doesn’t stop it. 
With Hair Regeneration, this injection that is typically applied once, and maybe a second time in 15 months depending on the individual situation, we’re consistently having patients regrow hair that hasn’t been growing, or in a long resting phase called telogen. We’re able to stop the hair loss progression, induce the shedding of thinning hair so regrowth of thicker hair can take its place. Our patients actually getting thicker hair without transplant, and without taking any medication. This procedure has become very popular, and people come to us from all over the world for it. I’ve actually started a company called TrichoStem™ Hair Regeneration to build new facilities to bring this technology closer to people who can’t get to us in our two offices in New York. 
If you are willing to take the finasteride, I recommend you go ahead and take it. Statistically, it’s unlikely you’ll have issues with sexual function. The majority of patients who I’ve treated who had any issues with sexual side-effects were able to stop the drug and go back to normal. I haven’t had a single patient who had long-term problems with sexual side-effects after the cessation of finasteride. From my clinical experience, and experience of colleagues who I discuss this concern with in meetings, we actually had a significant consensus agreeing that there is a commonality. In clinical practice, whether it’s a drug, device, or technique, doctors doing similar things will often share similar experiences. So this problem of not having good sexual function after ending the drug is highly unusual, so it needs further investigation. 
I think this as an opportunity to put into perspective the drug in terms of long-term sexual side-effects and its alternatives, and we’ve been very successful helping people who won’t take the drug, or cannot take the drug. I hope that was helpful, I wish you the best of luck, and thank you for your question.

William Rassman, MD (retired) · Answer

This is a syndrome that is only recently recognized and recognized by only a few doctors as evidence is sparse.  Nevertheless, it is a potential risk that you must recognize if the Post Finasteride Syndrome is real

Finasteride and permanent impotency and erectile dysfunction!

Answers (5)

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