I read on one post that Propecia caused someone to have pudendal neuropathy which caused both sensory and motor dysfunction in the genital tissues. Is this a Post-Finasteride-Syndrome? Is pudendal neuropathy a side effect?

The term “neuropathy” means damage to a nerve… so “pudendal neuropathy” is damage to the pudendal nerve. I cannot imagine how Propecia can cause damage to this specific nerve. Damage to the nerve is usually from mechanical injury (bike riding, falling on your buttocks, etc) or inflammatory issues (infection) or chronic medical conditions that damage your nerve, such as diabetes or multiple sclerosis. Propecia is a drug that that partially blocks the conversion of testosterone to DHT. If someone is going to claim that there is some special DHT relationship to a pudendal nerve, we might as well be blaming Propecia for our economy or the color of the sky.

Stating that a drug (Propecia) caused a neuropathy to the pudendal nerve is questionable, because there is no difference in the pudendal nerve to a nerve that innervates your thumb. The pudendal nerve is one of many nerves in your pelvic area (for both men and women) and one segment of it innervates your penis or clitoris. I believe many readers may have heard of sciatica when doctors refer to certain back pain caused by the sciatic nerve. The pudendal nerve is a distal branch of a sciatic nerve. Patients with back problems or pelvic area problems/trauma/tumor/etc can have pudendal nerve issues. Pudendal nerve damage can cause erection problems, but it will also cause perineal numbness or pain (see here).

If there is an erection issue, the most simple test is a nocturnal penile tumescence (NPT) test. Imagine a roll of stamps wrapped around a flaccid penis and taped. If you get an erection, the stamps will stretch and break at the perforations. I assume there are better devices out there and better tests, but this test can sometimes be a good starting point to help delineate if erectile issues are psychological or physical. Normally, men will have involuntary erections during sleep (aka “morning wood”). It would be interesting to see if the 70 or so men that reported permanent erection problems can achieve nocturnal (involuntary) erections and if they ever underwent these tests, But from my reading I believe the erection issues were self-reported and no subjective testing was performed.

In matters of medical health, the Internet is not a place to self diagnose medical conditions or become armchair physicians. But alas, it is what many readers will continue to do and the urban legends will propagate.

Tags: propecia, finasteride, dht, nerve damage, pudendal neuropathy