As I’ve mentioned before, I’m a part of an email group of hair transplant doctors that share information amongst each other. The other day I received an email from a well respected doctor (let’s call him Doctor A) reporting that he’s now had two patients in the past 12 months who had persistent erectile dysfunction (ED) even after they stopped finasteride (traditional 1mg dose). These are two patients out of thousands that this physician has prescribed to, and I have no knowledge of other potential health factors or even full details on the cases.

Other doctors in the group chimed in:

1. Doctor B in the email group responded that he had been prescribing finasteride from even before it was approved to treat hair loss and he has never seen one case in this situation.
2. Doctor C wrote about two patients who had the problem in some 1500-2000 patients.
3. Doctor D said that he’d also seen two patients in his 18 years of practice that talked about ED permanence.
4. Doctor E who has also been practicing about 18 years has seen no cases of ED permanence.
5. And then there’s me (I’ll be Doctor R). I echo that from the thousands of patients I have prescribed finasteride to, I have never seen nor heard of such a complaint after the patient has stopped the drug.

So while I don’t have specific case info or medical history of those claiming permanent side effects, it seems that there are 6 cases out of maybe between 6,000-10,000 prescriptions (estimated). Unless you’re one of the 6, the risk is extremely limited (if it is shown that the medication is the cause). I’ve always maintained (my opinion) that these side effects are reversible upon stopping the medication, as this has been reported in peer-reviewed studies and in thousands of my own patients. However, I make it my job here to educate our readers as I become more informed. I’m not writing this post with the intent to scare anyone, but do whatever you’d like with the information. We still don’t know for sure that the “permanent” ED cases are even related to finasteride. Remember, I do not sell finasteride to make Merck profitable. If that were the case, I wouldn’t tell patients (or readers of this site) how to cut into Merck’s Propecia profits by buying the generic 5mg and splitting the pills when discussing alternative suppliers.

The incidence of low testosterone in men is high. There are reports that 44% of men have low testosterone levels. We know that 20% of men have ED, 30% of men have ED, 40% of men have ED and so on. That is the market that Viagra sells to. Can we be confusing the ED observations from Propecia and the ED resulting from low testosterone levels? There are many causes of ED, so we should be careful not to state that the ED we are seeing was from the Propecia/finasteride that these men were taking.

I still believe in this medication fully for treating genetic male pattern baldness, and I must point out that these reports are still extremely rare. The alternative for the balding male is to continue to go bald. For some, that small risk of sexual side effects may not be worth abandoning their hair. Sill, the consumer (you) must make his own decisions on what to do with such reports. I fully expect my inbox to be flooded with “See, I told you so” emails from forum trolls, but if anything, this should show you that I’m not disregarding the claims outright. As I’ve always said, I’ve never seen any case and the medical literature supports that. I do, however, appreciate respectful discussion.

Also, keep in mind the study we mentioned yesterday about common everyday pain relievers like aspirin and ibuprofen being linked to erectile dysfunction. Who knows what else is in the systems of those claiming permanent ED.

I took Propecia for 7 months before developing erectile dysfunction over night and a low libido that onset more slowly. I immediately discontinued my use of the drug. Unexpectedly, one year later I still have erectile dysfunction and low libido, and my hairloss has not resumed!

I had my hormone levels tested by a neuroendicronologist and it was found that my DHT levels were far below the normal range for adult males. I had an appointment with a sexual psychologist and she determined it was a physiological issue. Is there anything I can do to restore my body to where it was before I took Propecia?

I have difficulty believing that you just developed erectile dysfunction (ED) overnight after taking the medication for more than half a year. You need to see an expert in sexual dysfunction. I have seen a few patients who had your symptoms, though none of them with rapid onset and all of them who stopped the drug saw a complete reversal in less than a week.

ED will likely lead to your confidence going down, which in turn causes the gradual of libido… but I do not believe that the ED can be blamed on Propecia if you have been off of it for some time.

Snippet from the study abstract:

PURPOSE: This post hoc analysis of the Medical Therapy of Prostatic Symptoms trial examined the effect of finasteride alone compared to placebo on the clinical progression of benign prostatic hyperplasia in men with a baseline prostate volume less than 30 ml, or 30 ml or greater.

MATERIALS AND METHODS: Men were randomized to placebo (737), 4 to 8 mg doxazosin alone (756), 5 mg finasteride alone (768) or doxazosin plus finasteride (786) (average followup was 4.5 years). Approximately 50% of patients had a baseline prostate volume of 30 ml or greater. The present analysis was based on the finasteride alone and placebo arms only, and included patients for whom baseline and end of study data were available. We examined the effect of treatment on the cumulative percentage of men who did not experience clinical progression of benign prostatic hyperplasia by study end.

Read the rest — Long-Term Treatment With Finasteride Improves Clinical Progression of Benign Prostatic Hyperplasia in Men With an Enlarged Versus a Smaller Prostate: Data From the MTOPS Trial.

This was new data mining of a previous study that included over 2200 men with an average followup of 4.5 years. The new study concludes:

“Long-term treatment with finasteride led to a significant beneficial effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with an enlarged prostate (baseline prostate volume 30 ml or greater). Finasteride had no significant effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with a smaller prostate (baseline prostate volume less than 30 ml).”