Finasteride – What Are The Real Sexual Side Effects?
The concept of a nocebo (a psychogenic effect of a drug) has been discussed in the various studies which focus on the sexual side effects of the drug Propecia (finasteride). The significant ‘hype’ on the internet, has driven many people to the conclusions that if they take this drug, they will become impotent. As doctors, we must discuss potential and known side effects of any drug we prescribe, but what happens following the disclosures, the patients read the internet and find many, many panicky young men who report sexual impotence from taking the drug. Is it real? We don’t know but what we do know is that many studies from other countries have not shown the high sexual side effects reported in the United States. So is this a Nocebo effect resulting from panicky people who read bulletin boards and web sites which focus on this issue.
Dr. Robert Haber, a very respected hair transplant surgeon from Ohio, started to test the concept of a nocebo effect and the general side effects on sex drive and sexual performance using patients who came into his office. This is an early report of his initial findings.
“While I also doubt the existence of PFS, about a year ago I started asking my finasteride patients to complete an anonymous sexual dysfunction survey. For years I frankly addressed the topic at every visit, and my impression was that the incidence of sexual dysfunction in my patients was similar to the 1-2% reported in the studies. I wondered if a more objective survey would reveal anything different. Many of you may recall that I suggested we all gather this data in our offices, but there was little interest.
I have data now on over 500 patients, and much to my surprise, the overall incidence of sexual dysfunction in my finasteride patients is 25%. When I started seeing this number develop, I started giving a similar survey to all male patients not on finasteride as well. I have a much smaller sample size thus far, but the overall incidence of sexual dysfunction in my non-finasteride patients is 24%!
Nonsense. You block a male sex hormone and there will be sexual consequences. Hair transplant surgeons have an interest in telling people finasteride is safe but there will always be effects.
Has anyone found a better price for Propecia than the $19.95 at BlinkHealth.com? Do they have the best price for pickup at CVS, Walgreens or Target? Thanks.
Dear Dave,
There are side effects of any drug. I think the doctors are communicating to the readers that the frequency of side effects in their experience are consistent with the thousands of patients participating in the clinical studies reviewed by the FDA (and publicly available) – and not the frequencies cited in lawyer-driven blogs and anecdotal, non- scientific observations.
This is a very irresponsible post.
I no longer get morning erections. I can still get an erection, but it is a lot harder (no pun intended) to do so.
I recall a meta-analysis of all the Propecia sexual dysfunction studies concluding that there were systematic methodological inconsistencies and faults.
Sure, people overthink this effect and might have erection issues based on psychology. But I didn’t overthink things and have actual erection issues.
Not an irresponsible post in the least. No one (including these physicians) says that side effects don’t exist, they say that the incidence has been exaggerated beyond the data – and the reports of any given individual that they “have the side effect” misses the point. As a physician-scientist, the most robust database is the one that the drug submission was based upon – randomized, blinded, placebo-controlled trials. There is no “meta-analysis” showing systematic “faults”. In fact, the most cited literature on these bogs from those who are concerned with irreversibility of side effects, another issue, tends to be uncontrolled, small retrospective cohorts – which begs the issue of the need for prospective, blinded trials rather than anecdote after anecdote after personal anecdote.
There is a lot of misinformation I’ve found out there on the internet, even this blog.
Contrary to what “PharmaMD” says, there was a meta study published last year that reviewed every published trial on Propecia and did conclude every single trial failed to provide sufficient information to evaluate the safety profile of the drug, especially for potentially rare side effects. A lot of hair transplant doctors, the authors of this blog included, are eager to completely dismiss the risks and seem to ignore any of the signals more balanced physicians would not.
https://www.ncbi.nlm.nih.gov/pubmed/25830296