Erectile Dysfunction And Propecia, What To Do About It!
We have discussed that Erectile Dysfunction (ED) is a known side effect of Propecia (finasteride) and Avodart (dutasteride) in the range of 2% of men taking Propecia (finasteride). The side effect occurs in 1-2% of men. We have also stressed that ED is common in men not taking these drugs. In general ED affects 20% of men in their 20s, 30% of their men in their 30, 40% in their 40s, 50% in their 50s, 60% in their 60s and so on with an impact on 150 million men. ED can also be a sign of vascular disease or other systemic diseases such as high blood pressure or diabetes. Outside of the hair loss topic in BaldingBlog, many medication (other than Propecia) can cause ED or other sexual related issues. Vitamin D deficiency is one of the causes of ED that is easily treated. More notable are the anti-anxiety or anti-depressant medications as well as blood pressure medications. There is also a psychological component to ED where the lack of erection can be attributed to the mind. This is the reason that doctors are needed to diagnose and prescribe the medication.
When a patient is so worried or express anxiety that they may have ED from taking Propecia I can almost predict that they WILL have a side effect as the mind can be a powerful motivator. These patients I tend to generally not recommend Propecia (despite my effort at educating them) since they would be more preoccupied with the side effect than its benefit.
When on occasion a patient report back with some side effect, we decide on the course of action together. They can stop the medication or consider other options such as lowering the dose or taking a medication that may help with the erection problem. We also explore other extraneous causes such as their health, other medications that they may be on, and other emotional factors in their lives. To some, hair loss in it of itself can be a horrible and debilitating emotional trauma. On a few occasion, I have referred patients to a psychiatrist because hair loss affected them to a point of clinical depression and thoughts of suicide.
When a patient is in good mental capacity with extraneous factors accounted fand the patient still expresses the desire to take Propecia, we explore the option of medications to help with the ED. The following medications are used in general to treat ED (irrelevant of Propecia or its side effects).
Tadalafil Mylan (Generics UK Ltd) is used for the treatment of men with erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). It is a generic of Cialis (Lilly), which has been available since mid-November 2002. All of these drugs that I will discuss below require sexual stimulation to work. It is reported to last 48 hours with a slower onset. Some doctors recommend a daily dose of 5mg and this may have positive effects on your prostate as well as your ED.
Avanafil has been approved by the FDA for ED as early as about 15 minutes before sexual activity, although the official time to use it might be 30 minutes which makes the onset much faster than the other drugs.
Viagra was the first drug introduced for ED. It may be the strongest of the medications and many men report that when these other drugs fail, this one works.
There is no good scientific study reflecting men with ED from finasteride using the above treatments, but my personal appraisal and my experience prescribing these medications, these approaches can satisfactorily treat ED even while on finasteride.
The statistics posted in this blog entry are not correct. The frequency of ED in men in the 20s is much lower than 20% and it does not increase linearly by 10% every decade. It would be nice because the numbers are convenient, but it just simply isn’t empirically observed.
If you look at the Propecia clinical trials which included men under the age of 40, only about 1% in the placebo had sexual problems of any kind. A lot of hair transplants make the argument that sexual dysfunction is common to minimize the likelihood that sexual problems are caused by Propecia, but this is never backed up by fact mainly because it isn’t true.
It is true that it has not been studied in detail how PDE5 inhibitors will affect men suffering from finasteride related side effects, but many men who develop irreversible side effects also report limited benefit from erectile dysfunction medications. These drugs work for certain types of ED, psychogenic ED included, but it is commonly observed that they are not very helpful for men with post-finasteride-syndrome.
The statistics posted in this blog entry are highly correct, but – regardless – the main point is that many men in the absence of finasteride have ED from varying causes and should not assume ED in association with finesteride is always finesteride. Indeed, some of the implausible finesteride-caused scenarios written into this blog (ED minutes after taking first dose of finesteride, ED months after stopping finesteride) speak volumes to this issue.
In addition, as Dr Rassman implies, there is minimal if not absent scientific literature documenting that finesteride-associated side effects are irreversible – and such research is needed given the (mainly lawyer-driven) blogs. There is also good evidence that PDE5 inhibitors such as tadalafil (Cialis) and sildenafil (Viagra) are helpful for erectile dysfunction of any cause, although mainly studied in men with ED due to diabetes and post-prostatectomy.
Finally, because tadalafil (Cialis) and finasteride are both approved for benign prostatic hypertrophy, there is a recent study of significant interest comparing the erectile and sexual function of combination finasteride-tadalafil vs finasteride-placebo. Regardless of baseline sexual function, combination finasteride-tadalafil leads to statistically significant improvements in erectile/sexual function (compared with finasteride alone).
https://www.ncbi.nlm.nih.gov/pubmed/25353053
These statistics are frequently quoted on this blog without any backup. You can’t say they are ‘highly’ correct without providing any evidence – especially when you are making false claims.
Nobody disputes that ED can be caused by many things. This is hardly relevant. Finasteride is not any less likely to cause problems just because diabetes causes ED. Few of these problems are risk factors for men in their 20s, and the majority of PFS patients have already ruled out the most common culprits or else they would no longer be suffering.
PDE5 inhibitors work fine for some causes of ED but definitely not any cause as you claim. They will work alright for psychological ED for example, but not neurogenic ED. 70% of the population in the study you reference already had pre-existing erectile dysfunction not caused by finasteride. Of course you would see an improvement, on the whole population, when you introduce a PDE5 inhibitor. The design of this study has almost nothing more to offer other than Cialis helps men with ED.
This is a bit interesting… after each post that mentions something about the risks of finasteride, a poster will respond with misleading arguments not backed by facts, completely deny the dozen or so medical articles on the subject of post finasteride syndrome, and try to portray people with PFS as some kind of issue invented by lawyers. Post finasteride syndrome has been around for a long time before it became a legal matter. Any interested party can check for him/herself to see there are dozens of blogs/youtube videos/podcasts etc. that chronicle their catastrophic experiences with finasteride without any affiliation with a legal blog. The Propecia team at Merck may very well be in damage control mode to avoid another episode like Vioxx.
I have also noticed that this blog always automatically assigns me some kind of icon that I did not voluntarily choose. I would prefer for it to be blank, but the worst part is the picture that has been chosen for me is neither flattering nor easy on the eyes.