Penile Scar Tissue from Finasteride?
I recently read about a man who had been having issues with side effects from propecia only after many years of use (pain ‘down below’). He went to see a urologist who says that it is not unusual to see scar tissue in the penile tissue of long term finasteride users. Seeing as I have been considering taking propecia as a long term commitment this has me very concerned.
Can you reassure me on this at all? I’ve read that DHT is important for maintaining healthy tissue (binding to androgen receptors?) in all tissue apart from the muscles in the body.
I do not know how finasteride could give you penile scar tissue. This is news to me. Perhaps a urologist is a better person to pose this question. The only reassurance I can give is that I’ve never heard of a case of scar tissue forming because of Propecia, and can’t find any studies to suggest that this is a known phenomenon.
You must be careful with all the wealth of information available on the Internet, and understand that not everything you read is true. It’s very easy for things to be taken out of context or misinterpreted, which is why I always stress that you speak with a doctor face to face. Reading what someone on a forum wrote about what a doctor supposedly told him isn’t something I’d get unnerved about.
Over the years I have made commnts. If there is one common theme that I wish readers to know, it is that the worldwide scientific and medical literature is easily and freely accessible: http://www.nlm.nih.gov.
It is highly unusual that medical phenomena that have not been published in the scientific literature (even as a single case report) in any forum is truly real and robust based on reading something anonymous on an Internet site from someone who knows someone who heard about something from someone who knows a urologist who said that………….
BiotechMD raises a good point. If you are curious about a topic you should do some research yourself and employ your own common sense. A quick scan on the medical research shows the following articles:
https://www.asiaandro.com/archive/1008-682X/5/33.htm
This article was conducted in rats and shows that finasteride treatment degraded the integrity of the tunica albuginea and corpus cavernosum in adult rats.
Another more recent study demonstrated that androgen deprivation caused morphological changes in the penises of rats in addition to reduced weight.
https://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02661.x/abstract
These studies have not been performed on humans because the specimens are sacrificed in order to investigate the research questions. Since they are physically impossible to study in humans, you will have to extrapolate based off of whether you think rat studies will have any relevance to potential humans risks.
It’s probably always worth reading these with attention to detail. For instance the first study mentioned above suggests no difference between the thickness of tissues in rats in group A and group C and only group B (castration) were affected.
Also the finasteride dosage was 4.5mg/kg. This would be around 360mg of Finasteride p.d. for the average adult male human – around the average yearly dose for Propecia for MPB.
I don’t think anyone doubts that androgen levels affect male tissues and there are plenty of studies on castrated male humans if you want to read up on them. The important thing here is that castration results in near total loss of T, free T and DHT, whereas Finasteride would not impact on T or free T except in a possibly positive manner as it is blocking conversion to DHT.
I’m not a scientist or a doctor, but as usual, the devil is in the details.
Thanks for you input Paul. If you look at the table 2 in the top study you will see that the thickness actually decreased about 14% from the control group to the finasteride group, but you rightly mention the decline was not as great compared to the castrated group as one would hope. However, this isn’t really the interesting point to draw from this study. While the thickness does appear to be slightly reduced, finasteride-treated rats showed “a considerable amount of thick and irregularly-arranged collagenous fibers” compared to the control which show few elastic and collagenous fibers.
You are also right that the dose/weight ratio is larger than that of humans, but we also know that increasing finasteride beyond 1 mg does not greatly decrease the production of DHT. While this study has been performed on rats and not humans, it does raise many additional questions and provide a reason to believe that finasteride could cause reproductive tissue damage.
When the only evidence one has to substantiate a claim consists entirely of animal studies, it’s difficult to establish any sort of firm causal relationship. One of those studies that ‘fin user’ posted also concludes that “However, the interrelationship between androgen and the structure and function of the erectile tissue is not quite clear and sometimes even controversialâ€, which is far from a conclusive statement. It was also mentioned that these rats were taking over 300 times the dose that humans might take, and since dosages this high have not been tested on humans, the potential effects are unknown.
I did some searching and came across the following, very interesting study:
https://www.aua2012.org/abstracts/printpdf.cfm?ID=1153
This was conducted on men who suffer from persistent symptoms resulting from finasteride treatment. Results appear to show that finasteride does not contribute to penile vascular damage, even in men who suffer from persistent symptoms. Penile blood flow is quite normal in these men, and results do not indicate penile scaring or anything of the sort.
We can look at all the animal studies we want, but it won’t change the fact that long term studies done on 5-alpha-reductase inhibitors have never shown symptoms such as these. This is supported by 20 years of research done on tens of thousands of men. It’s a bit unbelievable that only in the last few years (coincidentally, at the same time the theory that finasteride caused severe adverse effects became popular) is when we started seeing all these ridiculous claims begin to surface.
Even with thousands of men swearing up and down that finasteride caused all their issues, it unfortunately just doesn’t cut it unless you can actually prove that the effects are related to finasteride. Until then, all we have is conjecture.
Thanks for bringing the AUA presentation to our attention. I did not know of this upcoming presentation but I have spoken with some of the doctors that were involved.
The doctors performed doppler ultrasound tests which measure the velocity of blood flow (hemodynamics) through the penis and found that blood flow did not explain the reported erectile dysfunction. Actually measuring whether there was ‘penile vascular damage’ is an entirely separate measure as a man can have abnormal penile tissues but still retain the ability to achieve an erection.
I am not in a position to publicly discuss the findings of their treatments, but they did find specific physiological abnormalities in some of the men that were not discussed in this abstract. Perhaps this will be further discussed at the symposium.
I took Propecia for years. I took a short break, then went back on because I heard it “shocks” the system (in a good way). Shortly thereafter (at age 21), I developed what I thought to be Peyronie’s, as I had what appeared to be scar tissues in my penis and reduced erectile capabilities and hardness. One of the leading urologists examined and has told me that he believes I have thrombosed vein, not Peyronie’s.
I stopped taking Propecia, although I would like to get an HT so I’m thinking of returning (although that might be very stupid).