Propecia, DHT, and Sperm

Hello Doctor:

Thanks for you candid forum. I have three questions for you. If I’m a male on Propecia to prevent hair loss, will taking protein supplements for body building militate against the benefits of reducing DHT by Propecia? And, how can I reduce the sexual side effects of Propecia; namely, the reduced sperm volume? Finally, is there any evidence yet that taking Propecia and its active agent long term will cause permanent side effects or potential diseases?

Thanks again

I’ll answer your questions in order and they are all good questions;

1. Protein supplements will not change how Propecia works, namely, by blocking DHT formation. I WOULD warn you against taking any steroids which conceivably could alter hormone levels and diminish the benefits of the Propecia.
2. The sexual side effects of propecia are often temporary, but if they persist for you, I usually recommend trying a half-tablet twice daily or even just once a day. You will get less than the full benefit (I am led to believe that 1/2 tablet may give you 80% of the benefit), but you will at least get SOME benefit and that is the important thing.

   Sperm volume and ejaculate volume are two different things. Ejaculate contains several body chemicals and fluids, not just sperm, and decreased ejaculate does NOT mean less sperm at all – as a matter of fact sperm levels for those with decreased ejaculate are usually still within normal levels, possibly higher. Decreased ejaculate volume was shown to occur in 0.8% of people taking propecia versus 0.4% of the placebo group in the initial studies (that decimal point is correct, it is LESS THAN one percent). Although the frequency of reduced ejaculate volume is reported small, in my experience after probing many men on this issue, it is far more frequent than the literature seems to suggest. If you are worried about potency or having problems with conception, I’d see a urologist and get your sperm count done.

3. Finally, the long term data for finasteride (~15 years of data) does not show any permanent side effects or potential disease. As a matter of fact, the data so far indicates that there is less prostate cancer in those taking it. So there you go!