Propecia is Working, But Things I’ve Read Have Me Worried
Dr. Rassman,
I am a patient of your who last saw you a few years ago regarding hair loss prevention. We decided the best course of action for me is to take Propecia and use Rogaine. I have since been taking Propecia and using Rogaine daily and so far, am pleased with the results and think that my hair loss isn’t progressing. I wanted to get your opinion because I have recently read articles which discussed sexual dysfunction as a result from taking Propecia. Even more recently, the FDA issued a warning with regard to this issue. Do you know anything about this and can you provide any insight? Also, would you recommend continuing usage? Any advice would be greatly appreciated.
Thanks in advance
You should be aware of these alerts, which is why we post about them here; however, the risks are very low and sexual side effects are rare (2%). If you have not had them, it should not be a problem… and if you are young and considering having children, you should see your doctor and get a sperm count to be sure that this problem is not impacting you.
As I’ve said before, one of my sons is taking Propecia, and it is working very well. I have not advised him to stop it when he recently asked me about it.
For the drug Propecia, the FDA found a total of 58 case reports in their AERS database that indicated sexual dysfunction may last more than 3 months after discontinuing the medication. These reports span the course of 13 years (1998 – 2011). As this is our first and only data to go off of, this suggests that, at worst, persistent side effects are *extremely* rare when we take into account the millions that have been prescribed the drug since it was released to the market in America.
When we see incidence rates this infrequent, it is difficult to rule out all other possible causes, such as pre-existing (possibly undiagnosed) conditions, other medications, mental disturbances, and so on. Sexual dysfunction in young men is quite rare, but when we are looking at such infrequent occurrences like these, it is very difficult to establish any type of causal association based on case reports alone.
Additionally, the FDA AERS database accepts electronically submitted side effect complaints from individuals who already believe their side effects were caused by finasteride. This makes establishing a causal association even more difficult, since we are basically looking at anecdotal reports from individuals that are often already convinced that finasteride was the cause of their problems. Of course this is a generalization, and does not fit every case, but I believe it is a significant factor.
There is strikingly little evidence that suggests finasteride may cause persistent symptoms, which is especially shocking since the medication has been on the market for over 20 years. Thus far, the only evidence that suggests finasteride may cause these severe side effects is unfortunately limited to case reports.
I do not contest the fact that finasteride can potentially cause serious, persistent and possibly permanent side effects in extremely rare cases, just as Aspirin can cause serious, potentially life threatening complications rarely. However, the perception that these types of reactions are common or even measureable in any modest sample of finasteride patients is completely unfounded by data we have currently available.
One thing I can say for certain is that we are sorely lacking data that quantifies or substantiates these persistent symptoms. One thing that many of these individuals are doing well is bringing significant media attention to their cause, which is absolutely fantastic. I would only hope this can equate to funding of studies and leading to an accurate diagnoses and hopefully, ultimately a viable treatment.