Does Finasteride Cause Permanent Sexual Dysfunction?

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By Daniel A. Danyo, M.D.

Finasteride (Propecia) is an oral medication that has been used to combat hair loss over the last 20 years.  It has been clinically proven to stop the process of hair loss and balding, especially in males suffering from androgenic alopecia.  It works by blocking the conversion of Testosterone to Di-Hydro-Testosterone (DHT).

The majority of men suffering from balding have either an excessive number of DHT receptors around the hair follicle and/or increased activity.  Finasteride (Propecia) blocks an enzyme called 5-alpha reductase which is the enzyme responsible for converting Testosterone to DHT.

Unfortunately, DHT is a parent compound for twelve different neurosteroids which may be diminished as a result.  In genetically susceptible individuals, the blockage of the 5-alpha-reductace enzyme may cause a permanent blockade in forming these neurohormones which are also involved with sexual function including libido, erectile function and ejaculation.  In genetically susceptible individuals, Finasteride may permanently effect the formation of these neurohormones, causing a syndrome called Post-Finasteride Syndrome.

Though rare and likely less than 2 to 3% of those taking Finasteride, some degree of Post-Finasteride syndrome can occur, leading to permanent sexual dysfunction.  There is now an international task force looking further into the mechanism of Post-Finasteride Syndrome and possible treatment options.  It is always important to take this syndrome seriously when considering whether to go on Finasteride for the treatment of male-patterned baldness.

In addition, the blockade of some of these neurohormones can cause anxiety and depression and this is part of the symptom complex with Post-Finasteride Syndrome.  Most physicians and even myself continue to prescribe Finasteride to patients.  More education is required for all patients requesting this medication.

The good news is that the majority of patients taking Finasteride do not suffer any sexual dysfunction or depression/anxiety.  Those that have been on this medication long-term will likely not develop the syndrome with continued use.

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