Erectile Dysfunction: Is Finasteride the Culprit?

Sexual dysfunction issues

Hello, doctor.
I started experiencing some hair loss issues two years ago, so I've been taking finasteride daily to prevent further hair loss.
I am aware that it may cause side effects such as erectile dysfunction or decreased libido.
Initially, the side effects were quite noticeable, with my penis being completely soft.
However, after some time, the side effects gradually diminished (as my dermatologist had mentioned), and the firmness is about 80% of what it used to be (in my opinion), but it's still sufficient.
Since high school, I have maintained a habit of masturbating about five times a week (even during a stressful period, I did it twice a day).
After starting finasteride, I have continued to maintain a frequency of about five to six times a week.
However, about two weeks ago, I noticed that the firmness has become inconsistent; sometimes it is as firm as it was after taking finasteride, and other times it is soft (note: this is the result the next day).
Then the following day, it returns to the firmness I experienced while taking finasteride.
This inconsistency has made me wonder if there is something wrong with my body.
Additionally, when watching adult films and masturbating, I used to experience a strong pleasurable sensation in the glans when I was about to ejaculate (a tight, stimulating feeling).
However, starting from two weeks ago, regardless of whether the firmness is normal or not, I no longer feel that tight stimulation after ejaculation; it just flows out or comes out in small spurts.
Is this also abnormal?
I exercise an average of three times a week, with each session lasting over 30 minutes (including various ball sports and running).
After ejaculation, I do not experience any pain in my testicles, nor do I have blood in my urine.
What could this issue be? If it is related to finasteride, it shouldn't take a year and a half to develop, right? Based on your experience, could you please help me understand what might be happening?

1111, 30~39 year old female. Ask Date: 2016/10/09

Dr. Sun Hongshun reply Urology

Hello, I'm not sure how you obtained your medication.
If it was prescribed by a physician, please consult that physician.
The duration of side effects from medication can vary from person to person.
I believe that urinary tract infections, as well as psychological or physical issues, cannot be ruled out.
I recommend consulting a urologist.
Wishing you good health.

Reply Date: 2016/10/09

More Info

Erectile dysfunction (ED) can be a complex issue, and it’s understandable that you’re concerned about the potential impact of finasteride (commonly known as Proscar or Propecia) on your sexual health. Finasteride is primarily used to treat male pattern baldness and benign prostatic hyperplasia (BPH), and while it can be effective for these conditions, it is also associated with sexual side effects, including decreased libido, erectile dysfunction, and ejaculation disorders.

From your description, it seems that you initially experienced significant side effects when you started taking finasteride, which is not uncommon. Many patients report that these side effects can diminish over time as the body adjusts to the medication. However, the recent fluctuations in erectile hardness and the changes in your orgasmic sensations could indicate that the medication is still affecting you, or it could be due to other factors.

Understanding the Symptoms
1. Fluctuating Erectile Hardness: The inconsistency in erectile hardness can be attributed to several factors. Finasteride can affect hormonal levels, particularly by reducing dihydrotestosterone (DHT), which plays a role in sexual function. Additionally, psychological factors such as anxiety or stress can also contribute to erectile difficulties. Given your history of stress and frequent masturbation, it’s possible that psychological factors are playing a role in your current experience.

2. Changes in Orgasm Sensation: The alteration in the sensation during ejaculation, where you no longer feel the intense pleasure you once did, could also be linked to finasteride. Some men report changes in orgasmic sensations while on the medication, which can be distressing. This could be due to the medication’s effects on nerve sensitivity or changes in the ejaculatory process itself.

Potential Causes and Considerations
- Medication Side Effects: As you mentioned, finasteride can lead to sexual side effects, and while these may improve over time, they can also persist or fluctuate. It’s important to monitor how you feel and discuss these changes with your healthcare provider.

- Psychological Factors: Anxiety, stress, and even performance anxiety can significantly impact erectile function. If you are feeling anxious about your sexual performance or the effects of the medication, this could contribute to the fluctuations you are experiencing.

- Physical Health: While you maintain an active lifestyle with regular exercise, other health factors such as hormonal imbalances, cardiovascular health, or even underlying medical conditions could also influence erectile function. It’s worth considering a comprehensive evaluation by a healthcare professional.

Recommendations
1. Consult Your Doctor: It’s crucial to discuss your symptoms with your healthcare provider. They can assess whether finasteride is the likely cause of your erectile dysfunction and may suggest alternative treatments or adjustments to your current medication.

2. Consider Psychological Support: If anxiety or stress is a contributing factor, speaking with a mental health professional could be beneficial. They can help you develop coping strategies and address any underlying issues.

3. Monitor Your Symptoms: Keep a journal of your symptoms, noting when they occur and any potential triggers. This information can be valuable for your healthcare provider in determining the best course of action.

4. Evaluate Other Medications: If you are taking other medications or supplements, discuss these with your doctor as they may also contribute to sexual side effects.

5. Lifestyle Modifications: Continue your exercise routine and consider incorporating relaxation techniques such as mindfulness or yoga to help manage stress.

In conclusion, while finasteride can be a contributing factor to erectile dysfunction, it’s essential to consider the broader context of your health, including psychological and lifestyle factors. Open communication with your healthcare provider will be key in addressing your concerns and finding an appropriate solution.

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