Managing Sexual Dysfunction from Finasteride: Key Insights and Guidance

Q: Managing Sexual Dysfunction from Finasteride: Key Insights and Guidance

Hello： The package insert can be referenced at https：//info.fda.gov.tw/MLMS/ShowFile.aspx?LicId=02020198&Seq=021&Type=9 (Regarding side effects, it states that there is no difference in sexual function between the drug and placebo in years 2-4). <br>Following this, there is a sec

Sexual dysfunction related to medication use?

Hello, Dr.
Du.
I have been experiencing hair loss issues and started taking Finasteride 5 mg (Finta, Proscar) about three months ago, taking 1/4 of a tablet daily.
Initially, everything was normal, but after about two months, I began to experience sexual dysfunction, including difficulty achieving an erection, insufficient rigidity, and even premature ejaculation.
My libido has significantly decreased, with only morning erections being relatively normal.
I have read that the likelihood of developing sexual dysfunction from this medication is not very high, and some individuals report a return to normal function after continued use, so I decided to keep trying.
Now, after nearly three months, I can achieve an erection at critical moments, but the rigidity is still not quite sufficient, and my libido is starting to return to normal.
However, I am still quite worried, so I would like to ask for your advice on the following:
1.
Can I continue taking this medication? Will it cause any irreversible damage?
2.
How long should I continue taking it before considering stopping if my sexual function does not fully improve?
3.
If I stop taking the medication, how long might it take for my sexual function to recover? How long should I wait after stopping before seeking a consultation with a urologist if there is no improvement?
Thank you for your response.
I have been quite indecisive during this time and have been troubled by these issues.
I really hope to preserve both my hair and my sexual function, but if it comes down to it, I will reluctantly choose to give up my hair.

Chen, 20~29 year old female. Ask Date: 2020/10/22

Dr. Du Shixi reply Urology

Hello: The package insert can be referenced at https://info.fda.gov.tw/MLMS/ShowFile.aspx?LicId=02020198&Seq=021&Type=9 (Regarding side effects, it states that there is no difference in sexual function between the drug and placebo in years 2-4).
Following this, there is a section on the reported side effects of low-dose PROSCAR and/or finasteride post-marketing.
Due to these reactions stemming from voluntary reports from an uncertain number of individuals, it is not possible to accurately assess their frequency or establish a causal relationship with drug exposure.

- Immune system disorders: Allergic reactions such as itching, urticaria, and angioedema (including swelling of the lips, tongue, throat, and face).
- Psychiatric disorders: Depression, persistent decreased libido after discontinuation.
- Reproductive system and breast disorders: Persistent sexual dysfunction (erectile dysfunction and ejaculation disorders) after discontinuation; testicular pain; hematospermia; male infertility and/or reduced semen volume.
It has been reported that semen volume may improve or return to normal after stopping finasteride treatment (which I understand means there are case reports indicating improvement or normalization after discontinuation, but the manufacturer does not provide a definitive answer).
You may need to make your own decision.
Wishing you good health.

Reply Date: 2020/10/22

More Info

Managing sexual dysfunction related to the use of Finasteride, a medication commonly prescribed for male pattern baldness, can be a complex issue. It’s important to understand the potential side effects of this medication and how they can impact sexual health. Here’s a comprehensive overview based on your concerns.

Understanding Finasteride and Its Side Effects
Finasteride works by inhibiting the enzyme 5-alpha-reductase, which converts testosterone into dihydrotestosterone (DHT). While this action helps reduce hair loss, it can also lead to sexual side effects in some men. These may include decreased libido, erectile dysfunction, and ejaculation disorders. The incidence of these side effects varies, but studies suggest that they can occur in a small percentage of users.

Your Experience with Finasteride
You mentioned that after about two months of taking Finasteride, you began experiencing difficulties with erections, reduced sexual desire, and early ejaculation. It’s not uncommon for men to experience these issues when starting the medication, but it’s also important to note that some men report a return to normal sexual function after a period of continued use.
1. Should You Continue Taking Finasteride?
- If you are experiencing sexual dysfunction, it’s crucial to weigh the benefits of hair loss prevention against the side effects. Since you’ve noted some improvement in erectile function and libido, it may be worth continuing the medication for a bit longer. However, if the side effects are significantly impacting your quality of life, it might be prudent to discuss discontinuation with your healthcare provider.

2. Duration of Use and Monitoring Sexual Function
- There is no one-size-fits-all answer regarding how long to continue Finasteride if sexual function does not fully improve. Some men may see gradual improvement over several months, while others may not. If you find that your sexual function has not returned to your baseline after six months of use, it may be time to consider stopping the medication.

3. Recovery After Discontinuation
- If you decide to stop taking Finasteride, recovery of sexual function can vary widely among individuals. Some men report improvement within weeks, while others may take several months. If you have not noticed any improvement in sexual function after three months of discontinuation, it would be advisable to consult a urologist or a healthcare professional specializing in sexual health.

When to Seek Professional Help
If you experience persistent sexual dysfunction after stopping Finasteride, or if the side effects are severe, it’s essential to seek medical advice. A urologist can help assess your situation and may recommend treatments or therapies to address erectile dysfunction or low libido.

Conclusion
In summary, while Finasteride can be effective for treating hair loss, it can also lead to sexual dysfunction in some users. It’s essential to monitor your symptoms closely and maintain open communication with your healthcare provider. If you decide to continue taking the medication, keep track of any changes in your sexual health. If you choose to stop, be patient with the recovery process, and don’t hesitate to seek professional help if needed. Balancing your concerns about hair loss and sexual health is important, and a healthcare provider can help guide you through this decision-making process.

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