Why propecia erectile dysfunction

However, the prevalence in men in their 70s and 80s is much higher [ 39 ]. The ageing process is accompanied by a progressively increasing of organic impairment. Therefore, the more the global population ages, the more they are affected by several comorbidities [ 40 , 41 , 42 , 43 , 44 , 45 , 46 ].

In elderly patients, finasteride seems to have more adverse effects on sexual dysfunction such as ED. Data from epidemiological studies suggest a link between symptoms of BPH and ED in older men regardless of age, co-morbidity, or lifestyle [ 47 , 48 , 49 , 50 ]. These receptors might increase the tone of smooth muscle cells of the prostatic capsule and bladder neck in these patients.

Penile erection depends on a balanced contraction and relaxation of the cavernous smooth muscle [ 51 ]. In ED, the aforementioned receptors affect noradrenaline and androgens and favor the contraction of smooth muscle. This may complicate the process of relaxation of the same muscle and lead to ED [ 52 ].

Although most studies in this review found that finasteride for MAA was not correlated with ED, some patients reported side effects of finasteride associated with sexual dysfunction, including ED, male infertility, and loss of libido [ 8 , 53 , 54 , 55 , 56 , 57 ]. Androgen receptor and nerve density in foreskin prepuce specimens are associated with persistent sexual side effects, including loss of sensitivity in the genital area due to former finasteride use against MAA.

In their study, 8 males aged 29—43 years reported ED, including loss of penis sensitivity over 6 months after discontinuation of finasteride. Controls were 11 otherwise healthy matched men aged 23—49 years who had undergone circumcision for phimosis.

They never took finasteride or analogues. Differences in androgen receptor expression and nerve density in different portions of dermal prepuce were evaluated in these two groups. Density of nuclear androgen receptor in stromal and epithelial cells was found to be higher in cases mean This provides the first evidence of molecular and objective difference between patients with long-term adverse sexual effects after finasteride use vs.

ED induced by finasteride might be due to ER stress. In the present study, Finasteride resulted in reduced fertility and increased ER stress and apoptotic markers in the SD rats [ 25 ]. Sperm damage occurs when oxidative stress overcomes natural antioxidant defenses. Accumulation of free radicals coupled with an increase in oxidative stress has been implicated in the pathogenesis of several disease states.

Oxidative stress is a crucial regulator of ER function and activation of the UPR in disease conditions, as ER stress and increased oxidative stress production occur concurrently [ 26 , 27 , 28 ]. Oxidative stress can lead to ED by endothelial dysfunction in part through the activation of ER stress. Therefore, the mechanism of ED associated with finasteride needs to be clarified in the future.

Therefore, physicians should discuss with their patients the possible long-term effect of finasteride on sexual function, even in MAA patients. Evidence from clinical studies suggested that finasteride was associated with increased adverse effects on ED in men with BPH.

However, such association was not statistically significant in men with MAA. Some studies reported that finasteride had side effects on sexual dysfunction, including ED, male infertility, ejaculatory dysfunction, and loss of libido, even in MAA patients.

Therefore, well-designed randomized controlled trials are needed to determine the mechanism and effects of finasteride on ED. Physicians needs to discuss the possible long-term effect of finasteride ED with their patients, especially in the young healthy patients.

All researchers are receiving support from this grant, but there are no financial or other potential conflicts of interest to declare. However, the company had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

Disclosure: The authors have no potential conflicts of interest to disclose. National Center for Biotechnology Information , U. World J Mens Health. Published online Aug Find articles by Yu Seob Shin. Find articles by Keshab Kumar Karna. Find articles by Bo Ram Choi. Find articles by Jong Kwan Park. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Correspondence to: Jong Kwan Park. This article has been cited by other articles in PMC. Keywords: Alopecia, Erectile dysfunction, Finasteride, Prostatic hyperplasia. Open in a separate window. Correlation between finasteride-induced oxidative stess and endoplasmic reticulum stress. BPH: benign prostatic hyperplasia, ED: erectile dysfunction.

MAA: male androgenic alopecia, ED: erectile dysfunction. COMMENTS Although there is not enough evidence to prove the relationship between finasteride and ED, the nocebo effect should be taken into account when studying sexual effects of finasteride [ 37 ].

Footnotes Disclosure: The authors have no potential conflicts of interest to disclose. Approval of final manuscript: all authors. References 1. Changes in surgical strategy for patients with benign prostatic hyperplasia: year single-center experience.

Korean J Urol. Twelve-week, prospective, open-label, randomized trial on the effects of an anticholinergic agent or antidiuretic agent as add-on therapy to an alpha-blocker for lower urinary tract symptoms.

Clin Interv Aging. Early dutasteride monotherapy in men with detectable serum prostate-specific antigen levels following radical prostatectomy: a prospective trial. Investig Clin Urol. Horm Mol Biol Clin Investig. Androgenetic alopecia in men aged years: prevalence and risk factors. Br J Dermatol. Prevalence of male and female pattern hair loss in Maryborough.

J Investig Dermatol Symp Proc. Traish AM. Endocr Pract. J Sex Med. Molecular characterization of 6 unrelated Italian patients with 5alpha-reductase type 2 deficiency.

J Androl. Sex determination and differentiation. N Engl J Med. Effect of dutasteride on the risk of prostate cancer. They found 1. They found 4. Men younger than 42 who took the drugs for seven months or longer had about five times the risk of long-term trouble getting erections than men who took the drug for less time. It was a hard problem to fix. Taking Viagra or other drugs did not seem to help, they reported. Irwin Goldstein , director of sexual medicine at Alvarado Hospital in San Diego, says he has treated many men with problems he links to Propecia use.

And not all of the problems are sexual, he said. They have flat emotions. They have muted orgasms, reduced volume of ejaculate, reduced penile sensation.

In particular, the following facts need to be stressed:. The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem. Several studies have shown its safety over long duration of administration. The dosage given 1 mg is small and unlikely to cause side effects.

Even in those cases where side effects were reported, the changes were found to be reversible. There are very few effective alternatives to the drug and it is therefore important for the patient not to stop the drug unless he experiences any side effects.

The patient should contact the doctor for any advice, should he experience a side effect. Most importantly, the intake of the drug is totally voluntary, as male pattern hair loss is only a cosmetic condition and it is entirely up to the patient to take or not take the drug.

The treating physician should provide full information about the drug to enable the patient to make an informed decision. It is better to avoid the drug for any patient who has prior history of oligospermia, infertility, particularly if he is newly married and is trying to raise a family. In addition, the author also feels that in patients who are apprehensive about the side effects, it is worthwhile considering administration of lower daily doses or staggered pulse doses of the drug, to enhance patient compliance.

As discussed earlier, there is sound rationale for such regimens. Plasma half life of finasteride is hours and tissue binding is days. While 0. Efficacy has been demonstrated for all end points for finasteride at doses of 0. The value of such a regimen was shown in a preliminary study. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian Dermatol Online J. Venkataram Mysore. Author information Copyright and License information Disclaimer.

Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.

Keywords: Androgenetic alopecia, finasteride, sexual side effects. In particular, the following facts need to be stressed: The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem. Its effects are proven. Anitha B, Dermatologist, Venkat Charmalaya, for correcting the draft. Psychological effect, pathophysiology and management of androgenetic alopecia in men.

Mayo Clin Proc. Sawaya ME. Antiandrogens and androgen inhibitors. In: Wolverton SE, editor. Comprehensive Dermatologic drug therapy. Philadelphia: Saunders; McVary KT. Sexual dysfunction. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; Localization of androgen receptors in human skin by immunohistochemistry: Implications for the hormonal regulation of hair growth, sebaceous glands and sweat glands.

J Endocrinol. J Sex Med. Medical therapy for benign prostatic hyperplasia: Sexual dysfunction and impact on quality of life. Int J Impot Res. Finasteride 5mg and sexual side effects: How many of these are related to a nocebo phenomenon? Finasteride in the treatment of men with androgenetic alopecia.