Nelson, hello greetings from South America! I am 33-years old and currently on testosterone replacement therapy (TRT). Should I use finasteride (Proscar, Propecia) with testosterone?
I am HIV positive, udetectable, CD4 500. I am 5’8″ tall and weigh 165 pounds. My latest lab analysis: Total Testosterone: 407 ng/dl (reference: 41-827), free testosterone: 7.60 pg/ml (reference: 8.8 -27), SHBG: 32.5 nmol/L (reference: 13-71).
A: Finasteride (brand name: Proscar), which was approved by the FDA in 1992, inhibits production of dihydrotestosterone (DHT), which is involved with prostate enlargement. Its use can actually shrink the prostate in some men. However, many men using Proscar complain of erectile dysfunction (DHT receptors may be involved in healthy erections). For men who experience this side effect, other medications may be of help. Proscar has also been found to decrease the risk of prostate cancer in men by 25 percent over a seven year period.
A lower dose of 1 mg of finasteride called Propecia was approved to help men regrow hair in their scalp. DHT has been associated with male pattern baldness. But even at that low dose many men experience erectile dysfunction. I am not sure what dose you are taking and if you are in fact having this side effect from finasteride.
In a study using testosterone replacement with or without finasteride, lean body mass and strength were not affect by finasteride. More on that paper here: http://jcem.endojournals.org/cgi/content/abstract/90/3/1502 (Exogenous Testosterone (T) Alone or with Finasteride Increases Physical Performance, Grip Strength, and Lean Body Mass in Older Men with Low Serum T)
Your total testosterone should be close to the mid range and your free testosterone is slightly low, so I would talk to your doctor about increasing the dose to about 20 percent more and retest after 4 weeks.
I guess some of us have to decide whether we want hair or we want strong erections.
About the author
Nelson Vergel is the author of "Testosterone: A Man's Guide- Second Edition" and co-author of the book "Built to Survive: A Comprehensive Guide to the Medical Use of Anabolic Therapies, Nutrition and Exercise for HIV (+) men and women", the founder of the Body Positive Wellness Clinic in Houston, and an expert speaker on exercise, nutrition, testosterone replacement, metabolism , sexual function and therapies to increase lean body mass and decrease fat.
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