Finasteride [5ARI] Induced/Associated Effects

[Michael Scally MD]

Hogan C, Le Noury J, Healy D, Mangin D. One hundred and twenty cases of enduring sexual dysfunction following treatment. Int J Risk Saf Med 2014;26(2):109-16. http://iospress.metapress.com/content/1021h330k91qv844/?p=63d8a1d6d08e45a3b653392b64b60354&pi=7

BACKGROUND: There have been reports for over a decade linking serotonin reuptake inhibitors, finasteride and isotretinoin with enduring sexual dysfunction after treatment stops.

OBJECTIVE: To explore the clinical pictures linked to all 3 drugs.

METHODS: We have selected 120 reports to RxISK.org reporting the problem and mined these for data on age, gender, drug of use, and impact of the problem.

RESULTS: The data make it clear that the three drugs show extensive overlap in symptom profile, regardless of sex or country of origin.

CONCLUSIONS: The availability of 120 reports from over 20 countries add to the case for the validity of the syndrome. This is severe and enduring condition can result in death. An understanding of its physiology and an approach to treatment are needed.

 

[blazinshotguns]

I been taking propecia for 6 months . I need to masterbate 2 to 4 times a day.

Can some one explain to me why propecia hasn't turned me into a 90 year old man with a child's penis?

 

[Michael Scally MD]

Ganzer CA, Jacobs AR, Iqbal F. Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride: A Survey of Men Reporting Symptoms. Am J Mens Health. http://jmh.sagepub.com/content/early/2014/06/12/1557988314538445.abstract

Finasteride is a synthetic 5-alpha reductase inhibitor, which prevents the conversion of testosterone to dihydrotestosterone and has been used for more than 20 years in the treatment of male pattern hair loss. Randomized, controlled trials have associated finasteride with both reversible and persistent adverse effects. In this pilot study, we sought to characterize sexual and nonsexual adverse effects that men reported experiencing at least 3 months after stopping the medication. Based on previous research on persistent side effects of finasteride, we constructed an Internet survey targeting six domains: physical symptoms, sexual libido, ejaculatory disorders, disorders of the penis and testes, cognitive symptoms, and psychological symptoms and was e-mailed to patients who reported experiencing symptoms of side effects of finasteride. Responses from 131 generally healthy men (mean age, 24 years) who had taken finasteride for male pattern hair loss was included in the analysis. The most notable finding was that adverse effects persisted in each of the domains, indicating the possible presence of a "post-finasteride syndrome."

 

[Michael Scally MD]

Traish AM, Mulgaonkar A, Giordano N. The Dark Side of 5alpha-Reductase Inhibitors' Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer and Depression. Korean J Urol 2014;55(6):367-79. http://kjurology.org/DOIx.php?id=10.4111/kju.2014.55.6.367

With aging, abnormal benign growth of the prostate results in benign prostate hyperplasia (BPH) with concomitant lower urinary tract symptoms (LUTS). Because the prostate is an androgen target tissue, and transforms testosterone into 5alpha-dihydrotestosterone (5alpha-DHT), a potent androgen, via 5alpha-reductase (5alpha-R) activity, inhibiting this key metabolic reaction was identified as a target for drug development to treat symptoms of BPH.

Two drugs, namely finasteride and dutasteride were developed as specific 5alpha-reductase inhibitors (5alpha-RIs) and were approved by the U.S. Food and Drug Administration for the treatment of BPH symptoms. These agents have proven useful in the reducing urinary retention and minimizing surgical intervention in patients with BPH symptoms and considerable literature exists describing the benefits of these agents.

In this review, we highlight the adverse side effects of 5alpha-RIs on sexual function, high grade prostate cancer incidence, central nervous system function and on depression.

5alpha-Rs isoforms (types 1-3) are widely distributed in many tissues including the central nervous system and inhibition of these enzymes results in blockade of synthesis of several key hormones and neuro-active steroids leading to a host of adverse effects, including loss of or reduced libido, erectile dysfunction, orgasmic dysfunction, increased high Gleason grade prostate cancer, observed heart failure and cardiovascular events in clinical trials, and depression.

Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5alpha-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life. Physicians need to be aware of such potential adverse effects and communicate such information to their patients prior to commencing 5alpha-RIs therapy.

 

[Michael Scally MD]

Di Loreto C, La Marra F, Mazzon G, Belgrano E, Trombetta C, Cauci S. Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia. PLoS One 2014;9(6):e100237. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100237

Finasteride is an inhibitor of 5-alpha-reductase used against male androgenetic alopecia (AGA). Reported side effects of finasteride comprise sexual dysfunction including erectile dysfunction, male infertility, and loss of libido. Recently these effects were described as persistent in some subjects. Molecular events inducing persistent adverse sexual symptoms are unexplored. This study was designed as a retrospective case-control study to assess if androgen receptor (AR) and nerve density in foreskin prepuce specimens were associated with persistent sexual side effects including loss of sensitivity in the genital area due to former finasteride use against AGA. Cases were 8 males (aged 29-43 years) reporting sexual side effects including loss of penis sensitivity over 6 months after discontinuation of finasteride who were interviewed and clinically visited. After informed consent they were invited to undergo a small excision of skin from prepuce. Controls were 11 otherwise healthy matched men (aged 23-49 years) who undergone circumcision for phimosis, and who never took finasteride or analogues. Differences in AR expression and nerve density in different portions of dermal prepuce were evaluated in the 2 groups. Density of nuclear AR in stromal and epithelial cells was higher in cases (mean 40.0%, and 80.6% of positive cells, respectively) than controls (mean 23.4%, and 65.0% of positive cells, respectively), P = 0.023 and P = 0.043, respectively. Conversely, percentage of vessel smooth muscle cells positive for AR and density of nerves were similar in the 2 groups. The ratio of AR positive stromal cells % to serum testosterone concentrations was 2-fold higher in cases than in controls (P = 0.001). Our findings revealed that modulation of local AR levels might be implicated in long-term side effects of finasteride use. This provides the first evidence of a molecular objective difference between patients with long-term adverse sexual effects after finasteride use versus drug untreated healthy controls in certain tissues.

 

[ViaSwiss]

Dr. Scally, can you explain the study I quoted in laymans terms and what it means in the big picture of PFS ?

Di Loreto C, La Marra F, Mazzon G, Belgrano E, Trombetta C, Cauci S. Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia. PLoS One 2014;9(6):e100237. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100237

Finasteride is an inhibitor of 5-alpha-reductase used against male androgenetic alopecia (AGA). Reported side effects of finasteride comprise sexual dysfunction including erectile dysfunction, male infertility, and loss of libido. Recently these effects were described as persistent in some subjects. Molecular events inducing persistent adverse sexual symptoms are unexplored. This study was designed as a retrospective case-control study to assess if androgen receptor (AR) and nerve density in foreskin prepuce specimens were associated with persistent sexual side effects including loss of sensitivity in the genital area due to former finasteride use against AGA. Cases were 8 males (aged 29-43 years) reporting sexual side effects including loss of penis sensitivity over 6 months after discontinuation of finasteride who were interviewed and clinically visited. After informed consent they were invited to undergo a small excision of skin from prepuce. Controls were 11 otherwise healthy matched men (aged 23-49 years) who undergone circumcision for phimosis, and who never took finasteride or analogues. Differences in AR expression and nerve density in different portions of dermal prepuce were evaluated in the 2 groups. Density of nuclear AR in stromal and epithelial cells was higher in cases (mean 40.0%, and 80.6% of positive cells, respectively) than controls (mean 23.4%, and 65.0% of positive cells, respectively), P = 0.023 and P = 0.043, respectively. Conversely, percentage of vessel smooth muscle cells positive for AR and density of nerves were similar in the 2 groups. The ratio of AR positive stromal cells % to serum testosterone concentrations was 2-fold higher in cases than in controls (P = 0.001). Our findings revealed that modulation of local AR levels might be implicated in long-term side effects of finasteride use. This provides the first evidence of a molecular objective difference between patients with long-term adverse sexual effects after finasteride use versus drug untreated healthy controls in certain tissues.

 

[Michael Scally MD]

Dr. Scally, can you explain the study I quoted in laymans terms and what it means in the big picture of PFS ?

It means within this very small sample (8) they found something to support PFS.

Our findings revealed that modulation of local AR levels might be implicated in long-term side effects of finasteride use. This provides the first evidence of a molecular objective difference between patients with long-term adverse sexual effects after finasteride use versus drug untreated healthy controls in certain tissues.

 

[jonyoung]

So has anyone ever gotten cured? and if so how ?

 

[Michael Scally MD]

Lin W-L, Hsieh Y-W, Lin C-L, Sung F-C, Wu C-H, Kao C-H. A Population-Based Nested Case-Control Study: The Use of 5-Alpha-Reductase Inhibitors and the Increased Risk of Osteoporosis Diagnosis in Patients With Benign Prostate Hyperplasia. Clinical Endocrinology. http://onlinelibrary.wiley.com/doi/10.1111/cen.12599/abstract

Background 5-alpha-reductase inhibitors (5ARIs) are the potent androgen responsible for the development and enlargement of the prostate gland by decreasing dihydrotestosterone (DHT). This results in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppresses serum dihydrotestosterone levels [1]. Testosterone replacement therapy improves bone density in men with hypogonadal osteoporosis. This study explores the possible association between the use of 2 typical 5ARIs (finasteride and dutasteride) and the subsequent risk of osteoporosis diagnosis.

Methods We identified 1352 osteoporosis diagnosis cases and 5387 control cases without osteoporosis diagnosis from the claims data for patients with benign prostate hyperplasia (BPH), which are collected in the Taiwanese National Health Insurance Research Database (NHIRD). Four controls were frequency matched to each case according to age (every 5 years) and diagnosis date. We measured the effect of 5ARIs and determined the adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results We observed a 1.52-fold increase in osteoporosis diagnosis among patients with BPH using finasteride (95% CI, 1.01-2.30). Furthermore, a dosage analysis showed that higher doses of finasteride were associated with higher osteoporosis diagnosis risk (OR = 1.68; 95% CI, 1.01-2.81), relative to the patients not using 5ARIs.

Conclusion This population-based nested case-control study suggests that the use of finasteride can increase the risk of osteoporosis diagnosis among patients with BPH. The effects were more prominent in patients using higher doses of finasteride.

 

[Michael Scally MD]

Yim E, Nole KL, Tosti A. 5alpha-Reductase inhibitors in androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes. http://goo.gl/OrgQEZ

PURPOSE OF REVIEW: The authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5alphaRIs) for androgenetic alopecia (AGA).

RECENT FINDINGS: The 5alphaRI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5alphaRI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility.

Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website.

To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5alphaRIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy.

SUMMARY: Sexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5alphaRs including hydroxypropyl chitosan and liposomal and nanoparticulate systems.

 

[Michael Scally MD]

Traish AM, Guay AT, Zitzmann M. 5alpha-Reductase inhibitors alter steroid metabolism and may contribute to insulin resistance, diabetes, metabolic syndrome and vascular disease: a medical hypothesis. Horm Mol Biol Clin Investig 2014;20(3):73-80. http://www.degruyter.com/view/j/hmbci.2014.20.issue-3/hmbci-2014-0025/hmbci-2014-0025.xml?format=INT

5alpha-reductases, a unique family of enzymes with a wide host of substrates and tissue distributions, play a key role in the metabolism of androgens, progestins, mineralocorticoids and glucocorticoids. These enzymes are the rate-limiting step in the synthesis of a host of neurosteroids, which are critical for central nervous system function. Androgens and glucocorticoids modulate mitochondrial function, carbohydrate, protein and lipid metabolism and energy balance. Thus, the inhibition of these regulatory enzymes results in an imbalance in steroid metabolism and clearance rates, which leads to altered physiological processes. In this report, we advance the hypothesis that inhibition of 5alpha-reductases by finasteride and dutasteride alters not only steroid metabolism but also interferes with the downstream actions and signaling of these hormones. We suggest that finasteride and dutasteride inhibit 5alpha-reductase activities and reduce the clearance of glucocorticoids and mineralocorticoids, potentiating insulin resistance, diabetes and vascular disease.

 

[Michael Scally MD]

Singh MK, Avram M. Persistent sexual dysfunction and depression in finasteride users for male pattern hair loss: a serious concern or red herring? J Clin Aesthet Dermatol 2014;7(12):51-5. http://www.jcadonline.com/2014/12/persistent-sexual-dysfunction-and-depression-in-finasteride-users-for-male-pattern-hair-loss-a-serious-concern-or-red-herring/

The use of finasteride for the treatment of male pattern hair loss has recently been the focus of media and internet attention for potential irreversible sexual dysfunction and severe depression. The purpose of this study was to perform a critical review of the recent studies reporting prolonged sexual dysfunction and depression with the use of finasteride for the treatment of male pattern hair loss. A literature search was performed using PubMed to review the literature pertaining to any potential adverse effects with the use of finasteride and its treatment of male pattern hair loss. The authors conclude that the reports of potential irreversible sexual dysfunction and severe depression do raise concerns about the safety of finasteride; however, these studies are wrought with significant bias. Therefore, larger, randomized, double blind, controlled trials are warranted to further ascertain the true potential risks or confirm long-term safety profile of finasteride use.

 

[Michael Scally MD]

Highlights
· Post-finasteride patients show altered levels of neuroactive steroids.
· Post-finasteride patients show persistent sexual side effects.
· Post-finasteride patients show anxious/depressive symptomatology.

Caruso D, Abbiati F, Giatti S, et al. Patients treated for male pattern hair with finasteride show, after discontinuation of the drug, altered levels of neuroactive steroids in cerebrospinal fluid and plasma. The Journal of Steroid Biochemistry and Molecular Biology 2015;146(0):74-9. https://www.sciencedirect.com/science/article/pii/S0960076014000831

Observations performed in a subset of patients treated for male pattern hair loss indicate that persistent sexual side effects as well as anxious/depressive symptomatology have been reported even after discontinuation of finasteride treatment.

Due to the capability of finasteride to block the metabolism of progesterone (PROG) and/or testosterone (T) we have evaluated, by liquid chromatography–tandem mass spectrometry, the levels of several neuroactive steroids in paired plasma and cerebrospinal fluid (CSF) samples obtained from post-finasteride patients and in healthy controls.

At the examination, post-finasteride patients reported muscular stiffness, cramps, tremors and chronic fatigue in the absence of clinical evidence of any muscular disorder or strength reduction. Although severity of the anxious/depressive symptoms was quite variable in their frequency, overall all the subjects had a fairly complex and constant neuropsychiatric pattern.

Assessment of neuroactive steroid levels in CSF showed a decrease of PROG and its metabolites, dihydroprogesterone (DHP) and tetrahydroprogesterone (THP), associated with an increase of its precursor pregnenolone (PREG). Altered levels were also observed for T and its metabolites.

Thus, a significant decrease of dihydrotestosterone (DHT) associated with an increase of T as well as of 3α-diol was detected. Changes in neuroactive steroid levels also occurred in plasma. An increase of PREG, T, 3α-diol, 3β-diol and 17β-estradiol was associated with decreased levels of DHP and THP.

The present observations show that altered levels of neuroactive steroids, associated with depression symptoms, are present in androgenic alopecia patients even after discontinuation of the finasteride treatment.

 

[Drea'An]

I was prescribed this drug for my golf size prostate and flomax also. I have been blessed with a bit of intuition. A bell went off in my head about the drugs. I had five bottles of each and very leery about them. I wanted to used them for my rapid hair loss.
I went online and was shocked at what I read. I immediately shit-canned them. WHEW!

 

[Michael Scally MD]

Zwadlo C, Schmidtmann E, Szaroszyk M, et al. Anti-Androgenic Therapy with Finasteride Attenuates Cardiac Hypertrophy and Left Ventricular Dysfunction. Circulation. http://circ.ahajournals.org/content/early/2015/01/28/CIRCULATIONAHA.114.012066.abstract

BACKGROUND: -Compared to men, women have a better prognosis when suffering from aortic valve stenosis, hypertrophic cardiomyopathy or heart failure. Recent data suggest that androgens like testosterone or the more potent dihydrotestosterone (DHT) contribute to the development of cardiac hypertrophy and failure.

Therefore, we analyzed whether anti-androgenic therapy with finasteride, which inhibits the generation of DHT by the enzyme 5-alpha-reductase, improves pathological ventricular remodeling and heart failure.

METHODS AND RESULTS: -We found a strongly induced expression of all three isoforms of the 5-alpha-reductase (Srd5a1-3) in human and mouse hearts with pathological hypertrophy, which was associated with increased myocardial accumulation of DHT.

Starting one week after the induction of pressure overload by transaortic constriction, mice were treated with finasteride for two weeks. Cardiac function, hypertrophy, dilation and fibrosis were markedly improved in response to finasteride treatment in male, but also in female mice. In addition, finasteride also very effectively improved cardiac function and mortality after long-term pressure overload and prevented disease progression in cardiomyopathic mice with myocardial Galphaq overexpression.

Mechanistically, finasteride by decreasing DHT potently inhibited hypertrophy and Akt dependent pro-hypertrophic signaling in isolated cardiac myocytes, while introduction of constitutively active Akt blunted these effects of finasteride.

CONCLUSIONS: -Finasteride, which is currently used in patients to treat prostate disease, potently reverses pathological cardiac hypertrophy and dysfunction in mice, and might be a therapeutic option for heart failure.

 

[Deadballs]

Good for the heart then and shit for the mind.

Anyone know any ways of increasing neurosteroids cos my dick works flawlessly but my brain just doesn't give a shit anymore.

Weight lifting hasn't helped in 4 years. Running may benefit but only slightly.

 

[Michael Scally MD]

Irwig MS. Androgen Levels and Semen Parameters Among Former Users of Finasteride With Persistent Sexual Adverse Effects. JAMA Dermatol. 2014;150(12):1361-1363. http://archderm.jamanetwork.com/article.aspx?articleid=1904925

Recent postmarketing studies and the US Food and Drug Administration have found that finasteride, 1 mg, for androgenic alopecia has been associated with persistent sexual and nonsexual adverse effects. The mechanisms of these symptoms in humans are unknown. Finasteride, 1 mg, has been associated with male infertility, and 5% of men taking a 5α-reductase inhibitor had a dramatic decline in total sperm count to below 10% of baseline. The present study was designed to assess whether otherwise healthy former users of finasteride with persistent sexual adverse effects have a higher prevalence of low serum androgens and spermatogenic deficits compared with reference populations.

Low serum androgen levels at the time of the study cannot explain the persistent sexual adverse effects because mean levels were similar to those in other studies. Nonetheless, the prevalence of confirmed low androgen levels (13%) is higher than the expected 5% according to the reference ranges for the assays.

When the semen parameter results were compared with those from a general population of unscreened men from a World Health Organization study, the median semen volume was between the 25th and 50th percentiles, and the total motility was between the 10th and 25th percentiles.

Although the median sperm concentration was similar to that found in other studies, 16% (3 of 19) had severe oligospermia. For comparison, only 3% of fertile men have a sperm concentration under 10 million/mL.

Limitations of this postmarketing study include lack of baseline androgen levels and semen parameters, selection bias, missing data, and small sample size. Another limitation is that serum androgen levels often do not reflect tissue levels.

One study of men with persistent effects of finasteride found lower cerebrospinal fluid concentrations of DHT, allopregnanolone, and isopregnanolone and higher levels of testosterone and estradiol. Further research is needed on the subset of men who may be susceptible to 5α-reductase inhibitors.

 

[Michael Scally MD]

Lin WL, Hsieh YW, Lin CL, Sung FC, Wu CH, et al. A population-based nested case-control study: the use of 5-alpha-reductase inhibitors and the increased risk of osteoporosis diagnosis in patients with benign prostate hyperplasia. Clin Endocrinol (Oxf). 2015;82(4):503-8. http://onlinelibrary.wiley.com/wol1/doi/10.1111/cen.12599/abstract

BACKGROUND: 5-alpha-reductase inhibitors (5ARIs) are the potent androgen responsible for the development and enlargement of the prostate gland by decreasing dihydrotestosterone (DHT). This results in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppresses serum dihydrotestosterone levels.

Testosterone replacement therapy improves bone density in men with hypogonadal osteoporosis. This study explores the possible association between the use of two typical 5ARIs (finasteride and dutasteride) and the subsequent risk of osteoporosis diagnosis.

METHODS: We identified 1352 osteoporosis diagnosis cases and 5387 control cases without osteoporosis diagnosis from the claims data for patients with benign prostate hyperplasia (BPH), which are collected in the Taiwanese National Health Insurance Research Database (NHIRD). Four controls were frequency matched to each case according to age (every 5 years) and diagnosis date. We measured the effect of 5ARIs and determined the adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: We observed a 1.52-fold increase in osteoporosis diagnosis among patients with BPH using finasteride (95% CI, 1.01-2.30). Furthermore, a dosage analysis showed that higher doses of finasteride were associated with higher osteoporosis diagnosis risk (OR = 1.68; 95% CI, 1.01-2.81), relative to the patients not using 5ARIs.

CONCLUSION: This population-based nested case-control study suggests that the use of finasteride can increase the risk of osteoporosis diagnosis among patients with BPH. The effects were more prominent in patients using higher doses of finasteride.

 

[Michael Scally MD]

Chou CH, Lin CL, Lin MC, Sung FC, Kao CH. 5alpha-Reductase inhibitors increase acute coronary syndrome risk in patients with benign prostate hyperplasia. J Endocrinol Invest. http://link.springer.com/article/10.1007/s40618-015-0263-1

BACKGROUND: This study explored the possible association between the use of two typical 5ARIs (finasteride and dutasteride) and the risk of acute coronary syndrome (ACS) in patients with benign prostate hyperplasia (BPH).

METHODS: From the claims data of the Taiwan National Health Insurance (NHI) Taiwan, we identified 1843 ACS cases among BPH patients and randomly selected 7330 controls without ACS, with a similar mean age of 73 years. Multivariate logistic regression analysis estimated the odds ratio (OR) and 95 % confidence interval (CI) for the relationship between the 5ARIs medications and ACS risk.

RESULTS: We found that BPH patients who had received treatment with both finasteride and dutasteride were at a higher risk of ACS with an OR of 3.47 (95 % CI 1.05-11.5), compared to patients without 5ARIs treatment. Furthermore, the dosage analysis showed that there were no significant associations between ACS risk and uses of a single drug medication regardless the dosages. The ORs for those who took only dutasteride were 1.07 (95 % CI 0.39-2.99) with low dose and 0.73 (95 % CI 0.38-1.44) with high dose. The ORs for those who took only finasteride were 1.30 (95 % CI 0.89-1.92) with low dose and 0.98 (95 % CI 0.19-5.13) with high dose.

CONCLUSION: This population-based nested case-control study suggests that 5ARI use may increase ACS risk among patients with BPH when patients were exposed to both finasteride and dutasteride.

 

[Michael Scally MD]

Finasteride for Hair Loss: Some Risk for Sexual Dysfunction.
http://www.medpagetoday.com/MeetingCoverage/AAD/50666

Sexual adverse events occurred significantly more often in younger men who used finasteride (Propecia) to treat hair loss as compared with nonusers, data from a large patient record system showed.

Although the absolute numbers of men affected were small, exposure to low-dose finasteride tripled the likelihood of an impotence diagnosis and conferred almost a five-fold increase in the frequency of prescriptions for sexual-performance drugs and diagnoses of low libido.

Of more than 1,400 men 42 or younger included in the the analysis, 52 had a history of low-dose finasteride therapy. Nonetheless, investigators characterized the association between finasteride and sexual adverse events as "clinically and statistically significant."

The record search identified 157,998 healthy men younger than 42, including more than 1,441 who had a history of low-dose finasteride therapy for treatment of hair loss.

In the subgroup of finasteride users, Kiguradze and colleagues identified 17 men with diagnoses of impotence, 26 men who had a history of prescriptions for PDE5 inhibitors (such as sildenafil), and nine men who had diagnoses of low libido.

As compared with men who had no history of use of low-dose finasteride, the users had the following risks, including number needed to harm (NNH)

• Impotence diagnosis: NNH=129, HR 2.93 (P=0.00008)
• PDE5 inhibitor use: NNH=70, HR 4.75 (P<0.000001)
• Low libido diagnosis: NNH=201, HR 4.91 (P=0.00013)

Source Reference: Kiguradze T, et al "Sexual dysfunction in young men prescribed finasteride for androgenic alopecia: a large single-center observational cohort study" AAD 2015; Abstract 2008.