Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?

[Oscar]

[Size=4]Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?[/size]

Michael S. Irwig MD (Article first published online: 12 JUL 2012)
onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02846.x/abstract

[b]ABSTRACT
Introduction. Finasteride has been associated with sexual side effects that may persist despite discontinuation of the medication. In a clinical series, 20% of subjects with male pattern hair loss reported persistent sexual dysfunction for ≥6 years, suggesting the possibility that the dysfunction may be permanent. These subjects also reported a wide range of symptoms including changes in cognition, ejaculate quality, and genital sensation. Other medications have been associated with irreversible neurological effects, such as phenothiazines with tardive dyskinesias.

Aim. To prospectively study whether the persistent sexual side effects associated with finasteride resolve or endure over time.

Methods. Subjects (N = 54) with persistent sexual side effects associated with finasteride were reassessed after 9–16 months (mean 14 months). All subjects were otherwise healthy young men without any baseline sexual dysfunction, medical conditions, psychiatric conditions, or use of oral prescription medications prior to taking finasteride for male pattern hair loss.

Main Outcome Measure. Scores from the Arizona Sexual Experience Scale (ASEX).

Results. The participation rate was 81%. At reassessment persistent sexual side effects continued to be present in 96% of subjects. According to the ASEX scores, 89% of subjects met the definition of sexual dysfunction. Neither the length of finasteride use nor the duration of the sexual side effects correlated to changes in scores of sexual dysfunction.

Conclusion. In most men who developed persistent sexual side effects (≥3 months) despite the discontinuation of finasteride, the sexual dysfunction continued for many months or years. Although several rat studies have shown detrimental changes to erectile function caused by 5 alpha reductase inhibitors, the persistent nature of these changes is an area of active research. Prescribers of finasteride and men contemplating its use should be made aware of the potential adverse medication effects. Irwig MS. Persistent sexual side effects of finasteride: Could they be permanent? J Sex Med ;:–.[/b]

[BP7667]

Thanks Oscar I was looking around for that. Please leave some comments on the article over at abcnews.com.

[boston332]

Thanks for the link. These things are a bit of a double edged sword for me. On the one hand we need these to help convince those who have been given the Merck coolaide but on the other hand it’s like a punch to gut seeing “permanent”, “irreversible”, etc.

[spstriken]

while I appreciate this post but after seeing these kinds of posts ( after spending 3 years I have no doubt these sides are irreversible and the hope is very little or nothing)I become very depressed and don’t know how to cope with challanges in the life.

[deluxxxxxx]

propeciahelp.com/home

The latest news today with Dr Irwig said that almost no knowledge in neuroscience. patients are saying we have no cure pfs. as far as I’m concerned I do not want to live more. I have 12 years in this hell I want to die.

[deluxxxxxx]

It is problem of neuroscience, there is no cure!

[M_C]

At reassessment persistent sexual side effects continued to be present in 96% of subjects.

Fuck.

[moonman1]

@deluxxxxxx

It is problem of neuroscience, there is no cure!

“To explain the long-term neurological effects of finasteride, it is possible that reduced concentrations of neuroactive steroids are affecting the plasticity of neuronal architecture in regions of the brain responsible for sexual function.”

He does not state this as fact, just a possibility. If it is fact though, we are fucked…

[Mew]

It is problem of neuroscience, there is no cure!

It’s not JUST a “neuroscience” problem:

“In addition to the five sexual domains formally assessed by the ASEX, men reported a broad range of persistent signs and symptoms that point to the systemic effects of finasteride, as 5a reductase is widely distributed throughout many organ systems.”

At this stage, they seem to understand some of the basic mechanisms behind persistent erectile dysfunction:

Among the various types of sexual problems, erectile dysfunction has been the most studied thus far. In studies using castrated male rats, 5 a reductase inhibitors were found to have a detrimental effect on erectile function which was restored with DHT [24,25]. A recently published elegant series of experiments have further shown that a 30-day course of dutasteride to adult rats had a marked effect on erectile function. In vivo, rats exposed to dutasteride had a decreased ratio of intracavernosal pressure/mean arterial pressure in response to a 5 Hz voltage stimulation of the cavernosal nerve [26]. In vitro, strips of corpus cavernosum smooth muscle from the dutasteride-treated group showed decreased relaxation to electrical field stimulation and acetylcholine [26]. Immunohistochemistry demonstrated increased collagen deposition and altered expression of neuronal and inducible nitric oxide synthase in the dutasteride group [26]. Another recently published study found that rats treated with finasteride for 4 weeks had a 26% reduction in the weight of their corpora cavernosa as compared with a control group [27]. This finding is consistent with the reports of genital shrinkage reported by some of the human subjects in this study.

That said, they do postulate that the MENTAL side effects could involve decreased neurosteroids and interference with GABA-A receptors/function:

There is a solid and growing body of basic science evidence that finasteride reduces the concentrations of several neuroactive steroids that play a role in neurogenesis and neuronal survival… to explain the long-term neurological effects of finasteride, it is possible that reduced concentrations of neuroactive steroids are affecting the plasticity of neuronal architecture in regions of the brain responsible for sexual function."

“… There is no known blood or imaging test to study or measure neuroactive steroids or their metabolites in different areas of the brain associated with sexual function. One possible avenue for future human research is the measurement of neuroactive steroids in the cerebrospinal fluid via lumbar puncture, a relatively low-risk procedure.”

As the paper notes, further research is required to elucidate exact mechanisms and to determine who is susceptible to such side effects, based on genetic predispositions and testing for polymorphisms of 5AR and androgen receptors:

“Further valuable research could determine who would be susceptible to finasteride through genetic studies of polymorphisms of 5a reductase and the androgen receptor. Further research with validated instruments is needed to study the nonsexual persistent side effects associated with finasteride.”

For further info I suggest you purchase the paper and read through it in detail.

[spstriken]

@Mew

It is problem of neuroscience, there is no cure!

It’s not JUST a “neuroscience” problem:

“In addition to the five sexual domains formally assessed by the ASEX, men reported a broad range of persistent signs and symptoms that point to the systemic effects of finasteride, as 5a reductase is widely distributed throughout many organ systems.”

At this stage, they seem to understand some of the basic mechanisms behind persistent erectile dysfunction:

Among the various types of sexual problems, erectile dysfunction has been the most studied thus far. In studies using castrated male rats, 5 a reductase inhibitors were found to have a detrimental effect on erectile function which was restored with DHT [24,25]. A recently published elegant series of experiments have further shown that a 30-day course of dutasteride to adult rats had a marked effect on erectile function. In vivo, rats exposed to dutasteride had a decreased ratio of intracavernosal pressure/mean arterial pressure in response to a 5 Hz voltage stimulation of the cavernosal nerve [26]. In vitro, strips of corpus cavernosum smooth muscle from the dutasteride-treated group showed decreased relaxation to electrical field stimulation and acetylcholine [26]. Immunohistochemistry demonstrated increased collagen deposition and altered expression of neuronal and inducible nitric oxide synthase in the dutasteride group [26]. Another recently published study found that rats treated with finasteride for 4 weeks had a 26% reduction in the weight of their corpora cavernosa as compared with a control group [27]. This finding is consistent with the reports of genital shrinkage reported by some of the human subjects in this study.

That said, they do postulate that the MENTAL side effects could involve decreased neurosteroids and interference with GABA-A receptors/function:

There is a solid and growing body of basic science evidence that finasteride reduces the concentrations of several neuroactive steroids that play a role in neurogenesis and neuronal survival… to explain the long-term neurological effects of finasteride, it is possible that reduced concentrations of neuroactive steroids are affecting the plasticity of neuronal architecture in regions of the brain responsible for sexual function."

“… There is no known blood or imaging test to study or measure neuroactive steroids or their metabolites in different areas of the brain associated with sexual function. One possible avenue for future human research is the measurement of neuroactive steroids in the cerebrospinal fluid via lumbar puncture, a relatively low-risk procedure.”

As the paper notes, further research is required to elucidate exact mechanisms and to determine who is susceptible to such side effects, based on genetic predispositions and testing for polymorphisms of 5AR and androgen receptors:

“Further valuable research could determine who would be susceptible to finasteride through genetic studies of polymorphisms of 5a reductase and the androgen receptor. Further research with validated instruments is needed to study the nonsexual persistent side effects associated with finasteride.”

For further info I suggest you purchase the paper and read through it in detail.

what is the use of buying and reading this all when we know it permanent and people are suffering more than 10 years with no improvement. There are some improvement stories but are very rare.I see no improvement at all in three years. I don’t know what to do. In the beginning I was optimistic but now very depressed. I admit it is very difficult. My all time is wasted on the internet looking for cure. Have strong desire to finish myself but my faith stops me.

[Len]

everything is permanent until you find a way to reverse it … our people are doing all they can to help us … we cannot give up you guys … we must stick together

[deluxxxxxx]

We all fucked! going to kill me. not worth it to live well.

[propeciashiz]

that is not the answer…we all feel bad but will get better.

[deluxxxxxx]

if the stem cells or genetic save us. of this curse. going to kill me.

[deluxxxxxx]

the stem cells we can help you with?

[propeciashiz]

we need to find the root cause my friend, then we can get answers.

[BP7667]

I don’t know why the heck you guys are Freaking out for… This study isn’t news to me… It’s obvious that our condition isn’t going to change without some sort of intervention. That said there is no reason to give up hope because we do not know if it is reversible or not at this point.

[Len]

i agree with broken pecker … this is a time to be happy with the results obtained from the efforts of this community and to keep pushing forward with all out might, together

[boston332]

It does seem that Irwig’s neurotransmitter theory along with what Awor had stated about finding “something significant” with regard to neurotransmitters is worriesome. It’s unclear (to me at least) if that is the root cause or a result of the root cause right now.

[Oscar]

@Mew

It’s not JUST a “neuroscience” problem

The focus of this paper is CLEARLY on how the neurological effects of Finasteride could cause sexual dysfunction. (ie, by removing the neuroprotective/neurogenesis effects of neurosteroids). He does not not discuss any other mechanisms behind Finasterides permanent side effects.

Other than that, he does dedicate a paragraph to show that DHT deprevation has caused similar changes in rats genitals.

So if anyone reads the study they will know that Dr Irwig thinks that the sides are between these two things, but with a very strong focus on the neurological effects.

>-------Important/Crucial things I would like to mention that are missing from this study;

*Despite the focus of the paper, he does not mention that the human brain is one of the few places without 5a-R2

*He doesnt mention that side effects usually get worse after stopping

*No non-sexual symptoms mentioned other than “change to mental abilities and/or depressive symptoms (17%)”.

*He estimates 1000+ sufferers worldwide based on membership of this forum, then contradicts himself by saying that this is a gross underestimate. Could just as easily by a gross overestimate.

*No mention of muscle loss. Despte the fact I have this, and Ive been included in both studies and repeated this symptom over and over.