in my humble opinion, the whole finasteride issue in regards to ED is not really that complicated. there are a large numbers of papers out there showing that androgen deprivation, including with finasteride, causes replacement of smooth muscle in the corpus cavernosum by fatty tissue and collagen (scar tissue) and degeneration of the tunica albuginea, which is the thing that ‘traps’ blood when you get an erection.
Effect of androgen deprivation on penile ultrastructure.
Shen ZJ, Zhou XL, Lu YL, Chen ZD.
Asian J Androl. 2003 Mar;5(1):33-6.
The physiological role of androgens in penile erection: regulation of corpus cavernosum structure and function.
Traish A, Kim N.
J Sex Med. 2005 Nov;2(6):759-70. Review.
to spell it out - if you give a rat finasteride for 8 weeks, his penis turns into fat and the smooth muscles mostly disappear, and the tunica albuginea turns ragged.
So, big surprise, block DHT for a period of time and the corpus cavernosum turns into fatty tissue and scar, and the albuginea degenerates. and big surprise, even if this is reversible, it will take time. a lot of time. way more than a few weeks.
Studies have shown that reintroduction of androgens will reverse (and least partially) this effect. Although, its usually never good when part of your body turns into fatty tisse.
anyway, this is not a wild or crazy theory. the only wild and crazy thing is that this drug is still out on the marketplace. also, i would suggest that what will happen as the years go by is that the rest of the men on propecia who have not yet had symptoms will have symptoms, because by taking this medication, they are lowering the threshold that they need to have to experience ‘normal’ ED by normal aging because although they still have enough residual function that they don’t notice, a little push and they will be done too. its just a matter of time for everybody exposed.
