The news seems to be getting progressively worse for the problems associated with the usage of finasteride (Proscar/Propecia). As if transient sexual dysfunction, Gynocomastia, Depression and Anxiety weren’t enough, it appears based on this just published study that these documented side effects can be permanent and long lasting in many individuals. The following article by ABC news goes into detail of one person’s account, which you’ll likely find both compelling and disturbing. 

Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?
1. Michael S. Irwig MD*


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. 

Propecia Alternatives
       We have featured several articles on this topic in prior updates. Propecia halts the progression of MPB and generates modest regrowth by lowering serum DHT. There are fortunately, several side effect free ways to lower serum that are profoundly health promoting. In a nutshell they consist of:

Black Tea (Theaflavin) Extract reduces DHT in circulation by 72%, additionally ENHANCES libido, sexual function via a concurrent increase in Testosterone, and unlike Propecia, a reduction in estrogen.
Super Absorbable Soy Isoflavones Combined with Mega Green Tea Extract reduces serum DHT by 80%. Published studies have shown that a modest amount dietary Soy Protein reduces DHT by 15-20%. The addition of Green Tea to Soy Isoflavones resulted in a dramatic reduction in DHT. A recent medical literature review showed that soy consumption had absolutely no documented negative effects of male hormone levels or sexual function.

Ultra Natural Prostate Formula- As opposed to lowering serum DHT, Ultra Natural Prostate Formula inhibits DHT binding to receptor sites via a critical CO2 extract of Saw Palmetto developed by Indena, an Italian phytochemical giant, that patented this specific extract as a treatment for hair loss. This formula also contains a high dose of beta sitosterol which reduces follicular (not serum) DHT activity. L’Oreal utilizes Beta Sitosterol as the anti-DHT agent of choice in their recently released Hair Mass for Men formulation. Ultra Natural Prostate Formula also counteracts Androstenedione., a major androgen player in hair loss with the usage of Flax and Norway Spruce Lignan Extract.

Astaxanthin – Reduces DHT by 65%, and concurrently raises Testosterone in a dose of 2-4 mg a day. Astaxanthin is also shown to reduce estrogen in men. Triarco, a New Jersey based bio-tech company has pursued patents for the use of Astaxanthin in combination with Saw Palmetto (Alphastat) as an intervention for both Prostate Enlargement and hair loss.

Comment      I personally use all of the above mentioned compounds in my own hair loss regime, but it is likely one treatment would suffice. Better though to be in overkill mode than in hair loss mode, any day of the week, in my opinion. In any event, I am getting a significant amount of crossover health anti-aging benefits.