By Dr. John Frank, M.D. | IAHRS, ABHRS, ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, March 16, 2012
Propecia – Possible Persistent Long-Term Sexual Effects are Worrisome but not Conclusive
Propecia (Finasteride), along with Avodart (Dutasteride), are the only FDA approved internal medications for stopping hair loss in males who suffer from Alopecia (Male Pattern Baldness). Like all drugs, Propecia has side effects. These include sexual dysfunctions such as reduced sex drive & impotence. Merck, the maker of Propecia, reports that these effects are both rare (affecting only 2% of the men who take it) and that they are short term, i.e., they end after one stops taking the drug.
Finasteride works to stop hair loss by inhibiting the production of Dihydrotestosterone (DHT) because DHT causes hair loss in those men who are susceptible. However, DHT is also an androgen, a male sex hormone, and any short-term sexual dysfunction side effects are likely due to Finasteride’s inhibitory action on DHT.
Medical researchers, however, know little of the long term effects of Propecia because it has only been in use since 1997, and to compound matters, recent concerns about the long-term effects of Propecia have arisen.
Two serious concerns are that the drug could lead to the development of prostate cancer (see: Does Propecia cause or prevent prostate cancer?) and that it could lead to sexual dysfunction that persists even after one stops taking the drug.
Propecia users became alarmed in December 2008 when news broke that the Swedish Medical Products agency (the Swedish equivalent of our FDA) concluded that the use of Finasteride might result in irreversible sexual dysfunction. A careful reading of the new Swedish Propecia usage guidelines reveals that the frequency of a possible irreversible side effect is unknown because such an effect has only been self-reported by users to the agency. In short, there is no formal study to back up the agency’s warning, but this did little to assuage users’ fears about Propecia.
Then last March (2011), another study reported in the “Journal of Sexual Medicine” further alarmed users. Abdulmaged M. Traish, professor of biochemistry and urology at Boston University and Bruce R. Kava, associate professor of urology at the University of Miami, reported that a broad review of the medical literature revealed that Propecia might indeed cause persistent sexual side effects. However, the number of men reporting persistent problems was a small percentage of the 1 to 2% who experience sexual dysfunction while taking the drug.
At almost the same time however, Dr. Irwig, a professor at George Washington University in Washington D.C., conducted interviews with healthy young men who reported persistent sexual side effects after discontinuing the use of Propecia. He too concluded that while only a small percentage of men experience any negative sexual side effects, an unknown percentage who do also seem to develop persistent problems.
Studies On Propecia’s Possible Persistent Long-Term Sexual Effects are Worrisome but not Conclusive
Dr. Kava, who reported existence in the medical literature of persistent sexual dysfunction in men taking Finasteride, says that because his and other studies are based on survey data and personal interviews, hard evidence that Finasteride can cause persistent sexual side effects is lacking:
That the effects might not be reversible is a concern,” he said. “But they haven’t convinced me yet, based on this data, because they don’t have any long-term data.1
In sum then, there are currently no Propecia long-term studies or medical trials that support the claim of persistent sexual dysfunction after using Propecia. Nevertheless, such claims are worrisome, and, as is the case for most drugs, the decision to take Propecia comes down to weighing the benefits against the potential side effects and doing what one can to reduce the risks. For example, if you’re using Propecia, one way to mitigate its negative side effects is to take what’s called a “Drug Holiday” from Propecia to give your body a break. You’ll need to work out such a schedule with your doctor.
Given that there are known short term side effects, and possibly (but unproven) persistent effects, before starting to take Propecia or Avodart, you should determine whether or not you really need it.
For example, you can have a medically trained hair loss specialist do a detailed microscopic biocapillation™ examination of your hair follicles to get a sense of the type of hair loss you’re experiencing. Typically, Propecia is most helpful when a significant number of hair follicles have entered into a state called “miniaturization.” If this hasn’t occurred, then you probably don’t need to use Propecia. Alternatively, if you’re already taking Propecia, and its positive effects are not obvious, then, again, a microscopic examination of your hair follicles can help determine if you’re even benefiting from Finasteride.
Finally, if you’re starting to experience hair loss, consider having a comprehensive biocapillation™ examination of your scalp and hair follicles to determine precisely the cause of your hair loss. While Alopecia causes most of the cases of balding, genetics plays only a very small role in all cases of hair loss. The goal of a biocapillation™ examination is to identify the true root cause of your hair loss and then prescribe natural corrective remedies. These natural corrective remedies can also support your hair follicles & scalp even if you are suffering from Alopecia. This can possibly let you reduce the amount of Propecia you need to take, and that can help reduce the risks of experiencing negative side effects.
Update 09 . 09 . 2012
The International Society of Hair Restoration Surgery (ISHRS) Task Force on Finasteride Adverse Events released a statement on September 9, 2012 saying:
To date, [we find that] there is no evidence-based data substantiating the link between finasteride and persistent sexual side effects in the numerous double blinded, placebo controlled studies using finasteride 1mg for hair loss.
See updated statement here.
References:
1. “Sexual side effects from Propecia, Avodart may be irreversible.” Steven Reinberg, USAToday.com, 3/13/2011; Dr. Bruce R. Kava quoted.
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