Propecia erectile dysfunction effect is real folks

[Notbaldyet]

Hi there,

I have been taking propecia for years. it was a miracle drug for me -- i was losing my hair when i was 19! i have lots of male relatives who lost their hair at the same age within a year. i am now 32, and i have all my hair!! yet, all this time, i had thought...i'm just getting older, things are not working quite as well. in fact, thinking back, i had lost my morning erections a long time ago and had pretty lousy quality erections otherwise. i recently had experiences with a new sexual partner that made me question whether this medicine was harmless or not, and then reviewed some of the medical literature. i then went to speak to my own doctor and he was certain it was the propecia. incidentally, i am a physician as well.

the medical literature directly looking at propecia is mixed. some say yes, others say its a 'nocebo' effect -- ie you think you lose your drive because you're on the med. however, i then came across an article which stunned me.

here is the background -- men with sickle cell anemia will get painful, damaging (ie penis can become permanently painfully scarred) erections called 'priapism' due to sickle blood cells getting 'stuck' in the small vessels during erections. so, a group of physicians in brazil tried to see what happened if they used Finasteride/Propecia to 'decrease' the number of erections these men had. guess what - it WORKED! they started at 5mg, and then tapered to 1 mg after 120 days, and there was a very significant decrease in episodes of priapism. 1mg, of course is the propecia dose. personally, i cannot see how this article would be anything other than clear and obvious evidence that propecia can cause erectile dysfunction, and certainly in a lot more than 2% of men, because all of these men had improvements.

in other words, in simple english, patients with sickle cell anemia may now get propecia to help them to NOT get erections as frequently so that they can NOT get priapism. ie this drug's so called 'imaginary' side effect is very, very real.

it is this paper that made me decide to stop taking the medication. i have no decided that i will just have to go bald until there is something better in the technology to help me. to each his own, and i do not blame anybody who is under 30, and definitely not under 25, from trying anything to save his hair -- but be warned. my recommendation is to try the medicine -- it is a definite miracle for hair, but if you see side effects, i would not continue unless you don't need to use your equipment for a while!

last thing i'll say is how terrible it is that society is so anti bald.

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here is the article for those who know how to look these things up:

Rachid-Filho D, Cavalcanti AG, Favorito LA, Costa WS, Sampaio FJ.
Souza Aguiar Municipal Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Urology. 2009 Nov;74(5):1054-7. Epub 2009 Jul 17.
Treatment of recurrent priapism in sickle cell anemia with finasteride: a new approach

this is a very reputable medical journal.

comments welcome

[gmonasco]

personally, i cannot see how this article would be anything other than clear and obvious evidence that propecia can cause erectile dysfunction, and certainly in a lot more than 2% of men, because all of these men had improvements.

The study didn't report a decrease in the ability of the subjects to get or maintain ordinary erections; it reported a decrease in the incidence of recurrent priapism. Those are two very different things.

Since the typical finasteride user is not someone who has sickle cell disease and suffers from recurrent priapism, this study's results cannot be extrapolated to the general population of finasteride users.

[Notbaldyet]

maybe. to be absolutely scientifically thorough about it, i would agree that you can't extrapolate since the study was done on a specific population. but how does one get recurrent priapism? perhaps recurrent erections? the other methods used to treat recurrent priapism are all testosterone inhibitors, but they have awful side effects. so the authors tried to choose something which didn't have the same 'awful' side effects but had similar effect. i don't know.

here is a quote out of the paper:

"Stilbestrol, which blocks testosterone production, has been effective in treating and preventing future episodes of priapism; nevertheless, its use presents important risks including gynecomastia and thromboembolic events.[16] The use of gonadotropin-releasing hormone analogs appear to be effective in controlling recurrent priapism; however, these hormone analogs reduce libido and are expensive. [14] , [17] Oral antiandrogens (flutamide) alone have been administered successfully for managing recurrent priapism in patients who did not tolerate injectable therapy, although its use was reported in a series with a limited number of patients.[1] The use of hydroxycarbamide has recently been reported in the prevention of recurrent priapism, but this study analyzed only one patient.[18] To the best of our knowledge, the present study is the first reporting the use of finasteride for treatment of recurrent priapism."

also, it is noteworth that 6 of the patients developed painless gynecomastia. perhaps related to the fact that they were a special population with sickle cell...but perhaps related to the fact that they were men on propecia.

as far as i'm aware, sickle cell disease does not affect the pituitary-gonadal axis...

[gmonasco]

but how does one get recurrent priapism? perhaps recurrent erections?

But again, the treatment for recurrent priapism is not to simply inhibit all erections.

the other methods used to treat recurrent priapism are all testosterone inhibitors, but they have awful side effects. so the authors tried to choose something which didn't have the same 'awful' side effects but had similar effect.

Note what the study says:

The use of gonadotropin-releasing hormone analogs appear to be effective in controlling recurrent priapism; however, these hormone analogs reduce libido and are expensive.

If the treatment for recurrent priapism were simply to find something that inhibited erections altogether, then obviously reduced libido wouldn't be a concern. It's incorrect to assume (as you are) that the use of finasteride to prevent recurrent priapism in a particular class of subject demonstrates that finasteride creates a general effect of erectile dysfunction among ordinary users. Those two concepts are very different things.

[Notbaldyet]

Maybe what the study suggests is that the effective treatments for priapism all have side effects of decreased libido (because they decr testosterone) etc and that finasteride is the most tolerable of these since its side effects are the most minimal. But, since finasteride is effective and it also interferes with testosterone one could speculate that its mechanism of action is similar.

What you are saying, and I appreciate it, is that although finasteride inhibits priapism and that perhaps finasteride does this through some other unknown mechanism and that since this study is on a certain population we can't use it for normal men. Maybe. But I think it is equally valid to wonder if perhaps the mechansim IS as simple as the other testosterone inhibitors and that stopping morning erections and decreasing the strength of other erections would be a way of decreasing priapism. As you said, and as most know, Finasteride does not stop ALL erections...just enough erections. And for some men, that may also be enough to interfere with normal function.

If you look at other studies, many suggest that there is a real effect of propecia. There is a recent 2010 systematic review which suggests that the ED dysfunction is real. I think that along with this more speculative study raises serious questions about this medicine. Its as though society has made it ok to take a medicine which seriously interferes with sexual function for the sake of looks. Imagine if women took estrogen suppresants if they had big asses. We would all be tsk tsking and wondering if it was worth it.

[ryan555]

I think it depends on how you define "erectile dysfunction." If you are talking about impotence, then certainly only a very small number of men experience this. If you are talking about any decrease in erectile quality, then the number is probably higher.

I don't understand the hysteria over this drug. All drugs have side effects. The birth control pill causes side effects in more than half of women who take it (including significantly decreased sexual sensation), but they don't seem to complain. I will admit that after I stopped taking Propecia about 7 months ago, my erections did get marginally better, but like you I was able to keep a full head of hair from 19 to 33. I see guys all over the Internet giving up on life because of hair loss and they are too freaked out to take a drug that will solve the problem because of all the stuff they read on all the freak out sites. I also see guys everywhere complaining that the drug destroyed them sexually yet they kept taking it for a decade. WTF?

If you're bothered by hair loss, try the medication. If you get side effects that are worse than the hair loss, then stop the drug. It's really pretty simple.

[Notbaldyet]

Ryan...agree. and I don't personally believe in the hysteria about permanent side effects. As far as I'm concerned once u stop the drug it makes no sense that things would not revert to normal. My issue with this drug is that its unclear whether it was investigated that carefully prior to marketing and whether the issue of ED with it, that is now pretty much clear in the literature, was discussed as fully as it needed to be. When I started to take this drug I was told it was harmless. It is...once you stop it. And like you said, is there are side effects, stop the drug. But some may not have even been aware of what to watch for.

[ryan555]

Ryan...agree. and I don't personally believe in the hysteria about permanent side effects. As far as I'm concerned once u stop the drug it makes no sense that things would not revert to normal. My issue with this drug is that its unclear whether it was investigated that carefully prior to marketing and whether the issue of ED with it, that is now pretty much clear in the literature, was discussed as fully as it needed to be. When I started to take this drug I was told it was harmless. It is...once you stop it. And like you said, is there are side effects, stop the drug. But some may not have even been aware of what to watch for.

I won't burden you with my life story, but I can tell you that I probably have more contempt for the pharma industry than anyone you'll find.

Having said that, I will defend Merck to a degree because all drug trials have to be limited in duration or they would never get to market. I think perhaps the number of men who experience some form of decrease in erectile function probably increases after long term use (especially as age becomes and increasing factor). When I started the drug at 19, I experienced zero side effects and I guess very gradually over the years some minor changes took place. Had I been a part of the study for 2 years, I would have reported no side effects. However, it is not uncommon for long-term symptoms of a drug to surface years after the trials have ended, which may be happening with Propecia. I don't believe that Merck distorted the trial results at all and that opinion seems to be validated by the many doctors who prescribe this medication.

I think what's really going on is that men FREAK OUT when anything effects our members, no matter how slight. Most of us would grow a sixth toe if we could keep a full head of hair, but if we get a 2% reduction in the size of our boners we think the world is coming to an end.

[Notbaldyet]

its the crazy thing, and it makes sense, that these two things which are so connected to virility are so important to me.

incidentally, i just came across a journal article in which finasteride 5mg was used for gender reassignment medical treatment for men wanting to become women.

i know its a powerful drug -- i kept every strand of my hair for years. i hope that when my hair falls out, my boners come back! my contention against those who say that its a 'permanent' change is -- if it was permanent, you woud probably permanently keep your hair. my guess is that once the hair starts falling out again, its a sign your levels have normalized again a month or two previously.

[ryan555]

i know its a powerful drug -- i kept every strand of my hair for years. i hope that when my hair falls out, my boners come back! my contention against those who say that its a 'permanent' change is -- if it was permanent, you woud probably permanently keep your hair. my guess is that once the hair starts falling out again, its a sign your levels have normalized again a month or two previously.

Many of the guys on the anti-Propecia websites claim that their hair did not change after quitting the drug. In fact, if they are experiencing long-term issues, it is almost certainly because their hormones did not readjust for some reason. I even read a thread where some of the guys were saying they wished their hair would start falling out because it would be a sign they are normalizing. Anyway, the chances of your body not returning to a pre-treatment state are extremely remote. What you don't know is how bad your hair loss would have been had you never taken the drug, nor what effect all the years on the drug might have in slowing your hair loss. I know a lot of doctors claim that you'll quickly "catch up" to where you would have been had you never taken the drug, but I'm not convinced this is true. I have spoken to a few guys who did not see much hair loss in the year after they stopped. I am about 7 months out from quitting and I have receded a bit, but it is not as bad as I thought it was going to be (knocking HARD on wood).