Finasteride and Persistent Sexual Dysfunction: Latest Updates

Finasteride may cause Persistent Erectile Dysfunction (PED)

Finasteride is an oral medication that is FDA approved for treating male pattern hair loss.  It is well known that sexual dysfunction is a potential side effect of finasteride that occurs in less than 2% of male users. Recently concerns have arisen that these side effects may be persistent in some - even after stopping the drug. A study by Dr Belknap and colleagues from Northwestern University in Chicago has given the first solid attempt at quantifying the risk of persistent sexual dysfunction with men using the hair loss drug finasteride. 

A look back

Studies to date and clinical trials in the 1990s first showed that sexual dysfunction was possible with finasteride. However, these studies did not show that men using these drugs experienced any residual side effects if they chose to stop the drug. In fact,  some of the clinical trials showed that side effects often went away even if men kept taking the drug.

Latest Data on PED

The authors in a new study examined a large database of patient records and looked for patients who had used finasteride and dutasteride and who also reported erectile dysfunction, decreased libido. In addition - the authors looked at the proportion of patients experiencing persistent sexual dysfunction or "PED"  (defined as erectile dysfunction occurring more than 90 days after stopping the drug).

The main messages of the study were that men using finasteride 1 mg have an approximately a 1 % chance of experiencing persistent erectile dysfunction (PED). About 1 in 3 young men who ultimately do experience erectile dysfunction using finasteride will experience persistent erectile dysfunction - and this can last several years (average 3.7 yrs in the study). The longer one is using these medications the greater the risk of PED.

 

Conclusion and Future

This study is important. We are moving away from wondering whether or not PED is real or not to now wondering what exactly is the risk (is it actually much less than the study quoted? ... or is it much more?).  The concept of PED is here to stay. Moreover, I do feel it is important to advise patients considering finasteride about these issues and to advise patients who are currently on these medications that these issues can still occur in users despite lack of any sexual problems at present.

An ideal study would be a randomized double blind placebo controlled study over 5 years. That has never been done. And likely never will be given the challenges, costs, etc. This would help us sort out the magnitude of risk. 

REFERENCE

Kigiradze et al. Persistent sexual dysfunction in men exposed to the 5 alpha reductase inhibitors finasteride or dutasteride. PeerJ 2017

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