Propecia, Proscar (finasteride) dosing, indications, interactions, adverse effects, and more

Effectiveness, Ease of Use, and Satisfaction

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Started 5mg finasteride for BPH couple years ago. I was miserable…2-3 bathroom trips nightly, discomfort in testicles (like I’d been kicked) and worst of all, blood in ejaculate that turned it brown. The latter thoroughly disgusted my wife and me. Took a few months to kick in, but now bathroom trips are 1-2, discomfort and blood are gone. Hooray! Downside is same as others have mentioned…..ge…

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Condition: Enlarged Prostate EffectivenessEase of UseSatisfaction

I am lactose intolerant and this medication has lactose as a basic ingredient which gave me terrible gas and stomach cramps.

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I took the 1mg Finasteride for 6 months for hair loss last year, despite my doctors apprehension to prescribe it. Honestly, while I was taking it, I didn’t feel any of the serious side effects except for the occasional soreness in the testicles, which I didn’t know was a result of the drug until now. On day one, however, I did notice a lack of erection and semen, but I think that was a result of me psyching myself thinking about the side effects rather than the drug actually affecting me. I did not feel anything again afterwards and I had no problem getting an erection or ejaculating. My hair, though, man oh man, I had no idea at the time how thick and full it had gotten! However, because my hair was still falling after taking it for 6 months, albeit at a reduced rate, I thought the drug wasn’t really working for me so well. And when I had my consultation with my doctor at the 6 month mark, she was concerned about the sexual side effects, even though I hadn’t experience any up to that point, she recommended I stop taking the drug considering my age. I was hesitant to stop but I agreed because, again, at the time I didn’t think the drug was working for me. Obviously now I am regretting it because my hair at the crown is thinning and there is more receding hairline. I am thinking about getting back on the drug, but I am concerned if the side effects will suddenly kick in this time if I take it. Read More Read Less

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Being a 49 yr. old male with thinning hair I decided to try 1mg of finasteride daily. After the 2nd month I started feeling anxious and a little down. I had a upset stomach and my libido was decreasing. I was starting to see some new growth at 3 months but I was seriously getting depressed and feeling very tired. I wanted to be one of the lucky guys who didn’t get side effects and had/kept an open mind. I think my hair was filling in at crown area, so I do believe this drug is good for growing hair and keeping what you have. Just be careful and monitor your mood and sexual side effects. I am very disappointed I cant tolerate this medication because it seemed to grow hair well. Read More Read Less

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Using for BPH, seems to be helping

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Have had BPH for 14-years or so. After my prostate MRI the doctor prescribed. After 2-weeks I had severe urges to simultaneously urinate

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Causes increased breast enlargement, not good and I don’t know that it helps with urination problems!

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I was prescribed this drug 5-7 years ago for enlarged prostrate. Noticed a decline in sexual drive, ejactulation and no noticeable ease of urination effort. Was then put on Tamosulin and had some improvement. Recent checkup doc prescribed Finasteride again to reduce prostrate along with remaining on Tamosulin. Now straining to urinate more….canâ??t figure what is going on. Samples of Cialis worked best but insurance wonâ??t cover…wonder if I can promise not to use it for sex?ð???

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Have been taking for about 9 months and notices that my hair loss has stopped and hair seems to be a little thicker.. Also notice some fine hair growing on temples and front of hairline. My barber says many many baby hairs growing in on thin spot on crown. his old 66 year old is quite pleased.

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I have been taking one Fincar (which is 5mg finasteride) daily for three years and I LOVE the stuff! BUT, I am not typical of the average patient user of it. I am three years into my medical regimen as a transitioning male to female transsexual, so I take it in conjunction with a daily dose of 10 mg Progynova (micronized progesterone), 100 mg Spirotone (spironolactone)and 6mg Estrofem (estradiol valerate). I love them all and what they all do together but I have no way of being sure which med is responsible for what.

I have had continuous, consistently adequate breast growth and the normal minor ‘growing pain’ typically expected to go along with it. My testicles have atrophied (shrunk) down to the size of small grapes, which is delightful! My penis has not atrophied nearly as much as I had hoped it would,and it still too often gets erected in that disgusting male way but I am patient. My only ejaculate now is about a 1/4 to 1/2 thimbleful of a clear, watery liquid which pleases me, as it indicates little to no natural production of testosterone and semen. Overall, I NEVER feel the least bit masculine ever and never want to and even out in boy drag strangers address me as Miss or Ma’am and she and her so I am ready for full time female and ‘bottom’ surgery!

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I tried for 3 weeks and my prostate felt like I just got off a mountain bike riding for 3 hours. It was a very uncomfortable feeling and constant. I did not notice any improvement in urine flow. Still getting up 3 times per night. Quitting the treatment now and letting the Urologist know.

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STILL GETTING UP 4-5 TIMES A NIGHT

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I am 82, been taking it for 3-4 years and I feel better. Still go 4 x a night, but the stream is greatly improved. I have the feeling my prostate has been reduced.

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I tried taking this at two different times, once at 51 years old and again at 53. both times i took due to a percieved thought i had a enlarged prostate, and was sold, by doctor, it could help my serious thinning in hair. Well first time i took for about a month and was on a cruise ship. I am in decent shape, and one morning i ran up a couple flights of deck stairs…done this a million times in the past….wow, could not get my heart to slow down. Normally i recover prett fast but it took about a minute for my heart to slow down….LONG time, felt like having a heart attack. Had another incedent while on excursion snorkling…scared the ….out of me. stopped the drug and when got home began working out….did a yearly phsical, and sugar was a little high, began treadmill 3 times week. year later decided to give another try for hair loss and perceived BPH, i say because i started drinking occasional pure cranberry juice, 8 oz daily for a week and think i may have killed a recurring infection in prostate. specialist said prostate was normal…but back to finasteride. Same stuff with the heart began happening after about 3 weeks. Hair did seem to get a little thicker but the heart thing was so damn scary i had to get off it…It took about 2 months to get back to normal but feel great again. Hair unfortunately did get more thin again but trying other things for that. full disclosure i drink about 12 oz coffee in morning, 12 in aftern oon and 8 oz at nigh so coffee may not mix well, i drink no alcohol and i smoke nothing. may have noticed a little less interest in sex but not problem getting it up. Read More Read Less

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I started taking finasteride 1 mg for the hair loss 3 months ago. I wish I started taking it long time ago. When I first learned about finasteride (aka propecia), of course I started researching about side effects. Impotence and ED were the most scary ones, and I did find many scary reviews over the web. So I decided not to try it out. 10 years later when my hair was visibly thinning, I had no choice but trying it out. I absolutely have no side effects whatsoever. The research shows that less than 2% feel has any sort of side effects, and I am not in that 2% unlucky group. As always, happy customers tell 3 people, and angry customers tell 3000! I wish I started taking this pill 10 years ago.Read More Read Less

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Oct 16 put on Finasteride but found it useless. Shortly after starting using a rash appeared on leg. Treated until Jan17 for Eczema then another GP said she thought it was an allergic reaction to Fineasteride. Stopped it immediately and rash improved slightly, but worse than that after itâ??s use became impotent because of this pill without doubt as it had never happened before with any other drug. Worse part of all itâ??s now March 18 and itâ??s still the same. Why NHS allow its use with such serious side affects is beyond me and mostly others.Age is totally irrelevant.Read More Read Less

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Was on just Tamsulosin. Started finasteride 3yrs ago and PSA now back to nr normal. No longer have any urgency to urinate and get up only once a night. Prostrate has shunk a lot.
But have erectile disfunction affecting a new relationship badly – viagra does not help and no semen now. Discontinuing but sticking with Tamsulosin.

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I took Fincar 5 for three years to shrink a very large prostate that was causing bladder and urination issues. After two years prostate had shrunk to roughly normal size and bladder/urination issues improved significantly. However in the last year year prostate grew again and all the bladder/urination issues returned with a vengeance. I had TURP procedure two weeks ago removing three quarters of my prostate and am again urinating “like a horse” 🙂 – and infrequently get up in the night. Side effects I experienced on this drug were reduced libido, lazy erection and next to nothing ejaculation with orgasm.Read More Read Less

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I am taking this Finasteride along with Tamsulosin .4MG (twice daily). I have BPH which got progressively worse. I had the usual symptoms, i.e. getting up 2 to 4 times a night to urinate. I could live with that, but sometimes, I couldn’t urinate even though my kidneys wanted me to. If I slept too long or was driving with no place to stop, it would just shut down. Considered Greenlight Laser Surgery, but tried adding finasteride and its seems to help. I did have problems with low libido, much reduced seman, and swelling in my breasts (they used to be “pecks”). Hair on my head does seem thicker. I am 75 and miss the good old days, but it is nice to pee when I feel the need.Read More Read Less

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With surgery the alternative to fix enlarged prostate my Doctor offered Finasteride, 5 mg. I have been on it for 2.5 years and I have noted less frequent need for getting up at night to urinate. Overall–good. Also take Saw Palmetto (for over ten years) and trying to decide if I should drop it?

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Pictures of Foods and Activities That Might Slow Down Prostate Cancer

IMAGES PROVIDED BY:

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SOURCES:

Prostate Cancer Foundation: “Nutrition, Exercise and Prostate Cancer.”

Albert Einstein College of Medicine: “Prostate Cancer: Nerves Play Key Role in Triggering Prostate Cancer and Influencing its Spread.”

Zahavich, R. Integrative Cancer Therapies, March 2013.

American Cancer Society: “What’s new in prostate cancer research?”

Academy of Nutrition and Dietetics: “Flaxseed & Prostate Cancer Risk.”

Johnson, J.J. Phytomedicine,January 2010.

Vitamin D Council: “Prostate cancer.”

Vitamin D Council: “What is vitamin D?”

Harvard Medical School + Harvard Health Publications: “Prostate Knowledge.”

Stenner-Liewen, F. Journal of Cancer, August 2013.

Traka, M. PLoS ONE, July 2008.

National Cancer Institute: “Prostate Cancer, Nutrition, and Dietary Supplements (PDQ) – Patient Version.”

Chen, J. Journal of Nutritional Science and Vitaminology, 2013.

Harshman, L. JAMA Oncology, July 2015.

University of Maryland Medical Center: “Turmeric.”

Teiten, M. Genes & Nutrition, October 2009.

Finasteride side effects and interactions, and how to avoid them

Finasteride is a steroid-like medication frequently prescribed to treat benign prostatic hyperplasia (enlarged prostate) and male pattern baldness. You’ll most likely find it in medicine cabinets and pharmacies as the brand names Proscar or Propecia, although a generic version is also available. 

The drug works by preventing the conversion of testosterone to dihydrotestosterone (DHT), which causes prostate gland growth and hair follicle shrinkage. It’s successful in decreasing prostate size for most patients and two-thirds of men taking it for hair loss report regrowth, according to Harvard. While certain finasteride studies have suggested female hair restoration as well, it’s not typically prescribed to women or children, especially pregnant women, as it can cause birth defects.

Simultaneously treating male pattern hair loss and BPH, two widespread concerns for men, makes finasteride seem like a male health superdrug. So is it? While it’s incredibly useful, finasteride isn’t perfect. Look beyond the surface-level benefits, and you’ll find various finasteride side effects, warnings, and drug interactions. Read on for an in-depth look at all three. 

RELATED: What is Proscar? | What is Propecia? | What is Finasteride?

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Side effects of finasteride

Propecia and Proscar are generally well-tolerated, but they come with a whole range of potential side effects. Finasteride belongs to a drug class called 5-alpha reductase inhibitors, which affect hormone levels and reduce male hormone activity, occasionally causing reproductive side effects like:

• Impotence/erectile dysfunction (reversed with discontinuation of medication)
• Ejaculation disorder
• Decreased volume of ejaculate
• Reduced sperm count
• Reduced sex drive

In addition to the side effects listed above, other common side effects reported with an incidence of approximately 1%-10% of patients taking the medication include:

• Orthostatic hypotension (low blood pressure upon standing)
• Dizziness
• Headache
• Weakness

Finally, less-common adverse effects, generally observed in less than 1%-2% of patients taking finasteride, include:

• Runny nose
• Skin rash
• Low blood pressure
• Testicular pain
• Breast tenderness

Patients taking finasteride might also experience increased urination. However, in the treatment of BPH (which often restricts urination), this can represent a return to healthy urinary flow. 

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Serious side effects of finasteride

Common finasteride side effects are enough to be an inconvenience, but they’re nothing out of the ordinary for prescription medications. In rare cases, however, more severe side effects can occur that require medical attention. These include:

• Persistent erectile dysfunction: In a recent study, 1.4% of men who began 5-alpha reductase inhibitor treatment developed sexual dysfunction that persisted at least 90 days after ceasing the medication. It’s not permanent impotence like some media sources have reported, but it can affect day-to-day sex life during and after treatment. 
• Infertility: To be clear, this isn’t life-long infertility. Some men may experience poor semen quality while taking finasteride, which typically improves after discontinuation of the medication.
• Depression: Finasteride can cause alterations to the hippocampus, which processes emotional responses, leading to depressive states and suicidal thoughts. Stress and anxiety can also stem from potentially inhibited sexual function.
• Increased risk of breast cancer: Certain studies have questioned a connection between finasteride therapy and male breast cancer, while others have found no correlation. Still, anyone taking the drug should be aware of cancer indicators like breast enlargement, swelling, pain, lumps, or nipple discharge, and visit a doctor if these side effects persist.
• Higher risk of high-grade prostate cancer: According to a study by the New England Journal of Medicine, finasteride reduces the risk of low-grade prostate cancer, but can increase the risk of high-grade prostate cancer. Long-term outcomes revealed no difference in survival outcomes comparing patients receiving finasteride versus placebo, and presumed contributors to this finding is that finasteride actually improves the ability to detect this type of cancer. 
• Allergic reaction: In rare cases, finasteride can cause a severe allergic reaction. Indicators like hives, difficulty breathing, and tongue or throat swelling warrant immediate medical attention.

Vision problems aren’t a typical finasteride side effect, although one study found a correlation. However, it was a fairly small sample size, so further testing might be necessary for confirmation. But this doesn’t mean it’s completely harmless to your vision. According to Dr. Yuna Rapaport, MD, MPH, the director of Manhattan Eye, “finasteride itself can cause subclinical damage to the retina and optic nerve, which may not affect your actual vision, but could be discovered on a special image.” Additionally, comparable prostate medications like Flomax can “affect the way the iris constricts and makes certain surgeries, particularly cataract surgery, more challenging.”

Dementia may be a concern, mainly because dihydrotestosterone affects cognitive function. The Journal of Neurological Sciences found higher risks of dementia during the first two years of 5-alpha reductase inhibitor therapy, but no increased risk after that.

After experiencing (or reading about) some of these side effects, some men will want to cut off their finasteride treatment. There aren’t any severe consequences or withdrawals after quitting finasteride cold turkey, but hair loss and prostate growth will likely resume unless another treatment takes its place.

Finasteride warnings

Generally, finasteride is a safe treatment option. That said, perhaps the biggest takeaway from all these side effects is that it’s not for everybody. According to the Propecia drug information from its manufacturer, Merck, and the FDA, finasteride “is not indicated for use in women or pediatric patients.” And this is especially true for pregnant women. The drug’s effect on unborn male children can be so detrimental that the FDA warns expecting mothers against even handling broken or crushed Propecia tablets. 

Anyone with pre-existing liver disease or liver function abnormality should exercise caution when using finasteride because it’s primarily metabolized in the liver. No specific dose adjustments are advised.

There are two standard finasteride dosages: 1 mg and 5 mg. When used for hair growth in patients with male pattern baldness or androgenetic alopecia, doctors typically prescribe 1 mg doses, while BPH patients often require 5 mg. Doses larger than 5 mg are not recommended. 

Although finasteride can treat hair loss, continued use is required to maintain its effects. A patient who begins finasteride treatment sees results, then stops, will see those results reverse. The 1 mg dose is safe for long-term use, but can also cause extended side effects. 

Finasteride interactions

Despite its side effects and warnings, finasteride hasn’t shown significant interactions with any other drugs in clinical trials. Still, there are common questions about taking certain common medications alongside Propecia or Proscar.

Patients who worry about finasteride’s propensity to cause erectile dysfunction (ED) and other reproductive disorders might wonder if they can take it simultaneously with Viagra, Cialis, or other ED drugs. The answer is yes. Not only can they be used together, but simultaneous use could help mitigate or prevent certain sexual side effects. 

But what about other hair growth treatments like Rogaine (minoxidil) or biotin? Yes, both of these are safe for simultaneous use with finasteride. Keep in mind, however, that Rogaine has its own set of side effects, which a patient might experience alongside finasteride side effects. 

Testosterone replacement treatment is also safe for use with finasteride in patients with low testosterone. 

And what about alcohol? Generally, alcohol and finasteride are a safe combination. However, certain studies show that daily, heavy drinking can increase the risk of high-grade prostate cancer, as does finasteride. So, using this drug with high daily alcohol consumption theoretically may compound the risk. 

How to avoid finasteride side effects

Unfortunately, side effects aren’t always avoidable. Sometimes, they just happen. Still, some measures and precautions can reduce the risk of finasteride side effects. 

The most basic precaution is to take the medication as prescribed by a healthcare professional. Patients can take it with or without food, but should only take one dose per day (any time of day). Typically, the drug’s effects aren’t visible for three months, after which consistent use is necessary for sustained benefits. 

Also, keep in mind that some side effects might only be temporary. “The side effects can diminish as you continue to take the medication, and they completely subside after you stop the medication,” according to Dr. Rapaport. So, patients experiencing adverse events can often stop them by ceasing the medication. There are some instances of sexual dysfunction that might persist longer before eventually tapering off. 

The bottom line is this: Do finasteride’s benefits outweigh the potential side effects? But the answer isn’t simple. It varies for each person, depending on their condition, medical history, priorities, and more. The best move for anyone considering a medication like Propecia or Proscar is to get medical advice from a doctor.

Finasteride and sexual side effects

Abstract

Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects. This article critically examines the evidence available and makes recommendations as to how a physician should counsel a patient while prescribing the drug.

Keywords: Androgenetic alopecia, finasteride, sexual side effects

INTRODUCTION

Some of the commonly faced questions by a physician while treating a patient of pattern hairloss are about the possible sexual side effects caused by finasteride. Reports in the press, internet sites, and misinformation by practitioners of alternative medicine, all have contributed to this image of the drug, and has lead to apprehension in the minds of patients. Often even dermatologists seem to hesitate to prescribe the drug on a long term basis. This article examines this subject in the light of evidence available.

ROLE OF ANDROGENS IN PATTERN HAIRLOSS AND SEXUAL FUNCTION

Pattern hair loss in males is androgenic in etiology. Antiandrogens such as finasteride are therefore useful in the management of the condition. Androgens, especially testosterone increases the libido. Any drug which interferes with the action of androgens is therefore assumed, by the lay person, to induce impotence. However, the precise role of androgen in penile erection needs to be fully elucidated.[1,2] Even an individual with low testosterone levels can achieve erection. In addition to androgens, visual, olfactory, tactile, auditory, and imaginative stimuli influence the libido. The penile erection is mainly under the control of parasympathetic nervous system. Ejaculation and detumescence require an intact sympathetic system.[2,3]

The androgens testosterone and dihydrotestosterone (DHT) have somewhat different actions. The enzyme, 5α-reductase converts testosterone to DHT. It exists in two isoenzyme forms. While type I is predominant in liver, type II is predominant in prostate, seminal vesicles, epididymes, hair follicles, and liver.[2] Within the hair follicle too, the two types have a different distribution. Type I 5AR, is present in the sebaceous gland, while type II 5AR is found on the outer root sheath of the hair follicles and dermal papillae. At all these sites, the testosterone is converted to DHT.[4] Although the type II 5AR enzyme has a more significant role in pattern hairloss (and therefore mechanism of action of finasteride), the predominantenzyme in scalp skin is type I ,largely because of localization to the sebaceous glands, which are large and plenty in scalp. Finasteride is a specific and competitive inhibitor of Type II 5—AR, and has therefore a selective action on hair follicles. Scalp skin DHT levelsfall by more than 60% after administration of finasteride, thereby suggesting that a significant amount of DHT found in scalp skin is derived from both local DHT production and circulating DHT. Thus, the effect of finasteride on scalp DHT is likely because of its effect on both local follicular DHT levels as well as serum DHT levels. This explains why relatively small dose of finasteride may be adequate therapeutically.

PHARMACOKINETICS OF FINASTERIDE

The bioavailability of finasteride 1 mg following oral intake ranges from 26-170% with a mean of 65%.[5] The average peak plasma concentration has been found to be 9.2 ng/ml measured 1-2 hours after administration. The bioavailability of finasteride is not related to food intake. Finasteride is extensively metabolized in liver by Cytochrome P450 3A4 enzyme subfamily and excreted both in urine and feces. The terminal half-life is approximately 5-6 hours in men between 18-60 years of age and 8 hours in men more than 70 years of age.[5]

SIDE EFFECTS RELATED TO SEXUAL FUNCTION

A number of studies have looked at the problem of side effects caused by finasteride.[6–11] These studies which are discussed below reveal that sexual adverse effects occur at the rates of 2.1% to 3.8%, erectile dysfunction (ED) being the commonest followed by ejaculatory dysfunction and loss of libido. These effects occurred early in the therapy and returned to normal on stopping or over a time on continuous use of the drug. The only causal relation between finasteride and sexual adverse effects is decreased ejaculatory volume because of predominant action of DHT on prostate.[5]

A comprehensive review of a total of 73 papers on medical therapies for BPH was conducted, with a focus on the effects of different pharmacological agents on sexual function.[6] The review revealed that finasteride is infrequently associated with problems of ejaculation (2.1-7.7%), erection (4.9-15.8%), and libido (3.1-5.4%).

The role of nocebo effect in the causation of ED due to finasteride has been investigated.[7] Nocebo effect refers to an adverse effect that results from the psychological awareness of the possibility of the side effects, but is not a direct result of the specific pharmacological action of the drug. In this study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED, when compared to the group without information.[7] The side effects were completely reversible in 5 days when the medicine was discontinued, confirming that nocebo effect has an influence in causation of side effects and suggesting the role of psychological factors.

Two studies in 1998 and 1999 showed that the incidence of these side effects with finasteride therapy was generally comparable to that observed with the treatment with placebo,[8,9] and there was no evidence of dose dependency or increased incidence with longer therapy out to 12 months. In addition, the side effects ceased in patients even when they continued to receive finasteride.

A long term study showed that drug-related sexual side effects such as decreased libido, ED, and ejaculatory disorders occurred in <2% of men.[10] These side-effects disappeared not only in all men who stopped the drug because of the side effects but also in most of those who continued therapy. The incidence of each side effect mentioned decreased to ≤0.3% by the fifth year of treatment with finasteride. The incidence of side effects were comparable to that of placebo both at one year and at 5 years.

A large prospective study in as many as 17,313 patients was conducted to look into the effects of finasteride and other covariates on sexual dysfunction as part of the analysis of The Prostate Cancer Prevention Trial (PCPT).[11] Sexual dysfunction was assessed in the 17,313 PCPT participants who received finasteride 5 mg during a 7-year period. Finasteride increased sexual dysfunction only slightly even at 5 mg dosage (which is much higher than the 1 mg administered in pattern hair loss) and its impact diminished over time. The authors concluded that the effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride. A recent review of the available literature too arrived at similar conclusions.[12]

However, there are more recent studies, which seem to have documented contrary findings.[13] Avery recent study by Irwig MS et al,[13] which has beenwidely reported in lay press and internet reported findings after conducting standardized interviews with 71 otherwise healthy men aged 21-46 years who reported new onset of sexual side effects associated with the temporal use of finasteride in which the symptoms persisted for at least three months despite stopping the drug. The study revealed that the subjects reported new-onset persistent sexual dysfunction (low libido, ED, and problems with orgasm) associated with the use of finasteride. The mean number of sexual encounters per month dropped and the total sexual dysfunction score increased for both before and after finasteride use (P < 0.0001 for both). The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date. However, there were many limitations in the study, such as small number of patients, selection bias, recall bias for before finasteride data, and no serum hormone analysis. The study recommended that physicians treating male pattern hair loss (MPHL) should discuss the potential risk levels with patients while prescribing the drug.

An important earlier study by Mella et al,[14] conducted a systematic review of twelve randomized trials evaluated the efficacy and safety of finasteride therapy in 3927 male patients. Moderate-quality evidence was found for an increase in erectile dysfunction (RR, 2.22 [95% CI, 1.03-4.78] and a possible increase in the risk of any sexual disturbances (RR, 1.39 [95% CI, 0.99-1.95]; However, the risk of discontinuing treatment because of sexual adverse effects was similar to that of placebo (RR, 0.88 [95% CI, 0.51-1.49] (moderate-quality evidence).

A number of isolated case reports have also been published on the effect of low dose finasteride on DNA changes in sperms,[15] on motility, and sperm counts.[16] These patients were under investigation for oligospermia and infertility when these findings were discovered. Significantly, these parameters improved after stopping the drug.

Another small study[17] reported three cases of young men, who had used finasteride for five years, investigated for male Infertility. Semen quality was investigated by light microscopy to evaluate sperm concentration and motility, sperm morphology by transmission electron microscope (TEM), presence of Y microdeletions by PCR, and meiotic segregationby fluorescence in situ hybridization (FISH). TEM analysis revealed altered sperm morphology consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies. One year after the men had stopped the use of finasteride without receiving any other treatment, a recovery of spermatogenetic process was observed. Motility and morphology improved whereas the meiotic pattern did not change.

Traish[18] conducted a review of different published studies and concluded that altered sexual functions such as erectile dysfunction and diminished libido are reported by a subset of men receiving finasteride, raising the possibility of a causal relationship. The review suggested discussion with patients on the potential sexual side effects and possible alternate treatments before administration of the drug.

In view of the conflicting and continuing data and importance of the subject, the International Society of Hair Restoration Surgery (ISHRS) established a Task Force on Finasteride Adverse Event Controversies to evaluate published data and make recommendations. The taskforce posted their initial update on the subject as follows:

“To date, 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 1 mg for hairloss. Reports of persistent sexual side effects have come from a variety of sources with some internet sites attracting individuals claiming to have sexual and psychological issues related to finasteride. While continued difficulty having erections after discontinuing finasteride has been reported in post-marketing surveillance the incidence of this problem remains unknown.This rare side effect is included in Merck’s patient product information in the United States, and in Public Assessment Reports of the Medicines and Health Regulatory Agency of the United Kingdom and the Medical Products Agency of Sweden.

The persistence of sexual side effects appears to be a rare event, and it has yet to be determined whether these recent reports represent a true causal relationship, or if they are simply coincidental and related to other factors such as the high incidence of sexual dysfunction in the general population, and/or the placebo effect. Also, little data is available concerning the medical and psychological work-up of these patients to exclude other potential causative factors.

At the present time, the mechanism of interaction between the brain, 5 alpha-reductase metabolism, and hormones on sexual dysfunction is speculative and poorly understood. Clearly, this is a complicated issue, which overlaps with other disciplines in medicine such as Endocrinology, Urology, and Psychiatry. More research is needed to assess the actual incidence of side effects, to determine if there is a true causal relationship for persistent side effects and if so, to identify who may be at risk. We hope to participate in a multidisciplinary forum to further evaluate this topic.

Millions of patients have benefitted from finasteride with no side effects at all, or minimal and reversible side effects. It is important for the medical community to verify anecdotal reports and if necessary, conduct further studies so that accurate information may be given to our patients to enable them to make informed choices regarding the use of this medication.

The ISHRS Task Force on Finasteride Adverse Event Controversies is in the process of gathering information and forming an interdisciplinary panel to address these issues and to keep our ISHRS members informed regarding post- marketing adverse events.”

(available from http://www.ishrs.org/articles/finasteride-announcement.htm 11 apr2011)

Thus, the evidence available about the safety of the drug can be considered as questionable, but cannot certainly be ignored. The matter needs further systematic investigation and documentation. However, there is no doubt that to the lay man the prospect of impotence while taking a drug for hairloss is daunting, however theoretical and small the risk may be. The drug brochures mention the possibility of the side effect and the patient is often unable to distinguish between the effects of 1 mg and 5 mg. Several websites give a rather unfavorable opinion about the side effects, contrary to the evidence presented above. Several blogs also discuss the side effects, and individual and anecdotal experiences are highlighted and often exaggerated. Any patient who reads such reviews is understandably apprehensive, and therefore may stop therapy with in a few weeks of starting or, in other instances, do not start the treatment at all. Losing potency for gaining hair is not an attractive proposition, however remote that possibility is!

In view of this, it is very important to properly counsel patients about the treatment. In particular, the following facts need to be stressed:

1. The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem.

2. Its effects are proven.

3. Several studies have shown its safety over long duration of administration. The dosage given (1 mg) is small and unlikely to cause side effects. Even in those cases where side effects were reported, the changes were found to be reversible.

4. There are very few effective alternatives to the drug and it is therefore important for the patient not to stop the drug unless he experiences any side effects.

5. The patient should contact the doctor for any advice, should he experience a side effect.

6. Most importantly, the intake of the drug is totally voluntary, as male pattern hair loss is only a cosmetic condition and it is entirely up to the patient to take or not take the drug.

7. The treating physician should provide full information about the drug to enable the patient to make an informed decision.

8. It is better to avoid the drug for any patient who has prior history of oligospermia, infertility, particularly if he is newly married and is trying to raise a family.

In addition, the author also feels that in patients who are apprehensive about the side effects, it is worthwhile considering administration of lower daily doses or staggered pulse doses of the drug, to enhance patient compliance. As discussed earlier, there is sound rationale for such regimens. Plasma half life of finasteride is 6-8 hours and tissue binding is 4-5 days.[5] Doses of 0.2 mg are adequate to suppress both scalp skin and serum DHT levels. While 0.2 mg caused 55% DHT suppression, 5 mg per day achieved 69% DHT suppression. Efficacy has been demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with 1 and 5 mg demonstrating similar efficacy that was superior to lower doses.[8,9,19] The drug may be therefore initially administered at 0.5 mg daily or one tablet alternate days, to gain confidence of the patient and the 1 mg/day dosage may be restored once patient is comfortable about the drug. The value of such a regimen was shown in a preliminary study.[20] However, further large, long term studies are needed to establish the value of such regimens.

Finasteride – MotherToBaby

This sheet is about exposure to finasteride in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare providers.

What is finasteride?

Finasteride is a medication approved for the treatment and prevention of male pattern baldness (hair loss in males) and benign prostatic hyperplasia (enlarged prostate). Finasteride is not approved for use in females but has been used “off-label”. Finasteride has been marketed under the brand names Propecia® and Proscar®.

I take finasteride. Can it make it harder for me to get pregnant?

Based on the data available, it is not known if finasteride can make it harder to become pregnant.

I just found out I am pregnant. Should I stop taking finasteride?

Finasteride is not recommended for use during a pregnancy. If you are taking finasteride and find out that you are pregnant, contact your healthcare provider.

Does taking finasteride increase the chance for miscarriage? 

Miscarriage can occur in any pregnancy. Scientific studies have not been done to see if taking finasteride could increase the chance for a miscarriage.

Does taking finasteride increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Experimental animal studies on pregnancy exposure to finasteride have reported that large doses might cause the sex organs in males to develop improperly. There are no human studies that have researched if finasteride use in pregnancy might cause birth defects. Based on animal research, there has been a concern for birth defects of sex organs in male babies if exposure happened when the sex organs are developing (8 to 12 weeks of pregnancy). Finasteride is not recommended for use in pregnancy.

Could taking finasteride cause other pregnancy complications?

Experimental animal studies suggested that finasteride exposure in pregnancy might affect testicular descent (which typically happens on its own in most males soon after birth), might cause preterm birth, and might affect memory in some exposed offspring. There are no human scientific studies on the use of finasteride in pregnancy.

If I touch or handle finasteride tablets during pregnancy, does the baby have an increased risk for birth defects?

People who are pregnant are told not to handle finasteride tablets that are crushed or broken during pregnancy as a precaution. However, it is highly unlikely that enough of the medication would get through the skin during the course of normal handling to be a problem.

People who are required to work with finasteride as part of their job should wear gloves, clean surface areas where pills are handled, and wash hands. Workers should discuss proper handling and storage with their occupational safety officer.

Can I breastfeed while taking finasteride? 

Finasteride is not indicated for use in females, and no data are available on its transfer into human milk. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

My male partner is taking finasteride. Should they stop taking finasteride before we try to become pregnant?

Your partner should discuss the benefits of taking the medication and any possible harmful effects from not taking it with their healthcare provider before deciding to stop treatment. If a person decides to stop using finasteride, it takes an average of 2 days for almost all of the drug to be gone from the body after the last dose.

If my male partner decides to continue taking finasteride, will it be more difficult for me to become pregnant?

There is no evidence that if your partner is taking this medication it will make it harder for you to become pregnant. Some small differences have been seen in the semen of people who take finasteride, such as low sperm counts. For most people, sperm levels returned to their normal levels when they stopped taking the medication. There are no studies that link this medication to infertility in humans.

My male partner is taking finasteride. Is there an increased risk for birth defects from exposure to semen?

There are no published research studies that have addressed this question in human pregnancy. A study in rats did not show an increased chance for birth defects in the offspring of female rats who had mated with male rats given finasteride. There has been a concern for birth defects of sex organs in male babies if a couple had unprotected sex during the critical time in pregnancy when the sex organs are developing (8 to 12 weeks of pregnancy). However, the amount of the drug found in semen is so small it is not thought to be enough to cause a problem for the developing baby if the exposure to the drug is only through semen with vaginal sex. In general, exposures that fathers or sperm donors have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

OTIS/MotherToBaby recognizes that not all people identify as “men” or “women.” When using the term “mother,” we mean the source of the egg and/or uterus and by “father,” we mean the source of the sperm, regardless of the person’s gender identity.

View PDF Fact Sheet

Hair Loss Drug Propecia Carries Risk of Losing Something Else

Two drugs used to treat both hair loss and prostate problems could carry another risk that men might want to know about: long-term sexual problems.

It’s a low risk— overall, just 1.4 percent of men who took the drugs suffered long-term erectile dysfunction. But it lasted a very long time: more than 3 ½ years after they stopped taking the drugs, the team at Northwestern University found.

Balding man, looking up.ozgurdonmaz / Getty Images

And 4.5 percent developed shorter-term erectile dysfunction.

The younger the men, the bigger the risk, they reported in the journal PeerJ.

The drugs are sold under the brand names Propecia, Proscar and Avodart and are known generically as finasteride and dutasteride. One dose treats the effects that can trouble men as they grow older and the prostate enlarges, from trouble urinating to discomfort. A lower dose can be used to stop hair loss.

“Our study shows men who take finasteride or dutasteride can get persistent erectile dysfunction, in which they will not be able to have normal erections for months or years after stopping finasteride or dutasteride,” Dr. Steven Belknap, a dermatologist at Northwestern University Feinberg School of Medicine, said in a statement.

Propecia got renewed attention recently when the New York Times quoted President Donald Trump’s physician Dr. Harold Bornstein as saying Trump takes Propecia for hair loss.

Related: Propecia Linked to Long-Term Sexual Dysfunction

The drugs act on an enzyme called 5-alpha reductase, which converts testosterone into its active form. The hormone testosterone has complex effects on the prostate, sexual function and on male-pattern hair loss.

They’re known to cause erectile dysfunction and loss of interest in sex, or libido. The Food and Drug Administration changed the labels on Propecia and Proscar in 2012 to reflect the reports of longer-term effects.

“Our study shows men who take finasteride or dutasteride can get persistent erectile dysfunction.”

But Belknap said the risks are not clearly calculated and they’re not always clearly presented to men who may take the drugs either for hair loss or to treat the symptoms of an enlarged prostate.

The full prescribing information says that the risks are not worsened by taking the drugs for longer, and that stopping the drugs clears the problem up.

But there are many reports that say otherwise and at least 1,300 finasteride-related lawsuits have been filed against finasteride’s maker, Merck.

“Some reports describe men with symptoms beginning within days of initiating finasteride and persisting for years after stopping finasteride,” the team reported.

The risks of the drug are discussed at length online and the controversy has encouraged a number of law firms to advertise litigation services specifically for men claiming they’ve been injured by taking Propecia.

So Belknap’s team studied the cases of more than 11,000 men who got the drugs between 1992 and 2013.

They found 1.4 percent of them developed persistent erectile dysfunction lasting on average 1,348 days – just over 3 ½ years. They found 4.5 percent of the men developed some sort of erective dysfunction.

The longer they took them, the bigger the risk.

Related: Hair Loss Drug Linked to Depression

“Among young men, longer exposure to finasteride posed a greater risk of persistent erectile dysfunction than all other assessed risk factors,” they wrote. Men younger than 42 who took the drugs for seven months or longer had about five times the risk of long-term trouble getting erections than men who took the drug for less time.

“Their only crime in life is to take an FDA-approved drug.”

It was a hard problem to fix. Taking Viagra or other drugs did not seem to help, they reported.

“Merck stands behind the demonstrated safety and efficacy profile of Propecia, which has been prescribed to millions of men since its FDA approval in the U.S. in 1997,” the company said in a statement. “Merck conducted well-designed clinical trials on the product and stands behind the results, which were reported to the FDA and regulatory agencies around the world.”

Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego, says he has treated many men with problems he links to Propecia use. And not all of the problems are sexual, he said.

“I have hundreds of these patients,” he told NBC News. “They have low libido. They have flat emotions. They see a woman, they say intellectually, ‘I know I am supposed to be interested in you. But I am actually not interested in you’. They have muted orgasms, reduced volume of ejaculate, reduced penile sensation.”

It’s because the target of the drugs, 5-alpha reductase, affects more than just sexual functioning. Testosterone, like all hormones, has a range of functions and enzymes such as 5-alpha reductase act on more than one hormone. “There are more than 10 very critically pathways that are prohibited from acting,” Goldstein said.

Goldstein, who was not involved in the study, said he was not reassured to learn that just 1.4 percent of men had long-term problems. “If it is 1.4 percent and there are several million people on this product, you looking at 300,000 men rendered impotent by a hair loss drug,” he said.

“Their only crime in life is to take an FDA-approved drug.”

Maggie Fox

Maggie Fox is a senior writer for NBC News and TODAY, covering health policy, science, medical treatments and disease.

90,000 Scandal erupted in France around a baldness drug for men

Published: 11/11/2017 – 17:10 Edited: 11/11/2017 – 17:16

Cases of depression and suicidal thoughts have been reported in men taking the baldness medication Propecia (finasteride) and its generics. This is reported by the French Pharmacological Survey (ANSM). On Saturday, November 11, Franceinfo publishes testimonies from men who have taken the drug.

Finasteride is prescribed only for men: in a small dose of 1 mg – for baldness – and in a dose of 5 mg – for the treatment of prostate adenoma. The French Pharmacological Survey recommended that finasteride (Propecia, Proscar and generics) be stopped immediately if symptoms of depression appear.

In France, this drug for the treatment of baldness is taken by about 30 thousand men. “It feels like I’m a ninety-year-old man,” says Frederick, 30, (not his real name).He stopped taking Propecia due to numerous side effects that caused him to quit his job. He still cannot get out of severe depression.

Same as 29-year-old Anthony. After taking Propecia, he developed anxiety disorders. At first, he did not associate them with a cure for baldness, but then he found many stories on the Internet of men with the same symptoms as his.

In September of this year, the Frenchwoman Sylvia Milon-Mathieu created an association to support the victims of this drug.Her son Romain committed suicide at the age of 25 after two years of taking Propecia. According to her, this drug was prescribed to Romain by a dermatologist in 2010, presenting it as a revolutionary method of treatment without side effects.

The association’s lawyer Charles Joseph Houdin says the drug victims are likely to sue its developer, the Merck laboratory.

Previously, it was already known about cases of depression when taking finasteride at a dose of 5 mg. Now, depression is on the list of possible side effects and on the instructions for the 1mg drugs.

It is also known about sexual dysfunctions when taking finasteride. Pharmacological surveillance also notes extremely rare cases of breast cancer in men who have taken this drug.

Frequently Asked Questions – The Post-Finasteride Syndrome Foundation

Please note that the PFC Foundation is not a medical organization and, as such, does not provide medical advice. A physician-patient relationship is not implied.Rather, this section of the site is intended to serve as a starting point for ongoing discussions between patients, doctors and researchers.

Question: What is post-finasteride syndrome?

PFC, which is listed by the Department of Genetic and Rare Disease Research at the National Institutes of Health Information Center and the National Organization for Rare Diseases database, describes serious and persistent side effects that persist long after the drug is stopped.These include sexual, neurological, physical and psychological adverse reactions in patients taking finasteride, a type II 5-alpha reductase enzyme inhibitor used to treat hair loss (propecia, finasteride 1 mg) or an enlarged prostate (proscar, finasteride 5 mg) … Symptoms include loss of sex drive, erectile dysfunction, depression, suicidal thoughts, anxiety, panic attacks, Peyronie’s disease, penis shrinkage, chronic testicular pain, gynecomastia, muscle atrophy, cognitive impairment, insomnia, and dry skin.(For a complete list of reported PFC symptoms, see the Post-Finasteride Syndrome Information page).

Q: How many men who take finasteride get PFC?

It is well known that a subgroup of men taking finasteride develop PFC. According to a study published in 2017 in the journal PeerJ and entitled “Persistent erectile dysfunction in men exposed to 5α-reductase inhibitors finasteride or dutasteride”, 1.2% of young men (defined as individuals between the ages of 16 and 42) who took finasteride for 206 days or more and had no history of sexual dysfunction developed persistent erectile dysfunction (EDD) that lasted an average of 4.2 years after discontinuation drug. The study also showed that the longer men are on finasteride, the higher the likelihood of developing EDS. Overall, men who take finasteride for at least 205 days are almost 5 times more likely to develop EDS than men who take it for less than 205 days.For symptoms other than CSA, no such statistical analysis with the participation of a critical mass of patients has so far been published. However, anyone interested in the absolute number of reported cases of PFC symptoms should consult the World Health Organization’s VigiBase ADRs Database, which currently contains over 17,000 adverse reactions. for finasteride.Among them there are more than 6,100 reproductive disorders, 4,100 mental disorders, 3,400 nervous system disorders and 3,100 skin disorders.

Q: Why do some patients develop PFC when taking finasteride, while others seem to have never had a problem with the drug?

A: This is a key question in the PFC research. Unfortunately, medical science has not yet determined what factors, genetic or otherwise, make patients prone to developing the disease.But we hope that clinical trials will be able to show this in the coming years. Meanwhile, judging by more than 2,500 PFC patients who have applied to the PFC Foundation since 2012, it seems that men between the ages of 20 and 30 are most susceptible to this disease.

Q: Is there a way to find out if I am affected by SFC?

A: There is currently no known test to determine if any patient taking finasteride will develop PFC. However, the PFC Foundation strongly recommends against using finasteride to treat hair loss.The same applies to all doctors. We strongly advise against prescribing finasteride for hair loss. We are firmly convinced that the risks of using finasteride in the vast majority of cases outweigh its benefits (i.e. an average 10% increase in the amount of hair on balding areas).

Q: Is there any medication or at least therapy for PFC?

Unfortunately, PFC is a disease for which there are currently no effective treatments.

Q: How long before an effective treatment for PFC is developed?

Nobody knows for sure. But the PFC Foundation is working as quickly as possible to fund research that promises to reveal the underlying biological mechanisms of PFC, while laying the foundation for identifying or developing effective treatments. At the same time, we are monitoring FDA trials for potentially promising products in clinical development. These developments are posted on our Research Initiatives page

Q: Are there any cases when patients with PFC recovered 100%?

There are no known scientific reports on the return of patients with PFC to full health status.But some PFC patients have told us that they recovered 80%, 90%, or even 99% over a period of one to three years. Other patients report that they adapt to their symptoms and stabilize their condition at some level over a period of one to three years. Unfortunately, a small minority of patients report an increasing severity of symptoms over time, especially with respect to some psychological side effects.

Q: I cannot find a doctor in my area who is familiar with PFC.Can you recommend it?

A: There is a page titled “Medical Professionals” in the Resources section of the PFC Foundation website. The list includes over 80 doctors, psychologists and pharmacologists who advise PFC patients and their families. Feel free to contact any of them with questions you may have, including requests for an appointment. (Unfortunately, our list of doctors and healthcare professionals does not cover the whole world, which is why we are constantly looking for new contacts.If you would like to suggest adding a physician knowledgeable about the PFC, please email Patient Relations Manager Philip Roberts at [email protected]).

Q: After describing my PFC symptoms to my doctor, he said that he had never heard of the disease. After that, he hinted that it was probably all in my head. What should I do in this situation?

A: Unfortunately, the PFC is still not known or recognized by the vast majority of all medical professionals, and many doctors severely stigmatize patients.If you come across such a doctor and depend on him for the treatment of PFC, it might be helpful for you to find a doctor who is more knowledgeable about the disease. One of the main goals of the PFC Foundation is to achieve universal understanding and acceptance of PFC as a serious disease. At the same time, we make every effort to publish as much medical literature and other disease news as possible on our website. There are cases when doctors do not recognize PPS as a real disease. If the PPS patient or their relatives are faced with such a problem, then try to talk with this doctor.If he is open to receiving new information, then ask him to carefully study the news and scientific literature about the PFC. More and more doctors who decide to learn more about PFC are contacting our Foundation directly to learn more about this disease.

Q: When I went to my doctor for PFC treatment, all he did was prescribe antidepressants. Is this the right course of action? Are antidepressants safe for patients with PFC?

The aforementioned 2017 study published in the journal PeerJ (Persistent erectile dysfunction in men exposed to 5α-reductase inhibitors finasteride or dutasteride) also showed that the use of selective serotonin reuptake inhibitors (SSRIs) was a risk factor for the development of erectile dysfunction (psychogenic ) when using finasteride against hair loss.However, no medical studies have been published that report the efficacy of SSRIs for the treatment of PFC. Therefore, we recommend that you be careful and discuss the potential risks with your doctor before deciding to treat PFC depression with SSRIs. Unfortunately, there has also been no published medical study reporting the efficacy of other antidepressants in treating PPS-related depression. PFC depression can be very debilitating, and finding effective treatments for PFC depression can be challenging and require considerable trial and error in consultation with your doctor.Separately, Sage Therapeutics is developing allopregnanolone and allopregnanolone analog products that are currently in trials for a variety of indications, including severe depressive disorders and insomnia.

Q: I would like to connect with other PFC patients in my area or anywhere in the world. Can you help me?

A: The PFC Foundation has a Patient Support Program that does just that. Anyone wishing to connect with other PFC patients and / or their family members should download our patient support form, fill it out and email us at social @ pfsfoundation.org. The program can also connect family members of PPS patients who have committed suicide with families of other PPS patients who have suffered the same fate.

Q: I am currently taking finasteride, but I have no PFC symptoms. However, as a precautionary measure, I want to discontinue the drug. If I do, can I get PFC after stopping the medication?

This question is difficult to answer, as there are a small number of patients with PFC who reported that they developed PPS only after discontinuation of finasteride.Other patients with PFC report symptoms of PFC when using finasteride, which worsen after the drug is discontinued. However, a 2017 study by PeerJ (Persistent Erectile Dysfunction in Men Exposed to 5α-Reductase Inhibitors Finasteride or Dutasteride) conclusively showed that the risk of developing PFC increases with duration of use. We just do not have enough knowledge yet to understand where the risk is greater, but we do know that the risk of developing PFC increases with the duration of drug use.

Q: I am currently taking finasteride, but I have no PFC symptoms. However, as a precautionary measure, I want to stop taking the drug. Should I stop taking the medicine right away, or is it better to gradually reduce the dose?

There is evidence that the longer someone takes finasteride, the higher the risk of developing PFC. In addition, although the drug is relatively quickly cleared from the blood (half-life 4.8-6 hours), it remains active for much longer as it irreversibly binds (and blocks normal functioning) to the target enzyme 5-alpha reductase (half-life 30 days ).After the action of finasteride is discontinued, the body must produce new 5-alpha-reductase molecules to replace those that were deactivated by finasteride. In other words, the biological effect of finasteride provides a relatively slow fading “drug effect” for about 30-60 days, even if you stop taking it without gradually tapering the dose. compared with a sudden stop of taking the drug.On the other hand, there are reports of people getting PFC within days of stopping finasteride. Therefore, no one knows if stopping the drug abruptly is safer than stopping it suddenly. Ironically, many PFS patients report that their sexual symptoms gradually worsen over time while taking finasteride.

Q: Can dutasteride also cause PFC?

A: Yes. Like finasteride, dutasteride (trade name Adovart) is a 5-alpha reductase inhibitor that has a similar chemical composition.We have received many reports of PFC-like symptoms from dutasteride-treated patients. In addition, the World Health Organization’s VigiBase Adverse Reactions Database to dutasteride describes an epidemiological profile similar to that of finasteride.

Q: I know there is currently no effective treatment for PFC, but can you recommend any special diet, exercise regimen, etc. that might help?

The PFC Foundation is not a medical organization and, as such, cannot offer medical advice or services.However, a number of PFC patients around the world with whom we regularly communicate have told us that they have adopted certain habits that help them cope with their illness. The best way to reach these patients is by participating in our Patient Support Program. When you submit your Patient Support Form to us, include a note in your email telling us that you want to keep in touch with PFC patients who are willing to share their coping strategies.Some of the doctors listed on our Medical Professionals page may also recommend these strategies.

Q: Can finasteride affect male fertility?

A: Finasteride, even in small doses, can cause a decrease in sperm count, sperm concentration and sperm motility, which can lead to male infertility in some men. These abnormal sperm parameters are dramatically improved after discontinuation of finasteride.In most, but not all of these men, these sperm parameters return to normal after stopping the drug. This is supported by a 2013 study published in the American Society for Reproductive Medicine’s Fertility and Sterility, titled Finasteride Use in Male Infertility: Effects on Semen and Hormone Parameters. ).

Q: Can finasteride topical form cause PPS in the same way as oral finasteride?

A: Most likely, yes.In 2013, the Swiss pharmaceutical company Polichem SA conducted a study published in the journal of the American Academy of Dermatology entitled “Single and Multiple Doses of Finasteride Topical in Subjects with Androgenic Alopecia”, which showed that topical finasteride was absorbed and reduced levels DHT (Dihydrotestosterone) in serum to almost the same extent as an oral drug. In addition, we have reports from patients who only used topical finasteride solutions and who developed PFC symptoms.

Q: Can women get PFC?

A: Most likely, yes. We are in contact with several women around the world who have informed us that they suffer from many of the same symptoms as male patients with PFC as a result of taking finasteride. One such woman, Sarah, starred in a 2016 documentary on Belgian public television titled “The Wonderhair Pill.” (Her story begins around 4:10 pm)

Q: I have PFD and would like to contribute to the study of PFD by participating in a clinical trial of this condition.How can i do this?

A: Currently, none of the PFC-sponsored studies are actively recruiting patients. But future research may require recruiting patients. If this happens, we will contact all of our patients to inform them of this and provide them with details of participation. But if you would like to “register” as a willing candidate in advance, please email us at [email protected] and we will record this in our database.

Additional PFC Foundation Resource Pages

Medical literature about PFC

PPS in numbers

Report your side effects

PFC Foundation News

Alfinal, Penester, Proscar, Finpezia, Propecia

Finasteride is a remedy to stop hair loss. Sometimes finasteride allows you to grow new terminal hair, but this rarely happens.It is believed that the main task is to stop further baldness. This medication is taken by mouth every day. Finasteride Propecia is approved for use by the US Food and Drug Administration ( FDA (Food and Drug Administration) or USFDA – a government agency subordinate to the US Department of Health). It is one of only two drugs approved by the FDA for the treatment of hair loss.

What are the names of finasteride-based drugs?

The only finasteride-based drug to stop baldness is Propecia (Propecia).In this preparation, there is 1 mg of finasteride for each tablet. For the treatment of baldness, take 1 tablet per day.

There is also Finpecia – the Indian analogue of Propecia (produced by the pharmaceutical company CIPLA), which does not differ from Propecia in composition and dosage – in each tablet 1 mg of finasteride. This drug is much cheaper than Propecia.

But there are also other drugs in which the active substance is still the same finasteride, but which are intended for the treatment of prostate adenoma.They do not differ in composition, but differ in the dosage of finasteride in each tablet, which is increased to 5 mg compared to Propecia and Finpecia. This includes the following drugs: Alfinal, Vero-finasteride, Penester, Proscar, Proterid, Finasteride, Finast and others.

How does finasteride work?

Finasteride, entering the bloodstream, begins to bind to type 2 5-alpha reductase instead of testosterone, thus preventing testosterone from being converted to digital testosterone.

What is type 2 5-alpha reductase?

5-alpha reductase is a human enzyme that converts the male sex hormone testosterone into the more potent androgen dihydrotestosterone, and is also involved in the formation of the neurosteroids allopregnanolone and THDOC. Thus, by reducing the amount of 5-alpha reductase (through its binding to finasteride), the total amount of dihydrotestosterone decreases. It is for this that finasteride is used – to reduce the concentration of dihydrotestosterone in the body.

What is DHT?

Dihydrotestosterone – a biologically active form of testosterone, formed from it in the cells of target organs under the influence of the enzyme 5-alpha reductase. Dihydrotestosterone binds much more strongly to tissue androgen receptors than the parent compound (testosterone). Excessive body hair growth and / or “male” type of hair loss on the head in both sexes is associated with increased formation of dihydrotestosterone in hair follicles.Dihydrotestosterone performs the following functions:

• Stimulation of sebum secretion of skin sebaceous glands
• Stimulation of proliferation (division) of prostate cells
• Stimulation or inhibition of hair on certain parts of the body
• Stimulates the growth of genitals in men during puberty
• Influences male erectile function (desire, while testosterone is responsible for erection)
• Suspected of affecting recovery after heavy physical exertion

Effect of finasteride on amount on body function?

After you start taking finasteride, your dihydrotestosterone levels will begin to decrease, which will not rise until you stop taking the drug.In this case, the testosterone level can rise up to 10%. Gradually, the concentration of dihydrotestosterone in the hair follicles will decrease, which is what we need.

How long should finasteride be used?

While you are taking finasteride, it works. If you stop taking, then the effect stops. Finasteride should be taken while your hair is dear to you, that is, all your life (or until a new, more effective remedy is invented).

When will the first results appear?

The first results can be revived in 6-12 months.In rare cases, the first results may appear after 3 months.

What is the chance that finasteride will work and stop hair loss (new hair will grow back)?

The third phase of Propecia’s trials was carried out over several years. The trials involved 60 dermatological clinics (33 in the US) and 1533 volunteers. Of this number, 1215 volunteers continued to take part in the Propecia trials in the second year. The age of the participants is 18-41 years old. The degree of baldness according to Norwood is 3-5.All participants took 1 mg of Propecia or a placebo every day.

Objective and subjective indicators were used to assess the results. Subjective analysis included a survey of participants about the results of treatment. Objective analysis included measurement of hair density and thickness, duration of the anagen phase, and other parameters. Subjective and objective scores were assessed by dermatologists who were unaware of what the participants were taking (Propecia or placebo).

The first year of testing showed the following results:

• increase in hair density +86 by 1 inch ² (+ 11%) for receiving Propecia
• hair reduction -21 per 1 inch ² (-2.7%) for placebo recipients
• new hair growth at 48% for those taking Propecia
• 7% new hair growth for placebo users
• 30% (out of 48%) slightly visible new hair growth for users of Propecia
• 18% (out of 48%) noticeable new hair growth for users of Propecia
• 6% (out of 7%) slightly noticeable new hair growth for placebo users
• 1% (out of 7%) noticeable new hair growth for placebo users

The second year of testing showed no further increase in hair density.However, further improvements in the general condition of the hair were noted, which is associated with an increase in the anagen phase and the diameter of the hair shaft. Placebo participants continued to lose hair.

How to take finasteride correctly?

Take 1 tablet of Propecia or Finpecia every day.

Finasteride compatibility with other drugs?

Yes. Many do so. But since other drugs (Alfinal, Vero-finasteride, Penester, Proscar, Proterid, Finasteride, Finast and others) contain 5 mg of finasteride in 1 tablet, then you need to divide each tablet into 5 parts and take ¹ / ₅ pills every day.Thus, you will receive 1 mg of finasteride daily, as with Propecia (Finpecia). The use of alternative drugs is much cheaper compared to Propecia with the same effectiveness.

Will the results improve if I take 0.2 mg or 5 mg finasteride per day?

Studies have shown that dosages from 0.2 to 5 mg provide almost the same results. The difference is about 5-7% better binding of type 2 5-alpha reductase in favor of a dosage of 5 mg finasteride per day versus 0.2 mg.What can play an important role in the high sensitivity of the hair follicle to dihydrotestosterone.

Why then do many people take 1 mg of finasteride per day?

Because many have not heard of the above studies. And, of course, it is extremely inconvenient to divide 1 tablet with 5 mg of finasteride into 25 parts to get 0.2 mg.

Side effects after taking finasteride?

In rare cases – impotence, decreased libido, decreased ejaculate volume, gynecomastia.

Why doesn’t finasteride always stop further baldness?

Finasteride inhibits type 2 5-alpha reductase, which accounts for approximately 70% of the total amount of 5-alpha reductase in the body. But there is also type 1 5-alpha reductase, on which finasteride has no effect. Therefore, this enzyme continues to exist in the hair follicles. In addition, if the follicles are hypersensitive to DHT, even a small amount will be sufficient to continue hair loss.

It is also possible that type 1 5-alpha reductase is much more active than type 2 5-alpha reductase in a particular individual.

Finasteride (Propecia / Proscar) [LifeBio.wiki]

Finasteride molecule

Finasteride (trademarks Proscar and Propecia from Merck, among other generic names) is a synthetic drug for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness.The drug is a type II 5-alpha reductase inhibitor. 5alpha-reductase is an enzyme that is responsible for converting testosterone to dihydrotestosterone (DHT).

Pharmacological group: Drugs for the treatment of benign prostatic hyperplasia
Pharmacological action: Drug for the treatment of benign prostatic hyperplasia (BPH).
A competitive and specific inhibitor of type II 5-alpha reductase – an intracellular enzyme that converts testosterone into a more active androgen – dihydrotestosterone (DHT).It is a synthetic 4-azasteroid compound. Effectively reduces the level of DHT both in the blood and in the tissue of the gland.
Systematic (IUPAC) name: N- (1,1-dimethylethyl) -3-oxo (5alpha, 17beta) -4-aza-androst-1-ene-17-carboxylic acid
Legal status: available by prescription only ( UK, USA)
Application: oral
Bioavailability: 63%
Metabolism: liver
Half-life: in the elderly – 8 hours, in adults – 6 hours
Excretion: fecal (57%), in urine (39%) as metabolites
Formula: C ₂₃ H ₃₆ N ₂ O ₂
Mol.mass: 372.549 g / mol

Finasteride: Application

Benign prostatic hyperplasia

In medical practice, Finasteride is used to treat benign prostatic hyperplasia (BPH), popularly known as “enlarged prostate”. The FDA approved dose is 5 mg once a day. To achieve therapeutic results, it may take six or more months of treatment with Finasteride. When you stop taking the drug, the disease may start to develop again within about 6 to 8 months.Finasteride reduces the manifestation of symptoms associated with prostate adenoma, such as difficulty urinating, night trips to the toilet, retention at the onset of urination, and decreased urine flow.

Action

Synthetic 4-azasteroid compound, competitive inhibitor of type II steroid 5-alpha reductase. This intracellular enzyme converts testosterone into the active 5-alpha-dihydrotestosterone (DHT). Inhibition of DHT production leads to a decrease in the size of the prostate gland.Finasteride does not have an affinity for the androgen receptor, so that during its use, testosterone-dependent symptoms such as weight gain and hirsutism do not appear. As a result of the use of finasteride, the concentration of DHT in serum, urine and DHT present in the prostate decreases, which reduces the size of the prostate, increases the maximum volumetric flow rate of urine, reduces the risk of acute urinary retention and the risk of requiring surgery. A decrease in the concentration of DHT in the scalp prevents the miniaturization of hair follicles, halting the balding process.After oral administration, bioavailability is about 80%, food intake does not affect absorption. Finasteride binds approximately 93% to plasma proteins, crosses the blood-brain barrier. Metabolism occurs in the liver under the influence of the isoenzyme CYP3A4 of cytochrome P-450. About 60% of the drug is excreted in the feces, about 40% in the urine. t1 / 2 is 5-6 hours, in patients over the age of 70 – 8 hours. The effect of the action, which consists in reducing the concentration of DHT, is retained for 24 hours.

Finasteride: indications for use

It is used exclusively in men to control the course and treatment of benign prostatic hyperplasia in order to reduce the size of an enlarged prostate gland, increase the maximum urinary outflow rate and reduce symptoms associated with hyperplasia, reduce the risk of acute urinary retention and the associated likelihood of surgery (including transurethral resection of the prostate and prostatectomy).Treatment of male pattern baldness (only in men).

Finasteride: contraindications

Hypersensitivity to any component of the drug. Do not use in women and children (due to the ability to inhibit the conversion of testosterone to dihydrotestosterone, this drug, when taken by women during pregnancy, can cause anomalies in the development of the external genital organs of male fetuses). The condition of patients with a large residual urine volume should be carefully monitored for the development of uropathy caused by urinary tract obstruction.

Drug interactions

There were no clinically significant interactions with other drugs.

Pregnancy and lactation

Category X. Not applicable to women. Pregnant women or women of reproductive age should avoid contact with crushed or broken tablets containing finasteride.

Method of administration and dosage

Benign prostatic hyperplasia: 5 mg once a day, regardless of food intake.In order to evaluate the effect of treatment, finasteride must be taken for at least 6 months. A decrease in the risk of acute urinary retention occurs within 4 months of treatment. There is no need to change the dose in renal failure or in elderly patients. Male pattern baldness: 1 mg once a day; the duration of treatment should be at least 3 months.

Finasteride from alopecia

In a 5-year study of men with mild to moderate hair loss, hair counts found that two out of three men who took 1 mg of Finasteride daily regained hair growth.In contrast, all men in the study who did not take Finasteride experienced hair loss. In the same study, based on photographs reviewed by an independent group of dermatologists, it was determined that 48% of patients taking Finasteride experienced visible hair regrowth, and another 42% experienced no further hair loss. The average hair count in the treatment group remained above baseline, and the difference in hair count between participants in the Finasteride and placebo groups increased steadily over the five years of the study.Finasteride is only effective while it is being used. Hair that has grown during treatment falls out within 6-12 months after stopping therapy. In clinical studies, it has been shown that Finasteride and Minoxidil affect both the parietal region and the hairline, however, it is more effective on the parietal region.
A recent 10-year study of 118 men with androgenetic alopecia (alopecia) who took Finasteride 1 mg / day showed that 86% of men who continued treatment for all 10 years experienced an increase or maintenance of their hair growth rate, and only 14% of patients reported further hair loss.It was found that patients who showed the most hair growth during the first year of treatment had more pronounced hair growth after 5 years of treatment, with almost 69% of these patients continuing to grow hair, but many patients who did not experience growth during the first year of treatment experienced further improvement. It was also found that in patients over 30 years of age, hair growth tends to increase in the long term, presumably due to the fact that such patients experience more hair loss during their lifetime, compared to other age groups of the population.Side effects were observed in only 5.9% of patients, and none of them reported symptoms such as depression or gynecomastia. The authors concluded that the effectiveness of Finasteride in the treatment of androgenetic alopecia does not decrease over time, even in elderly patients (including patients over 40 years of age), and that the drug is generally well tolerated. The study separately considered patients who continued to use the drug. A recent case-control study of male pattern baldness who experienced psychiatric complications after discontinuation of Finasteride reported the presence of depressive symptoms and suicidal ideation in patients who also experienced sexual side effects when using the drug.Some users, in an attempt to save money, instead of Propecia buy Proscar (Finasteride 5 mg), and divide the Proscar tablet into several parts, thus bringing the dosage closer to the dosage of Propecia. To prevent contact with the active ingredient during use, the tablets are coated with a special layer. Dust or crumbs from broken Proscar tablets should be kept away from pregnant women or women who may become pregnant.

Improper use

Because of its antiandrogenic properties, Finasteride is sometimes used in hormone replacement therapy in transgender men in combination with a form of estrogen.However, there are too few data from clinical studies of the use of Finasteride for this purpose and the evidence for its effectiveness in this area is very limited. Indeed, Finasteride is significantly weaker than conventional antiandrogens such as spironolactone and cyproterone acetate. In addition, its use is associated with a high risk of depression and anxiety in both men and women; transsexuals are at a particularly high risk as such symptoms are very common among this group of patients.Therefore, it is not recommended to prescribe Finasteride as an antiandrogen for transgender men, as the drug increases the risks of harmful emotional side effects.
Finasteride has also been found to help mitigate the effects of withdrawal after chronic alcohol use.

Finasteride side effects

Finasteride side effects include impotence (1.1 – 18.5%), excessive ejaculation (7.2%), decreased ejaculate volume (0.9 – 2.8%), sexual dysfunction (2.5%), gynecomastia (2.2%), erectile dysfunction (1.3%), ejaculation disorder (1.2%) and testicular pain. According to the information included in the packaging of the product, recovery was observed both in men who discontinued treatment with Finasteride due to these side effects, and in the majority of men who continued therapy. The manufacturer also speaks of patient reports of persistent erectile dysfunction despite discontinuation of the drug. In December 2010, Merck added depression to the list of Finasteride side effects.
In November 1997, the FDA refused to recommend approval of Propecia for the treatment of male pattern baldness.Although not challenging its effectiveness, Committee members expressed some concerns about the potential for long-term adverse effects on sexual function and perhaps even on reproductive capacity due to the evidence of decreased ejaculate levels.

Prostate cancer

The FDA has added a warning to Finasteride’s packaging that the drug may increase the risk of high-grade prostate cancer. Although the effect of Finasteride on the risk of prostate cancer has not been established, evidence suggests that the drug can temporarily reduce the growth and prevalence of benign prostate tumors, but may also mask the early signs of prostate cancer.The main problem is presented by patients in whom prostate cancer, when taking Finasteride, develops to benign prostatic hyperplasia, which, in turn, can lead to a delay in the diagnosis and early treatment of prostate cancer, thereby potentially increasing the risk of developing full-fledged prostate cancer in these patients.
The 2005 Prostate Cancer Prevention Trial showed that at a dose of 5 mg per day, usually prescribed for BPH (benign prostatic hyperplasia), participants taking Finasteride were 25% less likely to develop prostate cancer at the end of the study compared with placebo. …One might mistakenly think that Finasteride increases the specificity and selectivity of detecting prostate cancer, thereby creating a visible increase in the risk of developing tumors with high Gleason scores. An update to this 2008 study found that finasteride reduced the risk of prostate cancer by 30%. In the original study, Finasteride-induced shrinkage of the prostate helped to identify bundles of cancer and aggressive cells. Most of the men in the study, with low and high rates of prostate cancer, chose to undergo treatment, and many of them had surgery to remove their prostate.The pathologist then carefully analyzed each of the 500 prostates and compared the cancers found during surgery with those originally diagnosed on biopsy. This study showed that finasteride did not increase the risk of developing high-grade prostate cancer.

Sexual side effects

There have been reports of cases of sustained decrease in libido or erectile dysfunction, even after discontinuation of the drug. In December 2008, the Swedish Agency for Medical Products conducted a safety study of Finasteride and concluded that taking Finasteride could lead to the development of irreversible sexual dysfunction.In the safety update, the Agency identified the occurrence of erection difficulties that persist indefinitely as a possible side effect of the drug, even after discontinuation of Finasteride. The UK Healthcare Products Regulatory Agency (MHRA) reports data on erectile dysfunction that persisted after Finasteride was discontinued. Similar changes were made to the labeling by the Italian government. For some time, there was a discrepancy between European and North American warnings about the dangers of developing persistent sexual side effects when taking Propecia.However, two years later, in April 2011, Merck revised the US warning for consumer and medical leaflets to include erectile dysfunction that persisted after Finasteride was discontinued. In April 2012, the FDA decided to endorse Merck’s proposed labeling since 2011, after including reports of persistent libido disorders, ejaculation disorders, orgasm disorders, and decreased libido on the warning label.

Anxiety and depression

Finasteride has been found to induce depressive and anxious behavior in animals.Accordingly, its clinical use has been associated with depression and anxiety in both men and women, as demonstrated by several reports from the medical literature. In one study, Finasteride 1 mg daily caused moderate to severe depression in 19 of 23 (83%) participants, including all patients. In addition, in some cases, marked anxiety has accompanied the development of depressive symptoms. Another study with a large sample of 128 men (no women) taking Finasteride 1 mg per day found that Finasteride increased both the Beck Scale and the Hospital Depression Scale for depression.The authors concluded that Finasteride should be used with caution in patients at high risk of depression.
In late 2010, Merck revised the Propecia label information in the United States and Canada, adding depression to the list of possible side effects of the drug.
In August 2012, a study of 61 former Finasteride users with persistent sexual side effects found that 75% of them experienced a significant increase in depressive symptoms compared to a control group.Among men taking the drug, 36% experienced severe symptoms, 28% moderate, and 11% mild. In addition, 44% of men had suicidal thoughts. In a control group of 29 men, 10% showed depressive symptoms, all of which were mild, and 3% reported suicidal thoughts. It was concluded that Finasteride may cause symptoms of depression and suicidal thoughts in some individuals, which persist even after stopping treatment.

Breast cancer in men

In December 2009, the UK Medicines and Medical Devices Regulatory Agency announced an update to the safety guidelines for Finasteride and the potential risk of breast cancer in men.The agency concluded that although there was no significant increase in the overall incidence of breast cancer in men in clinical trials with Finasteride 5 mg, an increased risk of breast cancer in men cannot be ruled out with Finasteride. A warning of such risk will be included in the product information. Merck has revised the warning on consumer and healthcare leaflets in the United States to include the risk of breast cancer in men.

Finasteride for women

The FDA has classified Finasteride as a Category X drug for pregnancy.This means that the drug can cause birth defects in the fetus. Pregnant women or women who may become pregnant should avoid any interaction with crushed or broken Finasteride tablets, as the drug may seep through the skin. Finasteride is known to cause birth defects in developing male children. Exposure to whole tablets should be avoided whenever possible, although exposure is not harmful as long as the tablet is not swallowed.It is not known whether finasteride passes into breast milk, so women should avoid using the drug. Finasteride can penetrate the semen of men, but Merck points out that contact of a pregnant woman with the semen of a man taking Finasteride is not dangerous. Finasteride affects donated blood and potential donors are generally restricted from donating for at least a month after the last Finasteride dose.

Finasteride in bodybuilding

Many sports organizations have banned Finasteride because the drug can be used to disguise the use of steroids.Since 2005, Finasteride has been included in the list of substances prohibited by the World Anti-Doping Agency. However, in 2009 the drug was removed from this list. A number of famous athletes who have used Finasteride as a hair loss remedy and have been excluded from international competitions are led by skeleton athlete Zach Lund, bobsledder Sebastian Gattuso, footballer Romario and ice hockey goalkeeper Jose Theodore.

Mechanism of action

Testosterone in men is produced primarily in the testes and also in the adrenal glands.Most of the testosterone in the body is bound to sex hormone binding globulin (SHBG), a protein made in the liver that transports testosterone through the bloodstream, prevents its metabolism, and prolongs its half-life. When released from its bond with SHBG, free testosterone can enter cells throughout the body. In some tissues, in particular in the tissues of the scalp, skin and prostate gland, testosterone, under the action of the enzyme 5alpha-reductase, is converted into 5alpha-dihydrotestosterone (DHT).DHT is a more potent androgen than testosterone (approximately 3-10 times more active against the androgen receptor, the site of action of androgen hormones), so 5alpha reductase may be considered to enhance the androgenic effect of testosterone in the tissues where it is located.
Finasteride, a 4-azasteroid and testosterone analogue, acts as a potent and specific, competitive inhibitor of one of two subtypes of 5alpha reductase, specifically the type II isoenzyme. In other words, it binds by an enzyme and prevents the metabolism of endogenous substrates such as testosterone.Type I and II 5alpha reductases account for approximately one third and two thirds of systemic DHT production, respectively.
Other substrates of 5a-reductase include progesterone, androstenedione, epi-testosterone, cortisol, aldosterone, and deoxycorticosterone. The full physiological effect of their recovery is unknown, but it is probably related to their release or is physiological in itself. Besides the fact that the drug acts as a catalyst in limiting the rate of testosterone reduction reaction, isoforms I and II of the enzyme 5alpha-reductase reduce progesterone to dihydroprogesterone (DHP) and deoxycorticosterone to dihydrodeoxycorticostenor (DHDOC).In vitro and animal models show that subsequent 3alpha reduction of DHT, DHP, and DHDOC leads to the creation of steroid metabolites that affect brain function by increasing GABA inhibition of gamma-aminobutyric acid. These neuroactive steroid derivatives increase the level of GABA at the GABA (A) receptors and have anticonvulsant, antidepressant and anxiolytic effects, as well as sex and alcohol-related behavior. 5alpha-dihydrocortisol from intraocular fluid is synthesized in the lenses, and itself can participate in the production of intraocular fluid.Allopregnanolone and DHDOC are neurosteroids, and the latter can affect the susceptibility of animals to epilepsy. 5alpha-dihydroaldosterone is a potent antidiuretic, although different from aldosterone. Its formation in the kidneys is enhanced by restricting dietary salt, which suggests that sodium can be stored as follows:

 Substrate + NADPH + H + → 5alpha-substrate + NADP + 

5alpha-BPH is one of the main hormones in the bloodstream in women with normal cycles and in pregnant women.When 5-alpha reductase is inhibited, Finasteride prevents the formation of testosterone in DHT by the type II isoenzyme, which leads to a decrease in serum DHT levels by about 65-70%, and to an increase in DHT levels in the prostate to 85-90%, where it is dominated expression of type II isoenzyme. Unlike dual inhibitors of both 5alpha-reductase isoenzymes, which can reduce DHT levels throughout the body by more than 99%, Finasteride is not able to completely suppress DHT production, since it cannot significantly inhibit the type I isoenzyme 5alpha-reductase due to its 100 times lower affinity for I in comparison with II.In addition to blocking the type II isoenzyme, Finasteride competitively inhibits the type II isoenzyme 5beta-reductase, but this is not believed to affect androgen metabolism.
By blocking the production of DHT, Finasteride reduces the activity of androgens in the scalp. In the prostate gland, inhibition of 5alpha-reductase reduces the volume of the prostate gland, reducing the development of benign prostatic hyperplasia (BPH) and the risk of prostate cancer. Inhibition of 5alpha-reductase also reduces epididymal weight, reduces motility, and alters the normal placement of sperm in the epididymis.Cause of mood-related and sexual side effects
DHT and neuroactive steroids (NAS) such as allopregnanolone (ALLO) and tetrahydrodeoxyorticosterone (THDOC) are potent positive allosteric modulators of the GABA receptor (acting on the same sites as euphoric and anxiolytic drugs such as benzodiazepines ), and are important endogenous neuroregulators with powerful antidepressant and anxiolytic effects, as well as playing a positive role in sexual functioning.Their biosynthesis depends on both isoforms of 5alpha-reductase. Finasteride reduces their formation in the body. This effect of Finasteride is the likely cause of the emotional and sexual side effects associated with the drug. In addition, since it involves not only DHT but also NAS, it could potentially also explain the fact that the effects associated with mood and anxiety are observed not only in men, but also in women.

Forms of issue

Trade names include Propecia and Proscar, which are used first to treat male pattern baldness and secondly to treat benign prostatic hyperplasia (BPH), both of which are Merck & Co. products.Propecia contains 1 mg Finasteride and Proscar 5 mg. Merck’s patent for Finasteride for BPH expired on June 19, 2006. Merck has received a separate patent for the use of Finasteride for the treatment of male pattern baldness. This patent expires in November 2013.
Studies have shown that the dose of Finasteride required to treat male pattern baldness is less than 1 mg. Petitions have been filed with the FDA to revise the approved dosages in light of the statistics and possible long-term risks.However, the FDA said that there are results from a study where, at a dose of 1 mg versus 0.2 mg, an increase in the effect was shown without additional risks. The same study also concluded that doses of 0.01 mg per day were ineffective in treating hair loss.
Finasteride is a lipophilic substance. Recently, the development of the topical Finasteride liposomal system has begun. Topical formulas may have some effect on reversing androgenic effects on hair follicles as well as hirsutism.More recent studies have looked at topical microemulsions and liquid crystal nanoparticles of Finasteride. In the latter case, the addition of glycerin, propylene glycol and polyethylene glycol 400 increased the penetration of Finasteride, while the addition of oleic acid reduced this penetration. Topical finasteride in combination with minoxidil is more effective than minoxidil alone. In small studies, topical finasteride in combination with other drugs has also been found to be effective.Surfactants can promote local penetration of the drug. Finasteride in the form of a gel for topical application has also shown its effectiveness.

History

In 1974, Julianne Imperato-McGinley of Cornell Medical College in New York attended a conference on birth defects. She reported a group of children, boys and girls in the Caribbean, with undetermined gender at birth, and originally raised as girls. However, with age these girls developed external male reproductive organs and, after the onset of puberty, other characteristic male characteristics appeared.The research team found that these children shared a common genetic mutation that resulted in a deficiency of the enzyme 5-alpha reductase and the male hormone dihydrotestosterone (DHT), which was found to be etiologically responsible for the developmental disorders of the male genital organs. After maturation, these people showed a smaller prostate size, an underdeveloped prostate, and no male pattern baldness.
In 1975, copies of the Imperato-McGinley presentation were spotted by P. Roy Vagelos, who was in charge of basic research at Merck at the time.The scientist was interested in the fact that a decrease in DHT levels leads to a shrinkage of the prostate. Dr. Vagelos set about creating a drug that could mimic the condition seen in these children to treat older men suffering from benign prostatic hyperplasia.
In 1992, Finasteride (5 mg) was approved by the US FDA for the treatment of benign prostatic hyperplasia (BPH), and is marketed by Merck under the brand name Proscar.
In 1997, Merck was able to obtain FDA approval for a second indication for Finasteride (1 mg) for the treatment of male pattern baldness, marketed under the brand name Propecia.

Stock:

Finasteride is a drug used to treat benign prostatic hyperplasia (BPH). A competitive and specific inhibitor of type II 5-alpha reductase – an intracellular enzyme that converts testosterone into a more active androgen – dihydrotestosterone (DHT). It is a synthetic 4-azasteroid compound. Effectively reduces the level of DHT both in the blood and in the tissue of the gland. Dispensed from pharmacies with a doctor’s prescription.

Notes

So far, no positive clinical effect of treatment with finasteride in patients diagnosed with prostate cancer has been shown.Before starting the drug and during treatment, it is recommended to conduct research in order to exclude prostate cancer. This is due to the fact that finasteride causes a decrease in the concentration of prostate specific antigen (PSA) in the serum of patients by approximately 50% and can mask the actual increased concentration of this antigen. The drug has no significant effect on the ratio of free PSA to total PSA. In patients taking finasteride for 6 months or more, PSA values ​​should be doubled compared to normal values ​​in untreated individuals.

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Finasteride treatment for alopecia – side effects

Do a quick Google search and you will quickly find terrible reviews from people who have used it as a hair loss remedy and have had terrible side effects – some irreversible.At the same time, numerous trials and studies have shown that it is very safe to take these drugs. So what is the truth about finasteride side effects?

What is finasteride?

Finasteride is a drug prescribed by doctors for the treatment of male pattern baldness (and benign prostatic hyperplasia, but we will not talk about it here).

It works by inhibiting the enzyme 5-alpha reductase, preventing the conversion of testosterone to dihydrotestosterone (DHT).DHT is thought to be the hormone responsible for androgenic alopecia (male pattern baldness). It binds to hormone receptors in hair follicles, causing them to contract and eventually stop producing hair.

Finasteride and hair loss

So, to put it simply, finasteride reduces the level of the hormone responsible for hair loss.

If you have already considered hair loss remedies, you may have heard that they are called differently: “Propecia” or “Proscar”.

Propecia is the brand name for tablets containing 1 mg of finasteride. This dose is taken as a daily pill to prevent hair loss.

Finasteride is also available in 5 mg tablets (trade name Proscar). This dose is prescribed for the treatment of benign prostatic hyperplasia, although people with hair loss can often buy it off-label and split the pill into multiple doses, which will reduce the cost of a single dose.

Taking 1 mg of finasteride per day reduces DHT levels in the scalp by about 70%. This is enough to stop, slow down and even reverse hair loss for most patients.

This treatment has been approved by the FDA and has been proven effective in numerous studies as an effective treatment for hair loss.

Finasteride – side effects

Finasteride has been proven to be a very effective remedy for hair loss. But like almost any medication, it can cause side effects.

Side effects listed by Merck, manufacturer of Propecia, include:

• Impotence
• Lack of interest in sex
• Difficulty reaching orgasm
• Abnormal ejaculation
• Swelling or tenderness in the chest
• Dizziness

The most common and controversial of these side effects are those related to sexual function.

So, in addition to reducing the level of DHT in the scalp, finasteride also reduces the level of DHT in the blood serum by about 70%. But the hormone DHT doesn’t just cause hair loss in men.

Dihydrotestosterone is an important male sex hormone, about 5 times more potent than testosterone. For example, during embryogenesis, it plays an essential role in the formation of male reproductive organs. On rare occasions, some men are born with congenital 5-alpha reductase deficiency (and therefore no dihydrotestosterone), resulting in pseudohermaphroditism.

It is easy to see how finasteride, by lowering DHT, can cause problems with sexual function in men.

In reviews of finasteride, many report side effects in sexual life, some of which persist even after stopping the drug. This may lead us to think that the incidence of side effects from finasteride is very high.

In the original study of finasteride, these side effects were found in only 2% of patients.

However, recent research has questioned the validity of this claim.Of the 34 clinical trials, none were found to have adequate safety reports. Among the most shocking discoveries about these studies were the following:

• 53% disclosed a conflict of interest
• 56% received financing from the manufacturer
• 76% had a drug safety assessment less than 1 year

If true, the incidence of sexual side effects from finasteride (Propecia and Proscar) could be much higher than the 2% originally reported.

If you spend enough time on the topic forums, you are likely to be intimidated by the idea of ​​taking finasteride to combat hair loss. After all, you shouldn’t lose your sexual function just to keep your hair.

However, it is important to remain objective when evaluating the pros and cons of finasteride as a hair loss treatment. Yes, there are legitimate concerns, but these unofficial online reports are not the most reliable evidence.

On the one hand, the people who are most likely to share their experiences with finasteride will be those who have had a negative reaction to it. If you’ve experienced dire side effects, you’re more likely to shout about it on the Internet than if everything went well. This can distort the perception of how dangerous it is.

The more people read about the scary side effects of finasteride, the more they will worry about taking it and the more likely they are to suffer from side effects.Placebo is a powerful drug. Many reports will indeed be genuine, but these reports need to be viewed in context.

This test, for example, showed that:

“Our results confirm that sexual side effects are actually much less common than reported in clinical trials. Sexual function of all patients remained stable during treatment with a 1 mg dose of finasteride. ”

And this trial, in particular, provides useful information on the potential sexual side effects of finasteride.Sleep-related erections were assessed using complex polysomnography to determine if finasteride had any effect. It’s hard to blame the placebo effect for these results since the subjects were asleep! Research found:

“Thus, finasteride did not consistently suppress sleep-related erections compared to placebo, finasteride primarily inhibits type 2 alpha reductase activity; however, type 1 alpha reductase is the main enzyme in the central nervous system.Consequently, the participation of DHT in maintaining libido and potency is not excluded. ”

Regarding the aforementioned study, which found the safety tests of finasteride to be flawed, it can be said to have a conflict of interest as well: it was funded by the Post-Finaride Syndrome Foundation.

Can finasteride be taken as a remedy for hair loss?

Finasteride is one of the most effective hair loss treatments currently available.It is effective in preventing further hair loss and, in some cases, can effectively help hair regrow:

Hair improvement after 12 months on Propecia:

But the risks are real. People suffer from side effects when taking finasteride. Medicines affect different people differently. However, taking finasteride is probably not as dangerous as some people think.

Propecia was approved for hair loss in 1997, so it’s been a long time since.This drug has been tested and proven to be safe. Its effectiveness has also been proven.

However, this is far from ideal. A decrease in systemic levels of DHT, the main male hormone, is not ideal. But in general, you should at least try to use this group of drugs if you are very worried about hair loss.

Be objective, try a course of several weeks (after consulting your doctor) and stop taking finasteride if you experience any side effects.

Hair Loss Treatment | anacosmo.ua

You’ve all seen ads in the back of men’s magazines, you’ve heard advertisements on the radio, and you’ve seen commercials about the effects of miracle drugs. The bottom line is that the vast majority of advertised products, as mentioned above, do not “cure”, but only temporarily stop or slow down the process of hair loss, but at the same time they can be used as supportive therapy. As a rule of thumb, if your hair loss treatment, as well as other drugs, is not approved by the FDA (Food and Drug Administration) or not recommended by the American Hair Loss Association, you are most likely wasting your precious time and money.Remember that successful hair loss treatment depends a lot on early intervention. It is very important to start treatment with an effective product as soon as you notice the onset of hair loss.

Effectiveness in the treatment of hair loss has been clinically proven in two drugs – Finasteride and Minoxidil

Finasteride (Proscara / Propecia)

Finasteride is the pharmacological name for the brand of drugs Proscar and Propecia. Finasteride was developed by Merck as a drug for the treatment of an enlarged prostate gland (Proscara).In trials on people with prostate problems, it was intriguing that increased hair growth was a side effect. Since Finasteride has already been approved by the FDA for the treatment of enlarged prostate in men, Merck & Company decided to continue researching Finasteride as a treatment for male pattern baldness.

On December 22, 1997, the FDA approved 1 mg Finasteride for the treatment of male androgenetic alopecia (male pattern baldness). Propecia is the first drug in history to effectively treat hair loss in the vast majority of cases.

How Finasteride (Proscara / Propecia) Works:

Finasteride has been successful because of its ability to specifically inhibit 5-alpha reductace, an enzyme that converts testosterone into the more active androgen dihydrotestosterone (DHT). Finasteride 1 mg can effectively reduce DHT levels by as much as 60% when taken daily. DHT shrinks and thinns the hair follicle, which ultimately leads to its weakening and, as a result, to baldness. A 60% reduction in DHT was sufficient to stop the progression of hair loss in 86% of men who took the drug during clinical trials.65% of the study participants experienced a significant increase in hair growth.

Currently, the only truly effective medically proven way to stop hair loss is to lower DHT levels. The American Hair Loss Association recommends finasteride as a drug for anyone interested in treating male pattern baldness.

Minoxidil (Loniten)

Minoxidil (Loniten) was the first drug approved by the FDA for the treatment of male pattern baldness.Over the years, Minoxidil tablets have been widely used to treat high blood pressure. Just like finasteride, researchers found a very interesting side effect of the drug – people grew hair in the most unexpected places: cheeks, fingers, and some even grew hair on their foreheads.

Several studies have shown that when applied topically directly to the scalp, hair can grow on balding areas. This worked to varying degrees, depending on the intensity of the process.For its time, this treatment was revolutionary.

While Minoxidil has been clinically proven to work, experts view it as a drug with little efficacy in combating hair loss. The positive is that Minoxidil does not have any effect on the hormonal background, but still the results are temporary at best and usually, after stopping the drug, over time, everything returns to normal.

With that said, the American Hair Loss Association still recommends the drug for those who have not responded to Finasteride treatment or for those who would like to add another product to their treatment.The AABB does not recommend Minoxidil as a first aid treatment for men with male pattern baldness.

Author

Oksana Fedoryachenko , dermatologist-trichologist of ANA-COSMO clinic.

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