Can Finasteride Cause Sexual Dysfunction?

Can Finasteride Cause Sexual Dysfunction?

Table of Contents

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I. Common Finasteride Side Effects

II. Why Does Finasteride Cause Sexual Dysfunction?

III. What Are the Serious Side Effects of Finasteride?

IV. How to Reduce Side Effects of Finasteride

V. Conclusion

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If you've been looking for an effective treatment for male pattern baldness, you've likely come across finasteride. This FDA-approved medication has been shown to be highly effective for regrowing hair and slowing further hair loss when taken daily.

However, as with most medications, finasteride can cause side effects in some men. The most common side effects are related to sexual function, including erectile dysfunction and reduced libido.

In this article, we'll take an in-depth look at the possible side effects of finasteride, focusing specifically on why sexual side effects like erectile dysfunction and loss of libido can occur. We'll also discuss steps you can take to reduce your risk if you decide finasteride is right for you. 

Common Finasteride Side Effects

As with most medications, finasteride therapy can sometimes come with a few unwanted side effects. In clinical trials, a small percentage of men experienced side effects, with the following being most common in order of occurrence:

• Erectile dysfunction
• Ejaculation disorder
• Decreased libido ¹

In the studies, these sexual side effects tended to occur early in treatment. However, they went away on their own as participants continued taking finasteride. Additionally, they resolved rapidly when participants stopped the medication. ¹

It's important to note that not every man experiences sexual side effects with finasteride. ¹ But if you do, and they persist or become bothersome, talk to your doctor. They can adjust your dosage or add other therapies to help manage troublesome side effects. 

Why Does Finasteride Cause Sexual Dysfunction?

Finasteride works by blocking an enzyme called Type II 5α-reductase, which is responsible for converting testosterone into dihydrotestosterone (DHT). ² While testosterone and DHT are both male sex hormones, DHT is much more potent. Many of testosterone's effects on the body only occur after it is converted into DHT. ³

DHT is the primary culprit behind male pattern baldness. By inhibiting 5α-reductase, finasteride can reduce DHT levels by 65% in just 24 hours after taking a dose. ² While this makes finasteride very effective for treating hair loss, it also reduces the total level of male sex hormones in the body (read Should Women Take Finasteride). This can lead to sexual side effects like erectile dysfunction, ejaculation problems, and decreased libido. ⁴ 

However, these side effects do not happen to all men who take finasteride. In clinical trials of 945 men, only 36 reported one or more of these side effects compared to 20 men taking a placebo. ² Researchers are working to determine who may be at higher risk. ¹

What Are the Serious Side Effects of Finasteride?

The most significant risks associated with finasteride include an increased risk of high-grade prostate cancer and birth defects if used during pregnancy.

• High-grade prostate cancer: Grades describe how cancer cells appear compared to healthy cells, with higher grades signaling more aggressive cancers. Studies reveal that while finasteride lowers occurrences of low-grade prostate cancer, it conversely raises incidences of the high-grade version. Researchers speculate this happens because finasteride shrinks the prostate, enabling easier detection of any existing aggressive cancers. Since finasteride works by inhibiting the hormone testosterone, which regulates prostate size, reducing testosterone leads to prostate shrinkage. However, since researchers are still working to find the exact reason behind this link, the FDA has issued a warning that finasteride may increase the risk of high-grade prostate cancer. ⁵

• Birth defects in male fetuses: Finasteride could cause birth defects if taken during pregnancy. It is not FDA-approved for women and is typically avoided in women of childbearing age. ² However, some doctors prescribe finasteride off-label to treat female pattern baldness. But experts strongly advise against this for women who may conceive, given the chance of birth defects in male fetuses. ⁶

How to Reduce Side Effects of Finasteride

If you're feeling a little anxious about potential side effects from taking finasteride, there are some steps you can take to help lower your risk.

• Opt for a lower finasteride dose: Studies indicate that a 1mg dosage of finasteride is effective in treating male pattern baldness and may be associated with fewer side effects compared to a 5mg dosage.

• Make healthy lifestyle changes: Unhealthy habits like smoking, poor diet, and lack of exercise can negatively impact sexual function. By avoiding bad habits and adopting better self-care routines, you’ll feel better overall and may experience fewer sexual side effects.

• Talk to a therapist: Speaking with a professional counselor can help reduce stress and anxiety, improve your self-confidence, and enhance your sex life. Therapy is a great way to get support in dealing with changes in libido or sexual function. ⁷

• Avoid the nocebo effect: Nocebo refers to side effects that occur due to the expectation of side effects, not because of the actual medication. Studies show that informing patients about potential finasteride side effects can actually cause those side effects to manifest, even if they are not pharmacologically linked. While you shouldn't ignore any serious symptoms, going into treatment with a positive and open mind can help prevent anxiety and negative expectations that lead to the nocebo effect. ¹

Conclusion

Finasteride can be an effective hair loss treatment when used properly under a doctor's care. While a small percentage of men in clinical trials did experience sexual side effects like erectile dysfunction and lowered libido, the exact causes are still being researched. Experts believe it may be related to decreased androgens or psychological factors like the nocebo effect.

If you're considering finasteride, go into treatment with an open mind and positive attitude. Try to minimize anxiety about potential side effects that you may have heard about. Stay in close contact with your doctor and report any issues right away. There may be lifestyle changes or additional treatments that can help manage symptoms.