Day: January 1, 2023

Hi.

I’m 35 and loosing hair. It’s likely that Propecia could be one good solution. However, from what I understand Propecia blocks DHT by limiting the creation of testosterone which is why it can stop balding process.

Now, I am working out seriously 4 times a week and trying to add on muscle. Muscle growth is due to testoterone. My question: how can my work out be still beneficial in terms of muscle growth if the testosterone is lowered because of use of Proprecia.

Thanks for your time.

Propecia does not decrease testosterone. It decreases the byproduct of testosterone known as dihydrotestosterone (DHT). DHT is what is implicated in male pattern hair loss. Taking Propecia increases testosterone by about 15% and benefit (although not proven) muscle building. Propecia can also apparently be used to mask muscle enhancers. You may recall from the recent Olympic games the controversy surrounding Propecia — Olympic Athlete Banned from Competition for Propecia Use.

I am 30 years old and a professional singer. I am beginning to show major thinning of my hair. I have been considering propecia for a while now. My question is could there be any side effects on my voice? Obviously, it is my livelihood and i don’t want to take a risk but then again having a decent head of hair is also important for my profession as well. Any info would be most helpful. Thank you!

I’ve not heard anything from my patients nor have I read anything in the medical literature about finasteride (Propecia) effecting the voice. There’s one young reader that sends me questions through this site from time to time suspecting his speech was altered by Propecia, but I have no way to verify that it was the medication or that it actually occurred.

I would just say that if you tried it and found any such side effects, the impact of the drug is gone in days so just stopping it should do. And just so we’re clear — I believe your voice would not be impacted by this drug.

Can you tell me, When using Propecia (3 months) is it safe to have unpretected sex without dangering female partner?

There is no danger to your partner from finasteride (Propecia) by having unprotected sex while you are taking this drug. Propecia’s manufacturer, Merck, does not warn of problems in this regard.

The question I am often asked is whether unprotected sex and pregnancy could cause problems for a man on Propecia. I believe that the answer to this question is that getting your lady pregnant should not be a problem when on Propecia, but if you are concerned about it, then you might stop taking it during the period when she is most fertile. I’ve written about that previously here and here.

Hi Dr. Rassman,

i am following up on a previous message i sent. I am wondering if you know of anyone who after taking propecia(finasteride) found the following symtoms- tinnitus with an overall feeling of pressure in the head. I only took the drug for two weeks and then stopped after these symtoms appeared. I am still suffering with this six months later. I had these same symtoms five years ago, (but was not taking propecia at the time) which lasted for one year and am wondering if the propecia could have triggered this again as it is used as a blocker, or might it just be a coincidence.

Hope you can answer this for me, thanks!

I do not know what may be the cause of your problem. While many drugs can cause tinnitus, it is relatively rare. More importantly, tinnitus can potentially be a sign of serious medical problems and suggests to me that you have some medical issue which needs to be addressed by an expert in middle ear problems. I personally have not seen any patients in the last 10 years with tinnitus as a side effect of Propecia. I’ve been asked about this once before, a couple of years ago — Propecia Causing Tinnitus?

Ok, I just have to ask. I have been searching around for information regarding pros/cons of starting propecia. I came to a web forum in which several people were discussing the fact that propecia made their penis crooked. I have not read this anywhere in the side effects category listed with Merck. Is this a real possibility?

I highly doubt your penis will grow crooked after taking Propecia (finasteride 1mg). Many men are born with a penis that leans to one side or the other (example, Wikipedia – Chordee). What you read on that web forum just goes to show how the internet can be misleading and you must take all the information available with a grain of salt.

NOTE: The following comes to us from a longtime reader that wishes to remain anonymous. He’s gifted us with some insightful posts in the past about the FDA, LLLT, and clinical trial regulations. His email is as follows:

—

The Journal of Sexual Medicine recently published an article that has been the source of several Balding Blog posts, including one that answered a reader who wondered if, “the study suggests up to 15% of men taking the drug might experience some form of sexual dysfunction” in context of “the warning label on Propecia (that) … only 2 percent of men might experience erectile dysfunction while using the drug…”.

As a fan of the Balding Blog and a clinical trialist (someone who interprets clinical trial data), and one who has no relationship to Merck or financial interest in finasteride use, I have reviewed the article:

• Dr. Rassman has correctly pointed out that this article is not a study per se, but a review of data in the literature from completed and published finasteride studies that included placebo groups.
• The review included 3 studies of men using finasteride (1 mg daily) for alopecia, 15 studies of men using finasteride (mainly 5 mg daily) for benign prostatic hyperplasia, and 2 for “none” listed as the condition.
• The 3 studies of men using finasteride for alopecia included a combined total of 1196 men receiving finasteride, and 1035 men receiving placebo.
• As Dr Rassman has nicely emphasized before, the “true” incidence of an adverse event (attributable to a drug) is the percentage of men who experience a side effect receiving an active drug minus the percentage of men who experience a side effect via placebo. It is important to emphasize that this equation implies no causality (i.e., if a man receiving a drug gets a side effect, it is attributable to his active drug or placebo regardless of other factors – such as diabetes – that may be causally involved).
• The largest incidence of sexual side effects among the 3 studies involving men with androgenic alopecia is from the smallest study involving only 286 men who received finasteride and were a considerably higher age (41-60 years) than men in the 2 other studies (ages 18-40 years). In older men, factors that contribute to sexual side effects (diabetes, coronary artery disease, and aging) are considerably more frequent. In this small study of 286 men, changes in sex drive were observed (over a period of 1 year of treatment and 1-year of follow-up) in 4.9% receiving finasteride and 4.4% receiving placebo (treatment effect of 0.5%). In the same study, erectile dysfunction was observed in 3.8% of men receiving finasteride and 0.7% of men receiving placebo (treatment effect of 3.1%). In the two larger studies – involving younger men – the incidence of erectile dysfunction was 0.5% (1.4 minus 0.9) in one study, and 0.75% (0.75% minus 0) in the other study.
• Taken together, these results are consistent with the incidence of sexual side effects noted in the finasteride (Propecia) US product label: decreased sex drive (1.8% finasteride vs. 1.3% placebo) and erectile dysfunction (1.3% vs. 0.7%).
• The “15%” figure contained in the Balding Blog post by a reader was based in part on the cited (and misleading) newspaper commentary from a business reporter that stated ”…up to 15% of men taking (Propecia) might experience some sort of sexual dysfunction.” Indeed, The Journal of Sexual Medicine article cites a study of 613 men aged 45-80 taking 5 mg finasteride daily for benign prostatic hypertrophy for 2 years. In this study, 15.8% of men receiving finasteride (compared with 6.3% of men receiving placebo) reported erectile dysfunction. This is 5 times the recommended dose for treating hair loss, though. The largest study, involving 2315 men aged 45 years or older (with prostate hypertrophy), showed the next largest effect on erectile dysfunction: 8.1% (finasteride) vs. 3.8% placebo. This latter figure is almost identical to the incidence of erectile dysfunction noted in the finasteride (Proscar) US label.

In summary, one can’t properly mix “apples and oranges” involving clinical trial data involving different doses of drugs with different patient populations and for different indications. The journal article offered no major insights to me but is a nice review of currently published work. To me, a significant issue of side effects is reversibility. Even a minor headache is devastating if due to an active drug and is not reversible.

Despite anecdotes from blogs, I have seen no case histories published in the medical literature of men using finasteride for androgenic alopecia who have developed irreversible erectile dysfunction that has been attributed to use of finasteride. I am not saying that such a phenomenon does not exist; I just have not read any well-documented case history. A newspaper commentary from a business writer that references a blog where a 32-year old man developed erectile dysfunction (“had pretty lousy quality erections otherwise”) of unknown duration 12 years after starting finasteride and who cites “(recent) experiences with a new sexual partner” is not compelling (to me).

is it ok to take propecia with a testosterone booster? and will i still lose my hair like crazy if i already am losing my hair?

Propecia is not 100% capable of undoing the hair loss effects of testosterone. It may have some protective effect against the testosterone (in hair loss), but better just to not take the testosterone and you will not have to protect yourself against something that you are not taking. I hope this is as obvious to you as it is to me.

I have had pain in my testicles after I started Propecia. Is there a relationships?

There have been occasional reports of testicular pain on Propecia (finasteride). I have had thousands of patients using this medication and this has never crossed my path as a patient complaint, but some other doctors in the community have reported this as a suspected rare side effect. One doctor reported that the pain came on with the drug and disappeared when the drug was stopped, suggesting a relationship. It could have been coincidental. Most causes of testicular pain are caused by athletic stresses and for the young men, it may have something to do with puberty.

I would stop Propecia, wait a month and start it up again. If it happens a second time, then assume that this is a side effect of this drug for you.

I saw the post today mentioning the testicular pain when on Propecia. I’ve been on Propecia almost 5 months now. I did have intense testicular pain after about a week or two on the drug. But right when I was about the quit, the pain went away and I haven’t noticed it since. Hope this helps.

I generally tell patients not to overreact to things. This is a good example where a little patience solved the problem. Thanks for sharing it with us.