Month: January 2023

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Finasteride is a risk in pregnancy with unprotected sex

A man wrote to me about this problem with his baby who developed a problem unique to 5 alpha reductase inhibitors

This is what Merck wrote:

Although the above comments reference 2 studies using a 5?mg dose, Merck (2007) also measured semen levels of finasteride in patients taking a 1?mg dose. The men were treated with 1 mg for 6 weeks. The highest level measured was 1.52 ng/mL, and the mean level was 0.26 ng/mL. Using the highest measured level (1.52 ng/mL), women exposed to a 5?mL ejaculate per day would be exposed to 7.6 ng/d (assuming 100% vaginal absorption). Merck (2007) found this level to be 750 times lower than the “no effect” level for developmental abnormalities in rhesus monkeys.

In summary, a 1?mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

This is what is really the issue:

Mohan et al states which clearly shows that even a small amount of finasteride that comes through the semen, the risk is real:
“Congenital scrotal agenesis is a rare anomaly that, to our knowledge, has only been reported in the literature on four previous occasions.. Scrotal development is initiated in the 7th embryonic week with the formation of labioscrotal folds on either side of the urogenital folds. Foetal testosterone is converted into more potent dihydro-testosterone by the action of the enzyme 5a-reductase type 2 which is expressed in these tissues. The scrotum is then formed as a result of enlargement and midline fusion of the labio-scrotal folds in response to the androgens…
Sinnecker et al. have shown that that 5a-reductase type 2 deficiency can result in a spectrum of phenotypes with varying degrees of virilization spanning from completely female to almost normal male. The phenotypes reported in our cases could be explained by a localised deficiency of 5a-reductase type 2, limited to the labioscrotal folds. This could possibly result in partial virilization of labioscrotal folds where in there is absence of development of normal scrotum but at the same time labioscrotal folds are prevented from developing into the complete female phenotype, i.e. labia majora. Later during topical therapy, the incompletely virilized labio- scrotal folds could have developed into normal scrotal tissue under the influence high concentration of testosterone. This is akin to the development of normal male external genitalia in children with 5a-reductase type 2 deficiency during pubertal testosterone surge.”
This condition is directly linked to 5a-reductase type 2 deficiency. I will get him all of the best medical treatment possible but I don’t believe the guilt will ever leave me. This is still a happy time with a baby but also the most traumatic. Thank you for your offer, I appreciate it. Please publicise these risks as much as possible as well. I look forward to hearing from you more in future.


2020-03-25 07:53:53Finasteride is a risk in pregnancy with unprotected sex

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Finasteride Interactions?

Hi Dr.,

I am a big fan of your site. I get to read your new posts everyday by subscribing to your RSS feeds. My question is, given that I take 1 tablet of 1mg Propecia everyday, will it interact with other supplements or even certain food?

For example, here’s a list of supplements that I take daily (i take throughout the day, separate times):
1. vitamin b complex and biotin
2. vitamin c
3. vitamin e
4. multi vitamin
5. omega complex
6. co-q10
7. methatione (gluthatione)

Or how about foods:
1. coffee
2. green tea w/ honey
3. soy milk
4. fiber (like wheat bread, fruits)

Just wondering if trying to be health by consuming these will counteract w/ Propecia or vice-versa? Hope this is a valid inquiry.

I have been getting these sorts of questions quite frequently lately. The supplements and foods you’re consuming shouldn’t have any negative interaction with Propecia. The only interaction I can think of with food is with grapefruit, which causes problems for a variety of medications.

The following 16 drugs are listed as having a moderate interaction with finasteride (Propecia): bosentan, diltiazem, diltiazem/enalapril, efavirenz, efavirenz/emtricitabine/tenofovir, fluconazole, fluvoxamine, itraconazole, nefazodone, nelfinavir, posaconazole, rifapentine, saquinavir, sirolimus, tacrolimus, and voriconazole. And there’s 1 drug that has a mild interaction: terazosin. These are the generic names, and for a more complete list (including brand names) see Drugs.com.

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Finasteride inhibition curve

This curve shows the value of different doses of finasteride on hair growth. Note that a reduction of dose to half has a small effect on value

 


2020-07-04 12:21:47Finasteride inhibition curve

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Finasteride Induced Depression

Hey doc, I found this interesting study on the web: Finasteride induced depression: a prospective study

and I was wondering if you can comment on whether or not Finasteride can induce depression?

I have heard previous studies that show this risk and report depression in some patients taking finasteride, but no one really knows if it is a direct relationship. This is a difficult assessment, as some of our patients may be depressed at the time they start treating their balding so then it’s a chicken-or-egg scenario, where one is left wondering which came first. Those that are losing their hair might have feelings of depression because of it.The good news is that this problem is rare and this drug is totally elective. Not taking it will just mean risks of progressive balding will become more likely without the drug, but it isn’t a lifesaving medication.

I try to get to know our patients and by getting into their head, I may understand who they are more than many doctors who just write a prescription.

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Finasteride increases hair weight

https://pubmed.ncbi.nlm.nih.gov/16781295/

This article demonstrates that finasteride has more of a beneficial effect on the thickness and length of hair growth than on the number of new hairs


2021-02-01 08:55:38Finasteride increases hair weight

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Finasteride, Increased Sex Drive, Water Semen and Long Term Use

I was wanting to know if you have any information/clinical observations concerning worsening of side effects for patients who continue to take finasteride? I ask this as I am experiencing watery semen. In addition to this, I have an extremely high libido that’s way too high for my own good. In regards to such, I have a very minimal, almost non-existent refractory period after ejaculation. After having sex the first few times around, my erection quality isn’t quite what was pre-finasteride. But this is a side effect that I can very much live with. In your clinic, what observations have you made concerning patients who have manageable side effects? Do they worsen or get better with time? Or is there a general consensus that they stay the same?

Good questions. When the water semen occurs it seems to stay until you sop the finasteride. Some people report it takes 3 months before the water semen goes away. I have seen an increased sex drive from some of my patients, even my own son experienced it. He loved that side ffect.

Most people find either (1) they get accustomed to the finasteride and the side effects eventually reverse, or (2) the side effects continue or even get worse. For those who have a reduced sexual drive or ED, some doctors, including me, feel that the longer the ED on the drug, the more likely that the irreversible PFS becomes a problem (although still a very small number of people fall into this category). For doctors like me who tell the patients with significant ED that can’t mange it on the drug, I tell my patient to stop taking finasteride. As a result, of the thousands of finasteride men I have given the drug to, I have never seen a case of PFS in my practice as many of my colleagues who have similar approaches to such problems.


2020-05-04 12:46:01Finasteride, Increased Sex Drive, Water Semen and Long Term Use

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Finasteride increased my sex drive and now it is out-of-control

On a proscar 5mg split into 4 from Walmart pharmacy. This latest drug has got me horny as fuck. Not sure why, but I’m always thinking about sex and my pecker is pointed straight up most of the time. WTF. Can some of y’all pass on your ED pls

I have had this complaint from some of my patients, including one of my sons. He just learned to have more sex.


2020-11-04 08:19:37Finasteride increased my sex drive and now it is out-of-control

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Finasteride impacting beard growth

Here to ask a question I’ve never seen asked, or at least never answered on this subreddit or anywhere else on the internet despite my effortful and differently-worded google searches.

I’m 20. I started balding at 14, and I started fin at 17. Switched to dut at 19. Now I’m 20, and I still don’t have beard growth despite having the genetics for insanely aggressive baldness and insane beard density. This makes total sense because I’m taking a DHT blocker but my question is- will I never be able to grow a beard if I continue with my DHT blocking regimen? Am I blocking myself from ever being able to grow a beard, or am I just blocking it for the time being while I’m taking the DHT blockers? The idea of never being able to grow a beard terrifies me and I think I’d rather go bald and have a beard than never ever have facial hair as an option, but if I can wait until I’m 25-30 and then grow a beard after ceasing dut/fin, I’d rather do that. Thanks for any and all responses this gets.

Dr. Robert Bernstein answered this question as follows:
As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any effect on facial hair. The reason is not clear.
It is interesting to note that testosterone stimulates growth of axillary and pubic hair, but not scalp hair. Scalp hair growth is not androgen dependent, only scalp hair loss is.
DHT stimulates terminal hair growth of the beard, trunk and limbs, external ears and nostrils. Of course, it also is responsible for the bitemporal reshaping of hairline as one passes into adulthood and causes male patterned baldness (androgenetic alopecia).


2021-04-25 11:04:46Finasteride impacting beard growth