Category: Drugs

I’ve been using Propecia for about 3 months now and my testicles are extremely soft and sensitive. Should I continue using it? Will this condition worsen to where I may become impotent?

Although testicular pain and tenderness are sometimes reported by patients who are on Propecia (finasteride 1mg), the rate of this side effect is the same as those on the placebo. Impotence is not one of the documented side effects of this medication and I would doubt any permanent side effect like this would occur from taking Propecia. My advice to you is to stop Propecia for a few weeks and see if the pain goes away. You may also cut the dose of medication to half a pill each day (after stopping it for a week or so to see if the symptoms go away). Some of our patients had good results by cutting the dose of medication. If you continue to experience the pain, stop Propecia and discuss it with your doctor.

“There are three general potential threats with Propecia: decreased libido or sex drive, erectile dysfunction and ejaculation disorders. Clinical tests showed that 1.8% of all men treated with Propecia experienced decreased libido, 1.2% – erectile dysfunction and 0.8% – decreased volume of ejaculated sperm.

Interesting to note that after 5 years of Propecia treatment, the above mentioned side effects disappear and only 0.3% of all patients still have them.”

Quote from site.

I am facing a decrease in libido during my first 3 days of propecia. What should i do, should i carry on taking it? it seems that the side effect dissapear, or should i stop it.

Stay the course for a month or so and see if the problem goes away. If not, I generally advise my patients to stop the drug for a week (everything should be back to normal) and then try taking a half a pill a day and see if that makes a difference. I would see the doctor who prescribed the Propecia to you and alert him/her of these problems.

Dr Rassman:
I started using Monixidil 5% two times a day combined with Nizoral shampoo 3xweek about two and a half months ago. I also added Propecia to my thinning hair treatment about a month ago. I started experiencing shedding about a month and a half ago and still I am shedding; my dermatolgist did not see anything wrong with my scalp by the time she Rx propecia. Is shedding normal under treatment for this long? The Monoxidil has irritaded my scalp which also seems to be part of treatment but I decided to take a 10 day brake which ends today (11/18/06) so I started using it again. The irritation has ended…so far and the Nizoral definetly helps.

I started the treatment as prevention, I am 43 and thinning but now I am questioning my decision because of the excessive shedding.
May you please offer some advice? When should I expect improvement on the shedding? Are those follicles still intact? My biggest fear is that I have caused more damage than good. Thanks for your help.

Shedding is occasionally reported when starting minoxidil or Propecia (finasteride 1mg). You must wait out the period until the shedding stops (about 3-4 months). This appears to be an acceleration of the hair cycle before the better growth kicks in. Your reaction to minoxidil indicates that you may not be able to take it. Some people get considerable irritation from it.

For some time now, some studies show a possible link between finasteride and depression. A recent article, titled “Finasteride induced depression: a prospective study”, discussed this connection and was published in BMC Clinical Pharmacology and appeared online in early October.

Some of the relevant points from the article are:

5alpha-reductase is a critical enzyme in the conversion of several steroids such as testosterone, progesterone, aldosterone and corticosterone in the brain. This enzyme converts testosterone to the most natural potent androgen DHT, and also it acts an important role in conversion of progesterone to dihhydroprogesterone (DHP)…..A decline in serum DHT level occurs after finasteride administration. This may contribute to finasteride induced depression. We [the authors] couldn’t find any significant change in the anxiety scores before and after the treatment

The authors conclude: This preliminary study suggests that finasteride might induce depressive symptoms; therefore this medication should be prescribed cautiously for patients with high risk of depression. It seems that further studies would be necessary to determine behavioral effects of this medication in higher doses and in more susceptible patients.

For the complete article, see BioMed Central.

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In a recent article in Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2006 Dec;55(6):1014-1023), dutasteride and finasteride were compared over a limited 12 week and 24 week study in 500 men in a study which had also compared placebo effects. The authors of the article are Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, Wilson T, Rittmaster RS; for the Dutasteride Alopecia Research Team.

Based upon photographs taken, dutasteride was superior to finasteride in this time frame. Dutasteride blocks both Type one and Type two receptors and the suggestion of the authors was that the combined block of these two receptors may be better than a block of one receptor in reversing the process. Clearly, the study needs to be extended well beyond 24 weeks.

The long term safety of Type 1 clocking for DHT production is safe and there is a natural model both genetically and through eating finasteride, but no comparable model exists for the DHT block of both receptors for safety, as the study above just discusses limited views of efficacy. The FDA’s position is still that dutasteride is not an approved drug for treating hair loss.