Propecia (1mg finasteride) is arguably the most effective medical hair loss treatment currently available. Though not a hair loss cure, countless men have used the drug to effectively slow the progression of balding and regrow hair since its approval for the treatment of androgenic alopecia (male pattern baldness) by the FDA in 1997.
Propecia works by inhibiting the conversion of testosterone to Dihydrotestosterone (DHT). Studies conducted by pharmaceutical manufacturer Merck & Co showed that almost 80% of men using Propecia stopped or even reversed their hair loss to some degree, while fewer than 2% exhibited “Drug-Related Adverse Experiences” or side effects. These side effects were said to be temporary and to subside upon discontinuation of the drug.
However, in the years since Propecia first entered the market as a hair loss treatment, numerous complaints have arisen from men who claim to have suffered severe and irreversible sexual side effects attributed to finasteride use. This has come to be known as “Post Finasteride Syndrome” or “PFS”.
As a result of these complaints, in April of 2012, the FDA mandated labeling changes to finasteride related products. Labeling changes to Propecia include “libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug”. Labeling changes to Proscar include “decreased libido that continued after discontinuation of the drug”. Labeling changes to both Propecia and Proscar include “reports of male infertility and/or poor semen quality that normalized or improved after drug discontinuation”
While a leap forward in terms of transparency and patient education, the list of side effects displayed on these labels is far from comprehensive. In fact, finasteride side effects can be sorted into three categories; sexual, physical and mental. The following is a comprehensive list of known and suspected symptoms:
Sexual Side Effects:
- Decreased or complete loss of libido (sex drive)
- Erectile dysfunction, impotence
- Loss of morning and spontaneous erections
- Sexual anhedonia, loss of pleasurable orgasm
- Decreased semen volume and force
- Penile shrinkage and numbness
- Peyronie’s disease – scar tissue along the length of the penis, causing the penis to bend when erect
- Scrotal shrinkage and numbness
- Gynecomastia – female-like breast development and enlargement
- Chronic fatigue, listlessness
- Muscle atrophy, weakness
- Muscle twitching
- Decreased oil and sebum production
- Chronically dry, thinning of skin
- Melasma – brownish macules and patches that typically affect sun-exposed areas on the face
- Tinnitus (ringing in the ears)
- Increased fat deposition, obesity and elevated body mass index
- Decrease in body temperature
- Reduced HDL cholesterol, raised fasting glucose and triglycerides
Mental Side Effects:
- Severe memory/recall impairment
- Slowed thought processes
- Impaired problem solving, decreased comprehension
- Suicidal ideation
- Emotional flatness and anhedonia
It is important to note that not all experts recognize the existence of PFS. Instead, they contend that these symptoms may be a coincidence and the result of other non-related issues. Furthermore, most men don’t experience any side effects at all.
Be that as it may, prospective users should be aware that a small percentage of men may experience temporary side effects and an even smaller number may find that these side effects persist even after stopping treatment.
If you are taking finasteride and are experiencing any of the aforementioned symptoms, be sure to contact your prescribing physician immediately.
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