We report on three cases of young men recruited at our Centre for Male Infertility who had used finasteride for five years. Semen quality was investigated by light microscopy to evaluate sperm concentration and motility. Sperm morphology was performed by transmission electron microscope TEM and the data were analyzed. The presence of Y microdeletions was investigated by PCR. Meiotic segregation was explored by fluorescence in situ hybridization FISH.
The newer application has resulted in greater use of the drug, albeit in Finasheride doses, by reproductive-age men. The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem. TEM analysis revealed altered sperm Finasteride sperm transmition consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies. Although these findings are in contrast to the first study that concluded that finasteride has no effect on spermatogenesis, the dose of finasteride used in this study was 5mg five times more that the dose used in male pattern baldness. Of 4, men seen at the clinic, Finasteirde 0. A number of Finasteride sperm transmition have looked at the problem transmitioj side effects caused by finasteride. Is the source of information credible?
Magic lube. INTRODUCTION
There is medicine out there from which you can almost die as a side Hairy cheeks. Effect of 1-mg dose of finasteride on spermatogenesis and pregnancy. J Clin Endocrinol Metab Not looking to have kids any sprem soon, but it is not clear to me whether this effect is Finasteride sperm transmition or not. Case reports have suggested that sperm counts improve within 3 months after discontinuing finasteride, they added. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Castor oil therapy for fertility uses the application of a castor oil pack over the uterus to improve blood flow and decrease congestion and inflammation. Finasterude palmetto extract is used to treat hyperplasia of the prostate gland because it inhibits the action of testosterone on the prostatic tissue. This article is a collaboration Beach babe background MedPage Today and:. Of course, this is just my opinion. Answer: Hi Dave, There are many causes that can affect sperm cell morphology: Toxicity Lack of specific nutrients Electromagnetic Damage It is hard to say if taking Finasteride has permanently affected your fertility.
Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
- This sheet talks about exposure to finasteride in a pregnancy and while breastfeeding.
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- It has been approved for treatment of benign prostatic hyperplasia and male pattern baldness, resulting in widespread use in men in reproductive age.
Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
This article critically examines the evidence available and makes recommendations as to how a physician should counsel a patient while prescribing the drug. Some of the commonly faced questions by a physician while treating a patient of pattern hairloss are about the possible sexual side effects caused by finasteride.
Reports in the press, internet sites, and misinformation by practitioners of alternative medicine, all have contributed to this image of the drug, and has lead to apprehension in the minds of patients. Often even dermatologists seem to hesitate to prescribe the drug on a long term basis. This article examines this subject in the light of evidence available. Pattern hair loss in males is androgenic in etiology.
Antiandrogens such as finasteride are therefore useful in the management of the condition. Androgens, especially testosterone increases the libido. Any drug which interferes with the action of androgens is therefore assumed, by the lay person, to induce impotence.
However, the precise role of androgen in penile erection needs to be fully elucidated. In addition to androgens, visual, olfactory, tactile, auditory, and imaginative stimuli influence the libido. The penile erection is mainly under the control of parasympathetic nervous system.
Ejaculation and detumescence require an intact sympathetic system. The androgens testosterone and dihydrotestosterone DHT have somewhat different actions.
It exists in two isoenzyme forms. While type I is predominant in liver, type II is predominant in prostate, seminal vesicles, epididymes, hair follicles, and liver. Type I 5AR, is present in the sebaceous gland, while type II 5AR is found on the outer root sheath of the hair follicles and dermal papillae. At all these sites, the testosterone is converted to DHT. Finasteride is a specific and competitive inhibitor of Type II 5—AR, and has therefore a selective action on hair follicles.
This explains why relatively small dose of finasteride may be adequate therapeutically. The bioavailability of finasteride is not related to food intake.
Finasteride is extensively metabolized in liver by Cytochrome P 3A4 enzyme subfamily and excreted both in urine and feces. The terminal half-life is approximately hours in men between years of age and 8 hours in men more than 70 years of age.
A number of studies have looked at the problem of side effects caused by finasteride. These effects occurred early in the therapy and returned to normal on stopping or over a time on continuous use of the drug. The only causal relation between finasteride and sexual adverse effects is decreased ejaculatory volume because of predominant action of DHT on prostate.
A comprehensive review of a total of 73 papers on medical therapies for BPH was conducted, with a focus on the effects of different pharmacological agents on sexual function. The role of nocebo effect in the causation of ED due to finasteride has been investigated.
In this study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED, when compared to the group without information. Two studies in and showed that the incidence of these side effects with finasteride therapy was generally comparable to that observed with the treatment with placebo,[ 8 , 9 ] and there was no evidence of dose dependency or increased incidence with longer therapy out to 12 months.
In addition, the side effects ceased in patients even when they continued to receive finasteride. The incidence of side effects were comparable to that of placebo both at one year and at 5 years. A large prospective study in as many as 17, patients was conducted to look into the effects of finasteride and other covariates on sexual dysfunction as part of the analysis of The Prostate Cancer Prevention Trial PCPT. Finasteride increased sexual dysfunction only slightly even at 5 mg dosage which is much higher than the 1 mg administered in pattern hair loss and its impact diminished over time.
The authors concluded that the effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride. A recent review of the available literature too arrived at similar conclusions. However, there are more recent studies, which seem to have documented contrary findings.
The study revealed that the subjects reported new-onset persistent sexual dysfunction low libido, ED, and problems with orgasm associated with the use of finasteride. The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date. However, there were many limitations in the study, such as small number of patients, selection bias, recall bias for before finasteride data, and no serum hormone analysis.
The study recommended that physicians treating male pattern hair loss MPHL should discuss the potential risk levels with patients while prescribing the drug. An important earlier study by Mella et al ,[ 14 ] conducted a systematic review of twelve randomized trials evaluated the efficacy and safety of finasteride therapy in male patients.
Moderate-quality evidence was found for an increase in erectile dysfunction RR, 2. A number of isolated case reports have also been published on the effect of low dose finasteride on DNA changes in sperms,[ 15 ] on motility, and sperm counts.
Significantly, these parameters improved after stopping the drug. Another small study[ 17 ] reported three cases of young men, who had used finasteride for five years, investigated for male Infertility. Semen quality was investigated by light microscopy to evaluate sperm concentration and motility, sperm morphology by transmission electron microscope TEM , presence of Y microdeletions by PCR, and meiotic segregationby fluorescence in situ hybridization FISH.
TEM analysis revealed altered sperm morphology consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies. One year after the men had stopped the use of finasteride without receiving any other treatment, a recovery of spermatogenetic process was observed. Motility and morphology improved whereas the meiotic pattern did not change. Traish[ 18 ] conducted a review of different published studies and concluded that altered sexual functions such as erectile dysfunction and diminished libido are reported by a subset of men receiving finasteride, raising the possibility of a causal relationship.
The review suggested discussion with patients on the potential sexual side effects and possible alternate treatments before administration of the drug. The taskforce posted their initial update on the subject as follows:. Reports of persistent sexual side effects have come from a variety of sources with some internet sites attracting individuals claiming to have sexual and psychological issues related to finasteride.
While continued difficulty having erections after discontinuing finasteride has been reported in post-marketing surveillance the incidence of this problem remains unknown. Also, little data is available concerning the medical and psychological work-up of these patients to exclude other potential causative factors. At the present time, the mechanism of interaction between the brain, 5 alpha-reductase metabolism, and hormones on sexual dysfunction is speculative and poorly understood.
Clearly, this is a complicated issue, which overlaps with other disciplines in medicine such as Endocrinology, Urology, and Psychiatry. More research is needed to assess the actual incidence of side effects, to determine if there is a true causal relationship for persistent side effects and if so, to identify who may be at risk.
We hope to participate in a multidisciplinary forum to further evaluate this topic. Millions of patients have benefitted from finasteride with no side effects at all, or minimal and reversible side effects. It is important for the medical community to verify anecdotal reports and if necessary, conduct further studies so that accurate information may be given to our patients to enable them to make informed choices regarding the use of this medication. Thus, the evidence available about the safety of the drug can be considered as questionable, but cannot certainly be ignored.
The matter needs further systematic investigation and documentation. However, there is no doubt that to the lay man the prospect of impotence while taking a drug for hairloss is daunting, however theoretical and small the risk may be. The drug brochures mention the possibility of the side effect and the patient is often unable to distinguish between the effects of 1 mg and 5 mg.
Several websites give a rather unfavorable opinion about the side effects, contrary to the evidence presented above. Several blogs also discuss the side effects, and individual and anecdotal experiences are highlighted and often exaggerated. Any patient who reads such reviews is understandably apprehensive, and therefore may stop therapy with in a few weeks of starting or, in other instances, do not start the treatment at all.
Losing potency for gaining hair is not an attractive proposition, however remote that possibility is! In view of this, it is very important to properly counsel patients about the treatment. In particular, the following facts need to be stressed:. The drug is probably the best available to treat androgenetic alopecia and the only one to address the root of the problem.
Several studies have shown its safety over long duration of administration. The dosage given 1 mg is small and unlikely to cause side effects. Even in those cases where side effects were reported, the changes were found to be reversible. There are very few effective alternatives to the drug and it is therefore important for the patient not to stop the drug unless he experiences any side effects. The patient should contact the doctor for any advice, should he experience a side effect.
Most importantly, the intake of the drug is totally voluntary, as male pattern hair loss is only a cosmetic condition and it is entirely up to the patient to take or not take the drug. The treating physician should provide full information about the drug to enable the patient to make an informed decision. It is better to avoid the drug for any patient who has prior history of oligospermia, infertility, particularly if he is newly married and is trying to raise a family. In addition, the author also feels that in patients who are apprehensive about the side effects, it is worthwhile considering administration of lower daily doses or staggered pulse doses of the drug, to enhance patient compliance.
As discussed earlier, there is sound rationale for such regimens. Plasma half life of finasteride is hours and tissue binding is days. While 0. Efficacy has been demonstrated for all end points for finasteride at doses of 0. The value of such a regimen was shown in a preliminary study. Source of Support: Nil.
Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian Dermatol Online J. Venkataram Mysore.
Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects.
They excluded men who had obstructive azoospermia or primary testicular failure. Upgrade coming: Click Here. Support Center Support Center. Int J Clin Pharm 40 4 : Thats why we really need to see info on 1 year or 2 year follow ups. You must log in or sign up to post here.
Finasteride sperm transmition. ACKNOWLEDGEMENT
Men using finasteride to treat baldness had a dramatic increase in sperm count following discontinuation of the drug, according to a review of records at male infertility clinic. Average sperm count increased fourfold and by as much as fold when the men stopped using the low-dose finasteride product, according to Keith Jarvi, MD , of Mount Sinai Hospital and the University of Toronto, and co-authors.
None of the patients had a decrease in sperm count after stopping finasteride. Discontinuation of the drug did not affect hormone parameters, sperm motility, or sperm morphology, they reported online in Fertility and Sterility. Initially approved for treatment of benign prostatic hyperplasia BPH , finasteride has been approved for male-pattern baldness for more than 15 years. The newer application has resulted in greater use of the drug, albeit in lower doses, by reproductive-age men.
A member of the 5-alpha-reductase inhibitor class , finasteride increases the ratio of testosterone to dihydrotestosterone DHT. Though androgens are essential to spermatogenesis, the relative contributions of testosterone and DHT are unknown, the authors noted. Few studies have examined the effects of finasteride on male fertility, and most of those have comprised small patient series. The 5-mg dose of finasteride used to treat BPH has a reversible negative effect on semen parameters. The 1-mg dose has been shown to have no negative effect on healthy men with normal spermatogenesis, but a few case reports have described impaired spermatogenesis, which was reversed after discontinuation of the drug.
To expand the investigation of finasteride and spermatogenesis beyond case reports, Jarvi and colleagues reviewed records of men who underwent fertility evaluations during to They excluded men who had obstructive azoospermia or primary testicular failure.
Laboratory studies included serum testosterone, follicle-stimulating hormone FSH , luteinizing hormone LH , and estradiol. Semen samples were obtained at least 48 hours after the last ejaculation but not more than 7 days afterward.
Of 4, men seen at the clinic, 27 0. The study population had several conditions pertinent to the examination: six had varicoceles, two had seminal infection with Enterococcus , two each had penile warts and an undescended testicle, and one each had Y chromosomal translocation. Three men were excluded because of maturation arrest and congenital epididymal obstruction.
The remaining 24 men had a mean age of 37 range of 26 to 54 , and 20 All 24 men were taking low-dose finasteride for baldness, and treatment duration averaged Reported doses ranged from 1. None of the men had hormonal evaluations before and after discontinuation of finasteride. Nine men with pre-finasteride evaluations had mean values of 7. Post-finasteride values in eight men averaged 7.
The authors found that 14 of the 24 men had semen analyses before and after discontinuation of finasteride, and the time between measurements averaged 6. After stopping finasteride, the men's mean sperm concentration increased Sperm count increased significantly from Sperm count increased across the range of values prior to discontinuation of finasteride, including an Case reports have suggested that sperm counts improve within 3 months after discontinuing finasteride, they added.
This article is a collaboration between MedPage Today and:. Action Points Note that this retrospective study in a small population of men seeking fertility treatment suggested that discontinuation of finasteride significantly increased sperm counts. Be aware that the effect was particularly prevalent among men with oligospermia at presentation.