Men who use finasteride for hair loss symptoms have reported sexual dysfunctions after discontinuing the drug. The researchers wanted to figure out the actual reasons behind these reported symptoms, and whether there was any truth behind these reports. They conducted a study and found no evidence of any androgen deficiency or decrease in cognitive function in individuals taking the drug and reporting sexual dysfunction.
Finasteride is used to treat men with benign prostatic hyperplasia (BPH), a non-cancerous increase of the prostate gland, and androgenetic alopecia, more commonly known as male pattern baldness. Androgenetic alopecia occurs largely due to genetics and the male hormone dihydrotestosterone (DHT). The study was published in JCEM.
The researchers compared the symptoms of finasteride users who complained of having sexual dysfunctions, with finasteride users who did not report of having any sexual dysfunctions, and with individuals who did not use finasteride.
The researchers had included participants aged 18 to 50, and who had used finasteride for 7 days or more but not used it in the past 4 months. Some patients reported the development of symptoms after ingesting just a few doses of finasteride, while others developed sexual symptoms after months or years of finasteride use.
The second group had men aged 18 to 50, who had used finasteride for hair loss but did not show sexual symptoms after discontinuation. The third group consisted of men aged 18 to 50 years, who had never used finasteride nor had any sexual symptoms.
The researchers did not include men over 50 since these sexual symptoms can arise due to age related factors. They also excluded men who reported symptoms of depressions before using finasteride as it would have messed up the results.
Since most of the reported symptoms had to do with the imbalance of testosterone and other sex hormones, the researchers performed a comprehensive assessment of hormone levels using highly specific liquid chromatography tandem mass spectrometry assays, body composition, mood, affect and cognitive function.
This systematic evaluation of men who reported persistent sexual symptoms after discontinuation of finasteride therapy for hair loss found no evidence of androgen deficiency. Genetic expression remained persistent across the groups including serum DHT levels, testosterone to DHT ratios, and circulating markers of tissue testosterone metabolism.
Furthermore, the bio indicators of androgen activity such as hair growth, acne and serum production, hematocrit, prostate-specific antigen (PSA) levels, indicator of prostate cancer, lean body mass were similar across all three groups.
Therefore, men who had previously used finasteride and who reported having sexual dysfunctions, their symptoms were unlikely due to androgen deficiency.
The men in the first group had moderately severe depression. The men in these groups who were symptomatic finasteride users also displayed higher levels of negative effect, yet lower levels of positive effect compared to men who were considered healthy.
The researchers however could not directly relate these symptoms to the drug itself since their depression could have been a result of their baldness. A study was conducted between November 10 to December 6, 2015, that had participants look at photographs of men before and after a hair transplant.
The participants rated men having hair as appearing more successful, youthful and having more sex appeal. It is possible that the men might feel depressed or displayed symptoms of sexual dysfunction due to how their partners perceived them, or the fear of how the opposite sex might feel about them.
The researchers concluded that larger prospective studies were needed in the future to confirm the results.
Due to the complex nature of the study, a causal relation between prior finasteride use and persistent sexual symptoms, mood changes, cognitive complaints or fMRI findings cannot be conclusively reached.
The researchers suggested that the symptoms of depression and past finasteride use could be purely a coincidence or that the depressed mood may have caused the symptoms of sexual dysfunction. It is still a mystery as to why only some of finasteride users experienced persistent sexual symptoms and low mood.
The clinical significance of the study was that it actually showed that symptomatic finasteride users, the users who complained of sexual dysfunctions, were not likely to benefit from androgen based treatments, including testosterone, DHT or any other sex hormone, since the patients did not show any androgen deficiency, enzyme inhibition during conversion of testosterone to DHT, or androgen insensitivity.
The researchers pointed out that it is highly important to turn attention to finding a cure for depression and sexual dysfunction. Since men suffering from baldness have a higher risk of depression and sexual dysfunction compared to the average population, they suggest to look out for a history of depression, and or sexual dysfunction before starting the treatment.
Indeed, we are getting to see remarkable improvements and scientific advancements in the health sector. Recently, a study, led by experts from Stanford University and Yale University, claimed that a JAK inhibitor drug, tofacitinb citrate, showed 50% or more improvement in restoring hair grown in alopecia areata (AA) patients. AA is a specific type of hair loss in which the immune cells mistakenly attack the hair follicles, making it an autoimmune disease.
Targeting the immune cells, this drug has emerged as a therapeutic option which can help in hair growth restoration at a cellular level. Out of 66 participants, 32% participants experienced more than 50% improvement in regrowth of scalp hair.
If we get to see similar advancements in hair treatments, they could as a byproduct help reduce symptoms of sexual dysfunction and depression.