Dr. John Crisler - The Post-Finasteride Syndrome - Persistent Propecia Side Effects

In this video we hear from Dr. John Crisler about The Post-Finasteride Syndrome - Persistent Propecia Side Effects.

Finasteride and male infertility: a case for prospective collaborative research databases?


Fertility and Sterility, Volume 100, Issue 6, December 2013, Pages 1528-1529

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Objective

To determine the degree of improvement in semen parameters after finasteride discontinuation.

Design

A prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride.

Setting

A male infertility specialty clinic.

Patient(s)

Men presenting for fertility evaluation from 2008–2012 on finasteride.

Intervention(s)

None.

Main Outcome Measure(s)

Semen and hormone parameters before and after discontinuation of finasteride.

Result(s)

At presentation, 27 (0.6%) of 4,400 men on finasteride. The mean duration of treatment with finasteride was 57.4 months, and mean dose was 1.04 mg/day. There was an average 11.6-fold increase in sperm counts after finasteride discontinuation. Of the men with severe oligospermia (<5 M/mL), 57% had counts increase to >15 M/mL after finasteride cessation. No man had a decrease in sperm count. There was no change in hormone parameters, sperm motility, or sperm morphology.

Conclusion(s)

Finasteride, even at low doses, may cause reduced sperm counts in some men. In this population, counts improved dramatically for the majority of men after finasteride discontinuation. The hormone parameters, sperm motility, and sperm morphology were unchanged after cessation. Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.

Key Words

Azoospermia;
5&#945;-reductase;
fertility;
finasteride;
oligospermia;
semen;
spermatogenesis

Study Confirms Persisted Sexual and Emotional Issues After Finasteride Use


Ganzer CA, Jacobs AR, Iqbal F. Persistent sexual, emotional, and cognitive impairment post-finasteride: a survey of men reporting symptoms. Am J Mens Health 2015;9(3):222-8. http://jmh.sagepub.com/content/9/3/222.abstract


Finasteride is a synthetic 5-alpha reductase inhibitor, which prevents the conversion of testosterone to dihydrotestosterone and has been used for more than 20 years in the treatment of male pattern hair loss. Randomized, controlled trials have associated finasteride with both reversible and persistent adverse effects. In this pilot study, we sought to characterize sexual and nonsexual adverse effects that men reported experiencing at least 3 months after stopping the medication. Based on previous research on persistent side effects of finasteride, we constructed an Internet survey targeting six domains: physical symptoms, sexual libido, ejaculatory disorders, disorders of the penis and testes, cognitive symptoms, and psychological symptoms and was e-mailed to patients who reported experiencing symptoms of side effects of finasteride. Responses from 131 generally healthy men (mean age, 24 years) who had taken finasteride for male pattern hair loss was included in the analysis. The most notable finding was that adverse effects persisted in each of the domains, indicating the possible presence of a "post-finasteride syndrome."