Thank you for your question.
You state in your question that you’re 32-years-old. You received a prescription for finasteride
1 milligram once a day and you are not concerned about having a lower libido but you are concerned
about long-term erectile dysfunction and sexual dysfunction. And so you are asking about that
as the relative risk for taking finasteride.
Well, I can certainly share with you my experience with patients who I’ve been treating since
the introduction of finasteride. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. Hair transplant
has been a part of my practice for many years and I’m the founder of TrichoStem™ Hair
Regeneration Centers. And we developed a non-surgical alternative to hair transplant as well as
an alternative to finasteride and I’ll go over that history a little bit.
To first answer the question about the experience with patients having long-term erectile dysfunction
and sexual side-effects, I think that you’ve touched upon a very controversial topic. And
I think that with the exception of a small group of people who have made this claim and
there has been a lot of momentum in terms of the fear of taking finasteride to the point
where, in our practice, people who come from all over the world come to us for a treatment
we developed called Hair Regeneration which I’ll discuss further later, they won’t
take finasteride. They categorically refuse to take it or they’ve taken it and they
developed side-effects. They didn’t like that. They got better after stopping the drug.
I think that when you’re talking about long-term sexual side-effects that occur inspite stopping
the drug, I think it still remains unresolved. I find it difficult to be able to really explain
how a pharmacologic process, when the drug is stopped, can continue. How are there permanent
changes that lead to the inability to have sexual function? There are certainly a lot
of opinions about it from the central pathways of the brain, etc. But I still think that
it remains to be determined. And given the number of people who take not only 1 milligram
of finasteride, well, there’s a drug that’s used for benign prostatic hypertrophy that’s
called Proscar which is 5 milligrams of finasteride. And then there’s another drug that is dutasteride
also a DHT blocker. So I still think that from the medical perspective, the relative
risk is very low.
However, that being said, I can tell you that from studies done of compliance with these
drugs, there is a real issue for the majority of people who seem to be taking it within
those studies and they’ll take it for the first year and then not take it for the second
year or just taper off with time beyond that and I’ve seen that in our practice. Clinically,
our patients will say they took it. They weren’t sure if it was working. They weren’t sure
if they were feeling right and they just stopped taking it. A lot of times, they just weren’t
sure that it was working so they just stopped altogether or they just decided that they
didn’t get around to refilling their prescription. I mean, there’s just a long list of reasons.
In fact, the point that I’m about to make as far as an alternative to finasteride that
may be of interest is that around the time that this concern was starting to pick-up
momentum, we were actually using something called Acellular matrix to help heal people
who were undergoing transplants to improve the survival of the grafts, to improve the
healing of the donor area. A side-effect was that thinning hairs were starting to get thicker
in a lot of different patients. So I took it upon myself to develop a system and process
and ultimately, we called Hair Regeneration. What makes this significantly different and
has become quite a relief for people who don’t want to take or can’t take finasteride is
that finasteride helps 60% of men, 40% it doesn’t. But also, it slows down the progression
and doesn’t stop it.
With Hair Regeneration, with this injection that typically occurs at least once and maybe
a second time in 15 months depending on the individual situation, we’re able to consistently
have patients re-growing hair that hasn’t been growing in a long resting phase called
telogen. We’re able to stop the hair loss progression. We are able to induce the shedding
of thinning hair and the regrowth of thicker hair which means that they’re actually getting
thicker hair without transplant and without taking any medication. So needless to say,
this procedure has become very popular and people come to us from all over the world
and I’ve actually started a company called TrichoStem™ Hair Regeneration and we are
trying to work on building facilities to bring this technology closer to people who can’t
get to us in our two offices in New York.
The point of that is that, I would say that when it comes to your decision and this is
how I explain to my patients, if you are willing to take the finasteride, go ahead and take
it. Statistically, it’s unlikely that you’ll have issues with sexual function. The majority
of patients, clinically who I’ve treated who had any issues with sexual side-effects
were able to stop the drug and were back to normal. I’ve not had a single patient who
had long-term problems with sexual side-effects after the cessation or ending of the drug.
Therefore, from my clinical experience and from the clinical experience of colleagues
who I discuss this concern with in meetings, it has not been something that we actually
had a significant consensus agreeing that there is a commonality which is also unusual.
In clinical practice, whether it’s a drug, whether it’s a device, whether it’s a
technique, doctors doing similar things will often share similar experiences. And so, this
problem of not having good sexual function after ending the drug is highly unusual. And
so, as I said, needs further investigation.
So, I think this was an opportunity to put into perspective the drug in terms of long-term
sexual side-effects as well as the alternatives that we’ve been very successful to help
people who just won’t take the drug or cannot take the drug.
So I hope that was helpful, I wish you the best of luck and thank you for your question.