Characteristics of Men Who Report Persistent Sexual Symptoms after Finasteride Use for Hair Loss

Some men who use finasteride for hair loss report persistent sexual and other symptoms after discontinuing finasteride therapy.

To determine whether these persistent symptoms after discontinuation of finasteride use are due to androgen deficiency, decreased peripheral androgen action, or persistent inhibition of steroid 5α-reductase (SRD5A) enzymes.

Finasteride-users, who reported persistent sexual symptoms after discontinuing finasteride (group 1); age-matched finasteride-users who did not report sexual symptoms (group 2); and healthy men who had never used finasteride (group 3).

Sexual function, mood, affect, cognition, hormone levels, body-composition, functional magnetic resonance imaging (fMRI) response to sexually and affectively-valenced stimuli, nucleotide sequences of androgen receptor (AR), SRD5A1 and SRD5A2; expression levels of androgen-dependent genes in skin Setting: Academic medical center Results: Symptomatic finasteride-users were similar in body composition, strength, and nucleotide sequences of AR, SRD5A1 and SRD5A2 genes to asymptomatic finasteride-users and nonusers. Symptomatic finasteride-users had impaired sexual function, higher depression scores, a more negative affectivity balance, and more cognitive complaints than men in groups 2 and 3, but had normal objectively-assessed cognitive function. Testosterone, DHT, 5α-androstane-3α,17|gb-diol glucuronide, testosterone-to-DHT and androsterone glucuronide-to-etiocholanolone glucuronide ratios, and markers of peripheral androgen action, and expression levels of AR-dependent genes in skin did not differ among groups. fMRI BOLD responses to erotic and nonerotic stimuli revealed abnormal function in brain circuitry linked to sexual arousal and major depression.

We found no evidence of androgen deficiency, decreased peripheral androgen action, or persistent peripheral inhibition of SRD5A in men with persistent sexual symptoms after finasteride use. Symptomatic finasteride-users revealed depressed mood and fMRI findings consistent with those observed in depression.

The Journal of clinical endocrinology and metabolism. 2016 Sep 23 [Epub ahead of print]

Shehzad Basaria, Ravi Jasuja, Grace Huang, Whitney Wharton, Hong Pan, Karol Pencina, Zhuoying Li, Thomas G Travison, Jag Bhawan, Renaud Gonthier, Fernand Labrie, Alain Y Dury, Carlo Serra, Allen Papazian, Michael O'Leary, Sami Amr, Thomas W Storer, Emily Stern, Shalender Bhasin

Research Program in Men's Health: Aging and Metabolism, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115;, Emory University: Department of Neurology, Atlanta, GA;, Functional Neuroimaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115;, Program on Aging, Hebrew Senior Life, Roslindale, MA;, Department of Dermatology, Boston University School of Medicine, Boston, MA;, Endoceutics, 2795 Laurier Blvd, QC City, G1V 4M7, Canada;, Section of Urology, Brigham and Women's Hospital, Boston, MA 02115;, Department of Pathology, Harvard Medical School, Boston, MA September 15, 2016.