Do you mind elaborating what other options are there for BPH or for hair growth. As a side note I’ve been doing finasteride 1mg for almost a year and my hair has gotten thicker/fuller a bit but it definitely affects (at least in my case) sexual function (especially pleasure). I think regular use of Cialis helped lessen the negative effects of Finasteride some, but not totally.
As far as hair is concerned, nothing beats 5ar inhibitors for hair growth and maintenance yet.
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How about minoxidil?
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Regrowth peaks at around the 12 month mark and the gradually declines from there. Can probably be used for monotherapy in some cases (especially to those unrelated to DHT) but with moderately aggressive to very aggressive AGA, minoxidil by itself won’t be enough.
https://www.sciencedirect.com/science/article/abs/pii/S0190962287700899
With finasteride and dutasteride we have several studies spanning 5-10 years showing maintenance and often times continued regrowth.
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@Kelman This question becomes more interesting with the recent data on cardiovascular benefits of finasteride. I have more comfort with Rx’ing dutasteride … but dutasteride probably doesn’t have the same cardiovascular benefits for a number of reasons. The whole issue of post finasteride syndrome is likely overblown - but probably exists. Either one can mess up sexual function to some degree; the issue is reversibility of that with stopping the medication. Looks good with dutasteride, but there are a number of pretty unhappy men who think finasteride has had an irreversible effect. Really tough to say if this is correct or not.
However, my risk/benefit for men who want this class of drug - or should have it (e.g. AUA guidelines, if your prostate is enlarged to 30 mL or more) I’ve been going with dutasteride. Now for men who are at higher risk for CAD … I’m going to have to have the discussion on finasteride and will be Rx’ing it in these men.
So I’m changing my opinion, but it’s nuanced and this is part of medicine, as new data comes forth, one has to adapt.
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but dutasteride probably doesn’t have the same cardiovascular benefits for a number of reasons.
Due to it’s potential impact on the liver?
Mechanistically it doesn’t make sense though. Dutasteride is a strong and irreversible inhibitor of both the 5ar type 1 and 2 enzyme with a half life 200x that of finasteride. Finasteride does get into the human brain much better than dutasteride but it’s both a very weak and reversible 5ar type 1 inhibitor so risk of affecting neurosteroids is low. Risk of depression from various studies ranges from non-existent to very low, most likely indicating no actual effect. All the case reports on fertility also show normalizing sperm health parametters after 1-3 months of cessation, whereas dutasteirde’s impact on fertility may last longer, potentially up to a year.
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You definitely have got bigger balls than me to go against @DrFraser on these matters LOL. Jokes aside you do make couple very valid point which I was about to note myself as I was contemplating switching from Fina to Duta. Perhaps not so fast. I’ll cut my 1mg Fina pill in half though since from what you’ve posted earlier it seems to have same or close to same effect on hair.
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I think we need to look at the bigger picture here. There’s likely 100-1,000x as many men under 50 on finasteride than on dutasteride so side effects will be reported on more often.
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Stick to your guns. Don’t waver just because there might be cardiovascular benefits.
I personally witnessed a college roommate develop Post-Finasteride Syndrome (PFS). I was the one who recommended the medication to him, though I did warn him about the risks of suicide and sexual dysfunction. After consulting a doctor, he decided to take it, and—unsurprisingly—developed ED.
These symptoms aren’t just “all in one’s head.” Significant research shows that sexual dysfunction can persist for years, as seen in:
- [Persistent sexual side effects of finasteride: could they be permanent? - PubMed]
- [Persistent sexual side effects of finasteride for male pattern hair loss - PubMed]
Furthermore, extensive studies indicate that Finasteride doesn’t just affect the $5\alpha$-reduced metabolites of progesterone and testosterone as intended; it also impacts their higher-level metabolites and precursors:
These are tangible physiological biomarkers being forcibly altered by the drug. The pudendal nerve injury may very well be irreversible—much like Alzheimer’s disease. The benefits of this drug simply do not justify the risks.