From the FDA Drug Label
The following additional adverse event related to sexual dysfunction that continued after discontinuation of treatment has been reported in postmarketing experience with finasteride at lower doses used to treat male pattern baldness... - sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e.g. reduced ejaculate volume). There have been postmarketing reports of male infertility and/or poor seminal quality; normalization or improvement of seminal quality has been reported after discontinuation of finasteride A 0.6 mL (22.1%) median decrease in ejaculate volume with a concomitant reduction in total sperm per ejaculate was observed. These parameters remained within the normal range and were reversible upon discontinuation of therapy with an average time to return to baseline of 84 weeks
Reversal of Sexual Side Effects: The FDA drug label reports that some sexual side effects, such as male infertility and/or poor seminal quality, may improve or normalize after discontinuation of finasteride treatment 1. Additionally, a study found that ejaculate volume and total sperm per ejaculate returned to baseline after an average of 84 weeks following discontinuation of therapy 1. However, erectile dysfunction, decreased libido, and ejaculation disorders have also been reported to persist after discontinuation of finasteride treatment 1.
- Key Points:
- Some sexual side effects may improve after discontinuation of finasteride
- Ejaculate volume and sperm count may return to normal after 84 weeks
- Other side effects, such as erectile dysfunction, may persist after discontinuation
- Clinical Decision: Due to the variability in individual responses, it is essential to monitor patients who have stopped finasteride treatment for persistent sexual side effects and consider alternative treatments if necessary 1.
From the Research
Sexual side effects of finasteride may not reverse in all patients after stopping the medication, with some studies suggesting that persistent sexual dysfunction can occur in a subset of individuals. The likelihood of side effect reversal may depend on factors such as treatment duration, dosage, individual sensitivity, and age. Finasteride works by inhibiting the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone (DHT), and this reduction in DHT can affect sexual function since DHT plays a role in libido and sexual performance. Some studies have reported that finasteride has been associated with sexual side effects that may persist despite discontinuation of the medication, with 96% of subjects in one study continuing to experience persistent sexual side effects after 9-16 months of follow-up 2. Another study found that the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date, with 94% of subjects developing low libido, 92% developing erectile dysfunction, and 69% developing problems with orgasm 3. A more recent review highlighted the emerging clinical problem of post-finasteride syndrome, characterized by sexual side effects, depression, anxiety, and cognitive complaints that persist despite drug withdrawal 4. Additionally, a retrospective cohort study found that the risk of persistent sexual dysfunction in men who stopped finasteride 1 mg therapy was higher than that for omeprazole users, with a mean time to first persistent sexual dysfunction event of 391 days after discontinuation of finasteride 5. It is essential for patients experiencing sexual side effects while taking finasteride to consult their healthcare provider before stopping the medication, as they may recommend dosage adjustments or alternative treatments based on the individual's specific situation and the risk-benefit profile. In terms of management, phosphodiesterase type 5 inhibitors may be considered for the treatment of erectile dysfunction, but patient preference and adherence to treatment should be taken into account 6. Overall, while some patients may experience reversal of sexual side effects after stopping finasteride, others may not, and healthcare providers should be aware of the potential risk of persistent sexual dysfunction associated with finasteride use.