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 Vol. 140 No. 7, July 2004     Archives 
 
Evaluation of Sexual Function With an International Index of Erectile Function in Subjects Taking Finasteride for Androgenetic Alopecia
Antonella Tosti, et al
Arch Dermatol. 2004;140:857-858.

ABSTRACT  

Objective  To evaluate variations in sexual and erectile function in subjects taking 1 mg of finasteride for androgenetic alopecia by administering the abridged 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire before and during treatment.

Design  In a multicenter study, 186 patients with androgenetic alopecia were asked to complete the IIEF-5 regarding the domain of erectile function before (at baseline) and 4 to 6 months after beginning finasteride treatment. The test was self-administered.

Setting  The study was conducted in 7 institutional dermatology departments in Italy (Bologna, Rome, Genoa, Cagliari, Milan, Florence, and Bari).

Patients  A total of 186 patients with androgenetic alopecia were evaluated before and 4 to 6 months after the initiation of finasteride therapy (1 mg). All patients (age range, 19-43 years; mean age, 28.3 years) were followed up as outpatients.

Results  The score on each of the 5 domains of the IIEF-5 did not show any significant change after 4 to 6 months of treatment.

Conclusions  Our results support the clinical impression that sexual side effects are actually much less common than reported in clinical trials. The sexual function of all patients remained stable during treatment with 1 mg of finasteride.

snip….

The main adverse effects related to finasteride therapy for AGA involve the sphere of sexual function (loss of libido, erectile dysfunction, and decreased ejaculate volume). In clinical trials for the evaluation of finasteride efficacy, sexual side effects have been reported in 4.4% of patients treated with the active drug and in 2.2% of patients taking placebo,1-3 with 1.4% of patients discontinuing the studies because of sexual side effects in the first year of treatment and 1.3% discontinuing in the extension studies. These adverse effects are less apparent in the clinical setting, where sexual side effects occur in fewer than 0.5% of subjects who take 1 mg of finasteride.4

snip…

In a preliminary study, we showed that the sexual and erectile functions of subjects taking finasteride do not significantly differ from those of age-matched controls.4 The aim of our current study was to evaluate variations in sexual and erectile functions in subjects taking 1 mg of finasteride for AGA by administering the IIEF-5 before and during treatment.

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Possible changes in score after 4 to 6 months of treatment vs baseline values were considered within the 5 domains of the questionnaire (partial score) and within each question. Statistical analysis was performed by means of the Wilcoxon test for paired nonparametric data. Table 1 shows the patients’ score on each of the 5 domains of the questionnaire before (at baseline) and after 4 to 6 months of treatment. No changes were statistically significant.
Androgens are known to play an important role in erectile function, and androgen receptors have been identified in cavernosal tissue of rats, although the involvement and precise role of these steroids in humans remains to be established.8-9 Hypothetically, finasteride could cause loss of libido, erectile dysfunction, and decreased ejaculate volume by a reduction in serum and prostate levels of DHT.10-11 Studies have shown that the drug does not affect spermatogenesis or semen production in young men.

Finasteride-induced sexual dysfunction is nevertheless a benign condition that completely resolves after therapy is discontinued. Sexual dysfunction has also resolved in most men who reported the condition but who continued to take finasteride anyway.3 The drug does not produce significant changes in serum levels of gonadotropins (leutinizing hormone and follicle-stimulating hormone) or in estrogen-testosterone ratios, although testosterone and estrogen levels slightly increase (approximately 15%) during treatment.

snip…

Our results support the clinical impression that sexual side effects are actually less common than is reported in clinical trials. This discrepancy may be attributable to the fact that subjects who enrolled in the clinical trials were informed about possible changes in their sexual function and were specifically asked about such changes at every visit, resulting in a higher percentage of reported adverse events than would normally occur. Physicians who prescribe the drug on a daily basis see sexual effects much more rarely, even if they inform their patients about the possible occurrence of these rare side effects. We did not evaluate changes in the ejaculate volume in this study because this subject is not assessed by the questionnaire, although a decrease in ejaculate volume is not rare in our experience.

We believe that the IIEF-5 could be routinely administered to subjects who wish to begin taking finasteride but are particularly worried about sexual side effects. In our experience, the questionnaire is well accepted by patients, who are often anxious about the possible occurrence of sexual side effects and who are eager to be carefully followed up during treatment.

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Hair loss disorders

Common hair loss disorders.

Springer K, Brown M, Stulberg DL.

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, dose attention to the appearance of the hair loss. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. (edited)

 Arch Dermatol. 1987 Nov;123(11):1483-7.

Male pattern baldness (androgenic alopecia) and Hair loss blog

Praxis (Bern 1994). 2001 Feb 15;90(7):241-8.

Status of scalp hair and therapy of alopecia in men in Switzerland

Trüeb RM, de Viragh PA; Schweizerische Arbeitsgruppe fur Trichologie.

A community-based interview and a questionnaire of men visiting the dermatologist for treatment of hair loss were conducted in Switzerland, to characterize the significance of scalp hair and self-perception of hair loss in Swiss men, and to evaluate current treatment of hair loss. 508 men, aged 15-74 years, regardless of the degree of hair loss, were interviewed by telephone, and 308 patient questionnaires were completed by 19 dermatologists. The questions addressed by the interview were: degree of self-rated hair loss, time invested for hair care, use or reasons for rejecting hair growing agents, relevant criteria for scalp hair, self-assessment with respect to different “hair communication types”. The questionnaire analysed the causes of hair loss, prior and current treatment modalities, and follow-up at the dermatologist. Respondents rated their hair loss on a 5-point, textual scale that ranged from ‘no hair loss’ to ‘bald areas’. 43% reported hair loss to some extent. For 42% a full head of hair was very important, especially for men under 29 years, who invested more time for hair care and had not lost hair. Of men with hair loss, 26% previously applied hair growing agents. Of men consulting the dermatologist for hair loss, 90% had androgenetic alopecia. 37% were previously treated: prior treatment was in 59% minoxidil, in 4% finasteride (Propecia), in 7% Aminexil, in 7% dietary supplements, and in 6% conducted by the hair dresser. In 79% treatment was switched to Propecia: of these, 73% adhered to the follow-up consultations at the dermatologist.

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