Propecia, finasteride and erectile dysfunction

This article on propecia, finasteride and erectile dysfunction was written by the author of  Perfect Hair Health.

I asked Rob to write this guest post for three reasons…

First, a high percentage of the visitors to this blog are former propecia users who are now suffering crippling erectile dysfunction long after they’ve dropped the drug.

Second, many of these men are now looking for another way to deal with hair loss that won’t cause these crippling sexual side effects.

And third….

The digital training that Rob has created, is bar none, the best I’ve seen in my 10 year online career….

Training that not only addresses hair loss, but also the underlying hormonal conditions that lead to male pattern baldness.

You can get more info on Rob’s course, as well as before and after pics of men who have used it, right here.

Now here’s Rob with more….

Erectile Disfunction, Post-Finasteride Syndrome, And The Hair Loss Connection

Hair loss affects up to 85% of American men by the age of 50. All too often, we turn to conventional fixes – drugs like Finasteride or Propecia – to help resolve the problem. But that’s not always the best path forward.

In fact, some hair loss drugs like Propecia are not only expensive, but can also harbor serious sexual side effects – low libido, impotence, and even erectile disfunction. When it comes to men’s health, you might be better off leaving these drugs on the shelf.

So how do drugs like Propecia fight hair loss? Are these drugs helpful in hair recovery? And why do some men experience persistent sexual side effects, even after stopping Propecia’s use?

To understand how Propecia works, we first need to understand the basics of hair loss. It begins with something called DHT – or dihydrotestosterone.

The Hair Loss-DHT Connection

If you’ve ever looked into the causes of hair loss, the first term people usually come across is dihydrotestosterone, or DHT. DHT is a hormone that’s made from testosterone.

Hair loss experts are quick to tell you that DHT is the root cause of hair loss.

I first heard about DHT when I was diagnosed with pattern hair loss in 2007.

After some discussion with my doctor, I learned the following:

For reasons not fully understood, hair loss begins when DHT starts accumulating in our scalps. Our hair follicles become sensitive to the DHT, then begin shrinking.

Over a series of hair cycles, the DHT makes our hair thinner and wispier, until our hair becomes so thin that it disappears. The end result: pattern baldness.

Here’s a graphical representation:


Beyond my doctor’s explanation, there are actually three findings that form the basis of the DHT-hair loss argument:

  1. DHT is higher in the scalps of men with thinning hair.
  2. If a man is castrated, his testosterone (and DHT) levels plummet forever. Men who are castrated before puberty (before their DHT levels spike) don’t go bald later in life.
  3. Some men lack an enzyme which converts testosterone into DHT in our scalps. Men who have this genetic condition never develop pattern hair loss.

That’s a very compelling argument… Just look at the extremes. If we never make any DHT, we never go bald. And if DHT is too high in our scalps, we lose our hair.

Based on this, it seems like DHT causes hair loss (it’s actually much more complicated, as we’ll uncover later).

And going by these studies, if DHT is the cause of hair loss, then maybe taking away DHT will help reverse it.

This idea became the basis for nearly every hair loss drug that’s ever gone to market… Including Propecia. The logic: if we want to reverse hair loss, we need to reduce DHT.

Enter Propecia – The DHT Inhibitor

One of the few FDA-approved hair loss drugs is Finasteride (branded as Propecia). So how does Finasteride work?

Finasteride Prevents DHT Conversion

Finasteride is a drug that helps prevent testosterone from converting into DHT, so that less DHT accumulates in our scalp tissues.

Remember that enzyme that some men lack, which makes them unable to convert testosterone into DHT in their scalps? That enzyme is called type II 5-alpha reductase.

Finasteride is a type II 5-alpha reductase inhibitor (or blocker).

Finasteride’s logic is as-follows: by inhibiting testosterone’s conversion to DHT, less DHT gets to your scalp, so you lose hair less quickly. If enough DHT is blocked, you might even halt your hair loss or experience regrowth.

Finasteride is a very effective DHT reducer. In fact, the drug can reduce scalp DHT by 50-70%.

But these effects are often short-lived. Since DHT levels must remain suppressed (for months and years) for Finasteride to theoretically work, you have to take it forever.

According to Propecia’s makers, if you stop taking the drug, DHT levels will return to baseline, and any hairs you’ve regrown will also disappear within a year.

What Does Propecia Cost?

The prices vary, but in general, a prescription for Propecia isn’t covered by medical insurance and costs around $60 per month.

Since the drug needs to be taken for life, the cost over a 20- year period is a little over $15,000.

Does Finasteride (Propecia) Have Any Side Effects?

Yes. As it turns out, type II 5-alpha reductase – the enzyme that converts DHT in your scalp – plays a number of hormonal roles in the body. Many of these roles aren’t yet understood.

But to get an idea of how important type II 5-alpha reductase is, let’s revisit one of the DHT-hair loss staple studies: the one about the men who are severely deficient in enzyme that converts testosterone into scalp DHT.

We know these men never lose their hair. Lucky them. When I first read about this deficiency, I found myself wishing I had it. Then I read about all its other consequences.

A type II 5-alpha reductase deficiency doesn’t just prevent hair loss…It also prevents DHT production during prenatal development.

Boys born with a type II 5-alpha reductase deficiency are also born with underdeveloped or ambiguous genitalia. Many parents even raise them as women – believing they are female – until puberty, when their secondary hormones kickstart some genital development.

Of the men who eventually develop a functioning genitalia, most of them are infertile.

So this enzyme – and DHT – are absolutely critical to male development.

With that said, we’re supposed to take Finasteride when we’re adults (not kids). So is there any harm in reducing our DHT levels when we’re fully grown and losing our hair?

In some cases, yes.

Finasteride: Sexual Side Effects

In some men, taking Finasteride for only a few weeks resulted in unresolved erectile dysfunction. For many men, these symptoms resolved after discontinuing the drug’s use.

For others, low libido and erectile dysfunction continued for years after stopping the prescription, sometimes never resolving at all.

Finasteride: Prostate Cancer

In 2011, Finasteride and Dutasteride (another 5-alpha reductase inhibitor) were forced by the FDA to amend their warning labels after research suggested that prolonged use increased the risk of high-grade prostate cancer.

Think about that. Dutasteride was actually initially developed to help reduce enlarged prostate glands. But ironically, the drug might give you prostate cancer in the process.

That doesn’t sound like a fair trade-off.

Finasteride: Reduced Sperm Count

In 2007, researchers found that Finasteride and Dutasteride reduced total sperm count by ~30% after six months of use. Sperm volume, concentration, and motility were also reduced.

But regardless of the side effects, is this drug effective?

If DHT is the root cause of hair loss, and Finasteride reduces DHT levels by 50-70%, then how much hair can we grow back if we start taking it?

Finasteride: Response Rate, Hair Regrowth Rate

Finasteride’s response rate is impressively high, estimated to be around 80-90%. That’s a majority of users who notice their rate of hair loss slow, stop, or reverse.

But how much hair can we expect to regrow? Most evidence points to just a 10% increase in hair count, along with some thickening of existing hair. That’s still good, but not nearly the miracle cure many expect.

In fact, most research indicates that Finasteride is more effective at slowing or arresting hair loss, but not necessarily reversing it.

But if that’s true – if reducing DHT levels only helps slow or halt hair loss, but not regrow much hair – then could we be wrong about the DHT-hair loss connection?


As it turns out, DHT is way more complicated than most people think. And our misunderstanding of this hormone is why so many men experience sexual side effects while taking Finasteride.

DHT – The Good And The Bad

There are actually a few different types of DHT. In fact, we can break down DHT into two major categories.

Firstly, there’s tissue DHT. This is the kind that binds to tissues like your skin and scalp.

Secondly, there’s serum DHT. This is the kind of DHT that circulates in your blood.

Hair loss experts lead everyone to believe that all kinds of DHT – both tissue and serum – are bad for your hair. But is this true?

Let’s start with tissue DHT.

As we already know, tissue DHT is higher in the scalps of

balding men. Scalp tissue DHT is linked to pattern hair loss. In the scalp, where DHT goes, hair loss follows.

But what about serum (blood) DHT?

One study suggests that serum DHT has no correlation with pattern hair loss. Another shows that serum DHT is higher in young men without hair loss.

That’s the opposite of scalp tissue DHT, and the opposite of what hair loss experts say. Based on this evidence, serum DHT is either uncorrelated to or protective against baldness!

Finasteride Blocks Both Serum And Tissue DHT,

Which Is Why Some Men Experience Sexual Side Effects

Unfortunately, drugs like Finasteride block both tissue and serum DHT.

As we now know, serum DHT is not only uncorrelated with hair loss, but is also critical for male development and sexual function.

If you reduce serum DHT to nothing, you can soon start experiencing sexual side effects – low libido, erectile disfunction, and reduced sperm count.

Why Are Some Men Affected While Others Aren’t?

DHT inhibitors affect everyone differently.

Researchers are still trying to uncover why Finasteride hits some men harder than others, but evidence is beginning to connect Finasteride and its sexual side effects to genetic polymorphisms and changes to neurological receptors, which may lead to long- term suppression of serum DHT levels (even after stopping its use).

There’s even a name for this condition…

It’s called Post- Finasteride Syndrome. And some researchers estimate that up to 20% of Finasteride users – current and former – might be experiencing some form of it.

Suffering From Hair Loss? Educate Yourself.

If you’re a young, sexually active man and suffering from hair loss, I think it’s better to explore alternative regimens first, and save the DHT-inhibiting drugs as a last resort.

New research suggests that while DHT is definitely implicated in hair loss, it may actually be the long-term accumulation of scalp fibrosis and calcification, which slowly starves our follicles of oxygen and causes our hair to thin.

It goes without saying that the best way to avoid Post- Finasteride Syndrome is to avoid taking Finasteride. While it’s easy to resort to hair loss solutions in pill-form, your sperm count and libido will thank you for the pass.

Propecia, Finasteride and Erectile Dysfunction – Conclusion:

I want to thank Rob for taking the time to write this guest post.

If you’re suffering with male pattern baldness…

Or are currently using propecia and would like to lose the drug and opt for a natural hair loss treatment plan instead, you can get more info on his product Here.

About the Author Mark

Article edited by Mark Wilson. Mark currently owns 5 sites in the men's sexual health niche and has published more than 5,000 articles and blog posts on dozens of websites all over the world wide web.

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