Journal Scan / Research · April 22, 2022 Disproportional Signal of Sexual Dysfunction Associated With Finasteride Use in Young Men With Androgenetic Alopecia Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• The authors conducted a pharmacovigilance analysis to investigate the association between finasteride use and sexual dysfunction in men with androgenetic alopecia. A total of 7700 reports of sexual dysfunction associated with finasteride were identified, with 67.9% of reports made between 2015 and 2019. There was a significant disproportionality signal for sexual dysfunction with finasteride versus drugs with a similar mechanism of action (eg dutasteride, tamsulosin, and minoxidil). This discrepancy was driven by men under the age of 45 years and androgenetic alopecia patients.

• Finasteride is associated with sexual dysfunction in men, especially those under the age of 45 years and with androgenetic alopecia; however, confounding factors by indication and stimulated reporting likely contribute to the recent increase in incidence reports.

–  Katherine M. Stiff, MD

Written by

 

 

Steven R. Feldman MD, PhD

Finasteride and sexual dysfunction

Years ago, after an episode of urinary tract infection, I went to see a urologist for, well, you do not want to know, because they do unspeakable things to guys who have urinary tract infections. Anyway, the urologist was also a specialist in managing sexual dysfunction. I was discussing with him how there is very little overlap between dermatology and urology except for the use of finasteride, which we use for alopecia. He said to me with an air of of surprise in his voice, "You use finasteride? Aren't you concerned about the sexual dysfunction side effects?"

At the time, I thought, well, he specializes in sexual dysfunction; so, he probably sees people all day who claim they have sexual dysfunction from finasteride and does not see the ones who do not have that side effect. His perception would be horribly biased by his practice of selecting patients who had a problem. I still thought that there is probably no relationship between finasteride and sexual dysfunction.

Nguyen et al's article describing a signal for sexual dysfunction from finasteride based on spontaneous reports still leaves me feeling as if there is no real signal. If finasteride did cause sexual dysfunction, almost certainly it would do it more with higher doses than with low doses, and I suspect that it would be extraordinarily unlikely for anybody who had sexual dysfunction and was on minoxidil to blame the minoxidil. Therefore, it seems entirely reasonable to me that there would be relatively more reports of sexual dysfunction from finasteride than from minoxidil. I do not see any basis for the authors conclusion, "it is unlikely that confounding factors alone account for the totality of the signal observed–there is likely a true underlying effect albeit not as significant as observed."  On the contrary, it seems that confounding factors and reporting biases alone would account for the so-called "signal" that was observed.

It is easy to draw mistaken conclusions from spontaneous reporting of data. That said, when starting patients on finasteride for alopecia, I would warn them of reports of sexual dysfunction. Educating patients about this risk may make the risk more likely (given the nocebo effect), but that is something we probably have to live with, given the potential repercussions of not warning someone who may develop sexual dysfunction.

Abstract 

In a recent study by our group, finasteride use was found to be associated with increased reporting of suicidality and depression in young patients with androgenetic alopecia. This previous analysis suggested that the association between finasteride and depression might be mediated by sexual dysfunction, which in men includes erectile dysfunction, diminished libido, and ejaculatory disorders. It is challenging to characterize the association between finasteride use and sexual dysfunction at the population level due to underlying age-related comorbidities causing sexual dysfunction in older men with benign prostatic hyperplasia (BPH) and possible nocebo phenomenon in which a negative outcome occurs due to expectations that an intervention will cause harm, amongst other factors.

Journal of the American Academy of Dermatology

Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: A pharmacovigilance analysis of VigiBase

J Am Acad Dermatol 2022 Mar 26;[EPub Ahead of Print], DD Nguyen, P Herzog, EB Cone, M Labban, KC Zorn, B Chughtai, S Basaria, DS Elterman, QD Trinh, N Bhojani 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.