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Urology/Your opinion on Finasteride


QUESTION: Dear Doctor,
I just wanted to know your opinion on the sexual side effects related to intake of finasteride ( Propecia/ proscar). Recently there has been upheaval on the internet about the permanent side effects like impotence,ED etc.

Can you kindly let us know your take on this matter? i.e based on your medical experience so far, what would be your thoughts?

Thanks a lot!

First let me say that many men even friends of mine taken finasteride and have no problems at all but some alarming data of younger patients have expressed having permanent ED after a course (1 month +) of the drug. This is usually used for hair loss treatment, the younger guys do not suffer BPH until later years as a general rule. We have no proof or clinical data to support the claim yet, but have been seeing men from all over the country and now world that have enrolled in a study sponsored by one of my two supervising professors Mohit Khera MD MBA MPH .

The exact mechanism has not been narrowed down just yet. Now I will tell you I have personally had multiple patients claim that they have taken the drug and within a months time lost the capability to attain an erection. The perplexing factor is I have injected them with a potent vaso-active agent to induce an erection and there was no significant erectile response . The blood vessels dilated but the smooth muscle of the penis would not go into the relaxed state to allow for veno-occlusion, subsequently causing a profuse venous leak. Now remember we do not put validity into 5 or 10 patients out of millions using the drug as a bench mark for alarm. I would not fear the small ratio of patients claims to not recommend this drug to a patient if they had severe BPH. Now mind you there is a homeopathic herb called Saw Palmetto that in high refined quality has the same mechanism to reduce prostate gland volume. This is not anecdotal as I have seen as much as 40% of a mans prostate reduce in size based on my trans rectal ultrasound measurements with the same scanner a year later after they started the supplement. I have also seen no response at all in others, my speculation was the fact that since there is no regulations on supplements by the FDA,therefore companies can claim there the active ingredient is in the product when there may be little or none at all.

I hope this was helpful for you in your decision making on the drug.

---------- FOLLOW-UP ----------

QUESTION: Dear Doctor,

Thanks a lot for taking time to reply to my question.
I have been taking proscar ( 5mg cut into 5 pieces from past 1 week). But then i looked into a lot of forums etc and hence asked the question. I am basically taking this to beat my hairloss problem ( I am 27 years old).
Although i am still getting nocturnal erection etc, today morning i just wanted to test this theory and watched some videos to see whether it would stimulate me but it dint. I do not know if i should be alarmed by this. I am thinking of stopping this.

I know you cannot give medical advice on this forum, but i would appreciate if you could let me know your thoughts. basically i am in a dilemma on when to call it quits. yesterday night i had erection, but today morning i dint.

Thanks and Sincerely,

Knowing you are 27 and right in the range of men with the condition I described I personally would not risk my erections for a better head of hair. This is probably not the most professional and appropriate response but being my nature is to be a straight shooter I am going to speak of what I would do and not what I recommend. I will recommend getting your hormone blood levels checked for high DHT as that's what causes hair loss. I can also state there is not any data or reports I have come across that Saw Palmetto ever caused ED or permanent ED. Remember this its rare to be struck by lightning but how many people will walk across a golf course with umbrella in hand during a lightning storm ?


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Thomas A Suppe RDMS CLT


Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.


For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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