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Urology/Finasteride and sex drive



How does finasteride decrease sex drive, and cause ED when it reduces the size of the prostate?

I emailed you earlier about my urinary tract issue, and you mentioned to me that it was prostatitis. I am taking shilajit tablets from Swanson at this point.

I have taken them for a week now, but don't notice much of a difference. Does it take time? I would take other drugs, but with caution.

I came across finasteride and it's usage and side effects. I can't understand how it can cause ED and loss of sex drive despite reducing the prostate gland?



Finasteride affects ED and libido through an effect on testosterone which is how it decreases size of the prostate.  Making the prostate smaller does not cause ED or loss of sex drive; its the effect on testosterone that does this.  To be fair, the majority of men who take finasteride do not have any problems as this affects only 5% or less of them.

Shilajit has no known or scientifically proven benefit in the treatment of prostatitis.  You should consult a physician to deal with these problems.  Proper treatment of diagnosed prostatitis includes avoidance of caffeine, antibiotics, anti-inflammatories and hot sitz baths.

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QUESTION: So does that mean decrease in testosterone, decreases the size of the prostate? And increase in testosterone would increase the size of the prostate?

I would go to the diagnostic center, but it costs $300 and I can't afford that much at this point. Are there any medications I can try which don't affect testosterone but also reduce the size of the prostate?

Thank you for your help.


Yes, increasing testosterone can increase prostate size to some degree but decreasing testosterone effect on the prostate will shrink it about 20-25%. Since this works by testosterone effect, there are no meds that can shrink the prostate that don't have the potential to affect testosterone levels, sex drive or erection function.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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