Introduction: Persistent sexual side effects have been repeatedly reported in men after discontinuation of (DC) Finasteride (FIN), including ED, orgasmic dysfunction and/or genital anhedonia/anesthesia. Khera et al (2020) reported persistent physical sequelae including penile vascular changes in 25 men after DC FIN. The purpose of this study is to replicate Khera’s research findings in a larger population with analysis of vascular, neurologic and hormonal testing routinely performed in our clinic.
Methods: A review of charts (2015-2020) was performed of men who DC FIN and had persistent sexual complaints. Our patient population had: normal sexual function (SF) prior to FIN use; experienced changes in SF within 6 months of DC FIN; and changes persisted > 6 mo. Information collected included sexual function history, current symptoms, validated instruments (IIEF, SDS-R, PSS, McGill Pain Score, PHQ-9), hormone blood test values, data from grayscale/Doppler ultrasound during pharmacological erection (15.4 MHz probe; Aixplorer® Ultrasound) and Quantitative Sensory Testing (QST).
Results: 91 patients (median age 39, IQR 32-46) met inclusion criteria, 9.6% of men evaluated during this period. The most common SF symptom was ED in 95% (87/91). The mean IIEF-EF score was 14 ± 8.63 (n=81), consistent with severe (43%), mild-moderate (23%), moderate (12%), and mild (10%) ED. 57 underwent grayscale/Doppler ultrasound; 77% exhibited abnormal erectile tissue inhomogeneity. Mean cavernosal artery PSV/EDV values (n=61) were left 30.4 ± 18.02/0.76 ± 2.86 cm/sec and right 29.63 ± 14.97/0.60 ± 1.89 cm/sec, respectively. Concomitant orgasmic dysfunction and genital anhedonia/anesthesia were noted in 57% and 48%, respectively. These patients underwent QST testing (n=65) and 60% had abnormal results. On presentation, 30% had DHT =30 ng/dl, 16% had testosterone (T) = 350 ng/dl, and 9% had calculated free T = 6 ng/dl.
Conclusions: In a large series, we replicated Khera’s findings of persistent physical sequelae associated with changes in SF in men after DC FIN. While more research is needed, this population is young, ED is most often severe, and testing shows a high prevalence of vascular, neurologic and hormonal pathologies.