Will Propecia Make Your Penis Fall Off?

But I Took Propecia and My Penis Works Great

Over ten years ago, I started taking Propecia. Contrary to the dregs of opinions on internet message boards and comment sections, I maintained my hair and penis did not fall off.  In fact, my penis remained highly functional. Let me be clear — Propecia did not my dick fall off.

Despite my anecdotal experience, there remains a strong stigma that Propecia will obliterate a man’s erection and sex drive.  Despite the low probability of side effects, magazines like Men’s Health or groups like the Post-Finasteride Syndrome Foundation would lead you to believe taking Propecia will hasten the coming of an erectile Armageddon.  On this fateful day, you will grow breasts supple enough to feed an infant.  The dead will rise, but your most important member, your penis, shall remain limp.

The “Big” Picture

Before I examine some claims against Propecia.  It’s important to remember the big picture.  First of all, Propecia is an FDA approved drug for hair loss. The active ingredient in Propecia is 1 mg of Finasteride, which is more commonly known as the generic version of the drug.  Despite hair loss being a multibillion dollar industry, Finasteride remains the only FDA approved medication for hair loss that requires a prescription. (In fact, it’s really the primary mover for companies like Keeps or Hims that make mountains of money by simply repackaging generic prescriptions for Propecia and Rogaine. )

People often complain that MERCK, the drug company who first produced Propecia, withheld or misrepresented their findings to the FDA for approval. On its face, this is a ridiculous claim. The process to approve a drug for public consumption is very difficult and expensive.  To keep things in perspective, it’s important to remember the difficulty of drug approval from the FDA.

• The average medication takes 12 years for both development and approval by the FDA.

• A drug company spends an average of 350 million dollars for the development and approval process of a new drug.

• Once companies develop a drug, they perform three and a half years of laboratory testing before submitting an application to the FDA to begin human trials.

• Out of every 1000 compounds to undergo laboratory testing, only one will ever make it to human testing.

• If the FDA approves the application for the new drug, three phases of human testing begin.

• Phase 1 lasts for about a year and uses 20-80 healthy volunteers to test for the drug’s safety.

• Phase 2 lasts two years.  One-hundred to 300 subjects are tested to determine the drug’s effectiveness.

• Phase 3 involves 1000-3000 patients in clinics and hospitals who are monitored carefully to determine drug effectiveness and to identify adverse reactions. This phase can take up to three years.

• The drug company then submits a 100,000 page application to the FDA for approval — typically a two and a half year process. After final approval, the drug becomes available for physicians to prescribe.

At this stage, the drug company will continue to report cases of adverse reactions and other clinical data to the FDA.

I shared these points to illuminate a simple truth to keep in mind:

The production of a new drug is time, labor, and capital intensive. New drugs must overcome an ungodly barrage of scrutiny to become approved. That scrutiny does not end after the drug’s approval.

The Millions and Millions

In addition to the nearly impossible task of getting a faulty drug through the FDA, it is important to remember just how many men have taken Propecia. The patent for Finasteride was granted in 1984 and first approved for use in 1992. The original use of Finasteride was for treating enlarged prostates in men. This medication was known as Proscar, which contained 5 mg of Finasteride. Propecia, the 1 mg version of Finasteride, wasn’t approved for treating hair loss until 1997.  In Propecia’s initial year, doctors prescribed the drug for over 400,000 men.  Currently, Finasteride is the 86th most common prescription in the United States with nearly eight million prescriptions filled every year — that’s just in America. Men have taken Finasteride for over 30 years to treat prostate enlargement or hair loss. Conservatively, there are likely more than 100 million men who have taken Finasteride across the world over the last three decades. Very few medications or treatments have been observed for so long across such large swaths of the population.

On the other hand, there are several products that have been marketed to the hair loss community while simultaneously criticizing Propecia. Remember, these products have not been approved by the FDA, have not been taken by millions of men over three decades, and have not been observed by medical professionals in clinical settings. In other words, these treatments are likely far more risky, less understood, and do not actually meet their claims to prevent or treat hair loss. Vitamins, supplements, sprays, topicals, shampoos, or other miracle products that people claim to cure hair loss have not remotely endured the same level of scrutiny of Propecia, even if they claim to be “natural.” Hair loss is also natural, but that doesn’t make it a good thing. The bottom line is other treatments do not reverse hair loss and could even be harmful, but it’s harder to vilify products that lack any relevant research or user data.

The widespread use of Propecia over three decades should give you comfort that you can likely slow or slightly reverse hair loss without deflating your most precious cargo. Many men and doctors have already preceded you, so you aren’t even being that brave by treating your hair loss with an FDA approved medication that your personal doctor will prescribe to you.

Is Propecia a Scapegoat for Erectile Dysfunction?

In MERCK’s initial study, 3.8% of men reported sexual side effects when taking Propecia.  This number alone seems high, but 2% of men in the placebo group also reported the same side effects. The difference between the placebo and control group was merely 1.8%.  The information submitted by MERCK suggest two things.  Less than 2% of men are actually adversely affected by Propecia. Secondly, many men experience sexual problems as they age regardless of their medication. Why else would a placebo medication also cause any sexual side effects or erectile dysfunction? Thus, Propecia becomes an easy scapegoat for a common and hypersensitive problem for men as they age:  erectile dysfunction (ED). It’s far easier to blame ED on Propecia than for a man to accept that he may be one of the 26% of men under 40 or upwards to 76.5% of all men that experience some form of ED in their lifetime. Just look at the numbers and ask yourself this question. What is more likely? Is it more likely that a man falls within the 1.8% of men who are adversely affected by Propecia, or is it more likely that a man is one of the 76.5% of men who suffer from erectile dysfunction and just so happened to be taking Propecia for hair loss?

If that isn’t conniving enough, take a further look at studies where the number of men who experienced Erectile Dysfunction is negligible when compared to the placebo.

• A review published in the Journal of Clinical and Aesthetic Dermatology analyzed data from eight studies that included more than 4,600 men taking Propecia. The review found that the incidence of erectile dysfunction in men taking Propecia was similar to the incidence of erectile dysfunction in men taking a placebo.

• A study published in the journal Dermatologic Surgery included data from more than 1,200 men taking Propecia. The study found that only 1.4% of men taking Propecia reported experiencing erectile dysfunction, compared to 1.3% of men taking a placebo.

• A study published in the journal Clinical Drug Investigation included data from more than 1,400 men taking Propecia. The study found that only 1.3% of men taking Propecia reported experiencing erectile dysfunction, compared to 1.1% of men taking a placebo.

• A study published in the journal Urology included data from more than 1,000 men taking Propecia. The study found that only 1.1% of men taking Propecia reported experiencing erectile dysfunction, compared to 0.9% of men taking a placebo.

Overall, these studies suggest that Propecia does not cause erectile dysfunction for most men. The incidence of erectile dysfunction in men taking Propecia is similar to the incidence of erectile dysfunction in men taking a placebo, indicating that other factors, such as the nocebo effect or preexisting conditions, may be responsible for any reported cases of erectile dysfunction.

With so many men taking Propecia, there are bound to be a few that do experience side effects. Nothing in life is completely risk free. If eight million men in America take Finasteride every year, it would be reasonable to expect upwards to 304,000 to report side effects — enough complaints to garner the attention of Men’s Health or fuel websites like Propecia Help. However, 160,000 of those men would be likely to experience problems with their sexual health anyways. Side effects occur with any medication, but when it comes to the holy sausage, many men throw all logic out the window and choose to let fear cloud their judgement. No one denies that Propecia causes sexual side effects for a few men, but I believe it is fair to consider how many men have unjustly blamed Propecia for their other health problems and perpetuate the fear of an otherwise well tolerated and effective treatment for hair loss. Doctors have safely prescribed Propecia for years and continue to do so. And for the few unfortunate men who do experience side effects, those side effects are reversed by discontinuing the medication.

Other Explanations for Post Finasteride Syndrome

What’s even more interesting, is that research is emerging that shows that people who claim they have longstanding side effects from Propecia either have a history of depression or are suffering from what’s known as the nocebo effect. While the placebo effect occurs when a test subject takes a sugar pill and shows improvement because they believe they are taking the real medicine, the nocebo effect occurs when a test subject takes a sugar pill and experiences the side effect of the drug because they believe they are taking the real drug.

Research on the nocebo effect has shown that it can have a significant impact on a person’s health and well-being. For example, a review published in the journal Psychotherapy and Psychosomatics analyzed data from 31 studies and found that the nocebo effect can lead to the development of various physical and psychological symptoms, including pain, nausea, anxiety, and depression.

The nocebo effect is thought to be related to the placebo effect, in which a person’s positive expectations about a treatment can lead to the improvement of symptoms. Both the nocebo and placebo effects are thought to be influenced by a person’s beliefs, expectations, and mental state.

There are several factors that may contribute to the development of the nocebo effect, including a person’s past experiences with medication, the way that a treatment is presented or described, and the presence of negative stereotypes or biases.

The Happy Ending

In conclusion, I can’t promise you with 100% certainty that Propecia will not cause you any adverse sexual side effects. However, I can tell you that you are much more likely to experience sexual issues from aging. That is just a fact of life. If you happen to be in the small 2-3% of men who do experience sexual side effects from Propecia, they will stop if you discontinue the medication. At the end of the day, your dick is not going to fall off. Just ask your doctor.

On the other hand, if you choose to do nothing about your hair loss, your hair will fall off over time. Eventually, we should have treatments that cure male pattern baldness. However, you are fortunate to live in a time where if taken early, both finasteride and minoxidil are powerful treatments to slow, stop, and even reverse hair loss. The key is to identify hair loss early in life and proactively treat your hair loss. These treatments are very effective and will help you to avoid having to consider riskier and more expensive procedures like hair transplants in the future.