Hello I'm 25 years old and suffer from male pattern

Patient

Q: Hello. I'm 25 years old and suffer from male pattern baldness. I've been taking 1mg Propecia daily for about 7 years. One of the side effects of Propecia is decreased libido/trouble maintaining erections, which unfortunately I experience sometimes.

I recently started using herbal supplements known to increase blood flow to the penis (muira puama, korean panax ginseng, horny goat weed) and I have noticed stronger erections.

My concern is, these herbal supplements supposedly increase testosterone in the body. The testosterone turns into DHT which causes hair loss, which is the reason I'm taking Propecia in the first place, to prevent the formation of DHT. But if these herbs do in fact increase testosterone, am I possibly countering the effects of the Propecia? I started using these herbs about a week ago, and it seems like I may be shedding a bit more than normal. (Although it could be I'm just more aware of it currently)

If these herbs are countering the effects of the Propecia because they increase testosterone, are there any herbs that increase blood flow to the penis without the testosterone increase?

Thank you very much!

Symptoms:  Decrease in libido/trouble maintaining erections sometimes due to Propecia.
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

It is indeed a fact that Propecia or finasteride causes suppression of DHT, a hormone that plays an important role in erectile physiology. Numerous animal and human studies have confirmed that Propecia and other 5-alpha-reductase inhibitor drugs can have an adverse effect on erectile response.

While lowering the body’s levels of DHT may correct hair loss, problems arise because this sex hormone is important for maintaining the structural integrity of nerves, smooth muscle, connective tissue and signaling pathways in the penis. This leads to mild to moderate erectile dysfunction and even decreased libido.

The herbal supplements which you have mentioned do increase the testosterone levels and help increasing libido and correcting erectile dysfunctions but at the same time testosterone do get converted to DHT which can in a way blocks the anagen phase of hair growth and hence can increase hair loss. It is the free testosterone which maintains the libido and if the levels are high then they get converted to DHT, this is an important fact which needs to be kept in mind. It is hence important to learn about serum free testosterone levels in blood and as you have been using these supplements since a week it is possible that sudden rise in the free testosterone levels would have given you temporary relief.

The crux in using a finasteride therapy to avoid sexual dysfunction is to opt for a drug free interval for a period of 10-15 days after a regular use for 3 months, this allows testosterone to replenish and avoid any sexual dysfunctioning side effects.
There is a delicate balance which needs to be maintained. Moreover as you have been using finasteride for last 7 years now regularly, its indeed a long time to use and you are bound to experience these side effects. Your query about using herbals to improve penile blood flow specifically shall not solve your concern or may be temporarily, but unfortunately there are no approved medications which are available.

Hence it is better to opt for drug free interval option which can allow you to maintain libido concomitant with usage of Propecia at the same time.

I hope i have answered your query in detail,
Wishing you good health,
Regards

Comments / Follow Ups

Patient: Would the testosterone increase from the herbals that I mentioned, be too much for the Propecia to prevent from becoming DHT? Or does the Propecia completely prevent the conversion into DHT, regardless of how much free testosterone I have in my body? I would just like to know if continued use of these herbal supplements will render the propecia useless because of the testosterone increase, or if the propecia will be able to handle the increase and remain effective at preventing hair loss.

Thank you
Doctor: Well it is truly difficult to say because these herbal medications have not been studied in detail and not enough studies have been conducted to comment on your query. They form a part of holistic medication. There are no trials conducted between propecia and herbal medications to conclusively comment upon each one's interactions with the other.
Regards
Doctor: Best would be to avoid herbal supplements and get a serum testosterone levels done and isolated DHT levels to compare both and then if required weekly low dose testosterone therapy may be instituted to overcome sexual dysfunction symptoms.
Regards

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