A study just published in The Journal of Sexual Medicine documents the persistent sexual side effects of finasteride (Propecia, Proscar), a medication commonly used for both male pattern baldness and prostate hyperplasia, that too often are not discussed when prescribed. The authors observe:

“Finasteride has been associated with reversible adverse sexual side effects in multiple randomized, controlled trials for the treatment of male pattern hair loss (MPHL). The Medicines and Healthcare Products Regulatory Agency of the United Kingdom and the Swedish Medical Products Agency have both updated their patient information leaflets to include a statement that “persistence of erectile dysfunction after discontinuation of treatment with Propecia has been reported in post-marketing use.””

They set out to…

“…characterize the types and duration of persistent sexual side effects in otherwise healthy men who took finasteride for MPHL,”…

…by investigating the new onset of sexual side effects lasting for at least 3 months despite discontinuing finasteride. What did their data show?

“Subjects reported new-onset persistent sexual dysfunction associated with the use of finasteride: 94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm…The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date.”

The authors admonished practitioners in their conclusion to offer patients the courtesy of full disclosure:

“Physicians treating MPHL should discuss the potential risk of persistent sexual side effects associated with finasteride.”

This report follows a study published earlier this year on persistent sexual side effects from finasteride and another 5α-reductase inhibitor (5α-RI), dutasteride, when used to treat urinary tract symptoms caused by prostate enlargement. They also stated:

“Prolonged adverse effects on sexual function such as erectile dysfunction and diminished libido are reported by a subset of men, raising the possibility of a causal relationship…We suggest discussion with patients on the potential sexual side effects of 5α-RIs before commencing therapy. Alternative therapies may be considered in the discussion, especially when treating androgenetic alopecia.”

Clinicians reading this will know that 5α-reductase inhibitors block the conversion of testosterone to dihydrotestosterone (DHT). DHT is 10 times stronger in conferring androgen stimulation on tissues—the loss of male hormone effects is more precipitous with smaller reductions of DHT. It is important to note that the hormone measurements were not done for these patients. Other factors, and other hormones, including estrogen and insulin, also affect the prostate. In the functional approach to MPHL and prostate hyperplasia the bioactive free fractions of testosterone, DHT and estrogen, along with other analytes are always measured to determine (1) if DHT is actually too high (not always the case), and (2) if a natural or synthetic 5α-reductase inhibitor is used, to make sure that DHT is not reduced too much (by follow-up tests). Excessive reduction of testosterone receptor stimulation is a risk not only for sexual side effects but also depression, cardiovascular disease, sarcopenia (loss of muscle mass), osteoporosis and other ailments.

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The standard bicycle seat can deliver a significant insult to the nerve and blood vessel supply to the male genitalia. There have been numerous studies investigating the relationship between bicycle riding and erectile dysfunction. The authors of a paper published a while back in The Journal of Sexual Medicine that reviewed the science set out to:

“…summarize accumulating data on the safety of bicycle riding based on medical evidence categorized by levels of evidence, including case reports, observational studies, case control studies, mechanistic studies, and population-based epidemiologic investigations. The secondary aim was to address the concerns of bicyclists and propose measures to minimize the risk of ED associated with bicycle riding.”

The mass of data revealed a clear picture and yielded specific recommendations:

“Bicycle riding more than 3 hours per week was an independent relative risk for moderate to severe ED. Therefore, bicycle riders should take precautionary measures to minimize the risk of ED associated with bicycle riding: change the bicycle saddle with a protruding nose to a noseless seat, change the posture to a more upright/reclining position, change the material of the saddle (GEL), and tilt the saddle/seat downwards.”

The authors note in their conclusion:

“Straddling bicycle saddles with a nose extension is associated with suprasystolic perineal compression pressures, temporarily occluding penile perfusion and potentially inducing endothelial injury and vasculogenic ED.”

In a subsequent paper published in the same journal this year the authors revisit the problem and begin by noting:

“For many years, reports in the literature have implicated bicycle riding as causing increased risk of erectile dysfunction (ED). Perineal compression during cycling has been associated with the development of sexual complications.”

They conducted a comprehensive review of the scientific literature and found that further studies had firmly established the risk of cycling-related sexual dysfunction and extended it to females:

“There is a significant relationship between cycling-induced perineal compression leading to vascular, endothelial, and neurogenic dysfunction in men and the development of ED. Research on female bicyclists is very limited but indicates the same impairment as in male bicyclists.”

The authors of a review published earlier in European Urology caution practitioners to be aware of this widespread phenomenon. They report that a range of problems have been documented:

“The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50–91% of the cyclists, followed by erectile dysfunction reported in 13–24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.”

They conclude by exhorting practitioners to be alert:

“Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.”

Perhaps this could contribute, at least to some degree, occurrences of ‘cyclist road rage’. Are there any remedies or recommendations for cyclists to follow? Another study in The Journal of Sexual Medicine investigated the condition in police officers:

“The average bicycle police officer spends 24 hours a week on his bicycle and previous studies have shown riding a bicycle with a traditional (nosed) saddle has been associated with urogenital paresthesia and sexual dysfunction.”

The officers manifested the typical problems, but also demonstrated some improvement when using a ‘no-nose saddle’:

“(i) With few exceptions, bicycle police officers were able to effectively use no-nose saddles in their police work. (ii) Use of no-nose saddles reduced most perineal pressure. (iii) Penile health improved after 6 month using no-nose saddles as measured by biothesiometry and IIEF. There was no improvement in Rigiscan® [nocturnal erection] measure after 6 months of using no nose saddles, suggesting that a longer recovery time may be needed.”

It only makes anatomical sense that insult to the nerves and blood vessels that supply the genitalia could cause sexual dysfunction in both males and females.

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Metabolic syndrome and it’s associated hormonal, neurological and vascular effects is a major factor affecting sexual function for women too, as described in this recent paper: “The MS is strongly correlated with erectile dysfunction, hypogonadism (predictors of future development of MS), and female sexual dysfunction.” [Note: MS = metabolic syndrome]

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I hope this post is widely distributed because, based on the gluten gene sensitivity test results and hormone profiles I am getting (consistent with these findings), a large percentage of men need to see it. Here are just a few research papers from major journals that seem to be largely ignored:

1. Gluten reactions cause tissue resistance to testosterone
2. Hypogonadism (impaired testicular function), infertility, and sexual dysfunction occurring with gluten reactions
3. Pituitary regulation of testicular function disrupted by gluten reactions

Do someone a favor and pass it on.

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