Erectile Dysfunction: A Common Sexual Symptom of Post-finasteride Syndrome

If you've read about Post-finasteride Syndrome (PFS), you're likely familiar with the persistent erectile dysfunction reported by many patients. In this article we review what erectile dysfunction is, how it presents in PFS, and the resources and support available for patients experiencing this symptom. 

What does persistent erectile dysfunction from finasteride entail?

Erectile dysfunction (ED) is a medical condition characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED not only affects sexual health but can also significantly impact a person's psychological well-being and interpersonal relationships. In addition to clinical erectile dysfunction, many PFS patients report a range of changes in erectile quality and frequency. These include but are not limited to:

  • Reduced erection quality: Erection quality considers an erection with regard to its suitability for penetrative sex, and is most commonly measured by hardness. 

  • Loss of spontaneous erections: Spontaneous erections are erections that occur independent of sexual stimulation. 

    • Loss of nighttime erections: Nighttime erections are a form of spontaneous erections that occur at night, or while an individual is asleep. A common term for this phenomenon is nocturnal penile tumescence (NPT).

  • Increased refractory period: In this case, the refractory period is the time after ejaculation where an individual is physiologically unable to get an erection. 

It should be noted that erectile dysfunction and other changes in erections are common side effects experienced while taking finasteride. Self-reports indicate that it can take up to 3 months for on-drug side effects to resolve after discontinuation of the drug. After that, the symptoms can be considered persistent. 

How PFS patients describe the effects of erectile dysfunction

Here are some descriptions from patients based on documented interviews and stories: 

“PFS has stripped me of my confidence… it’s hard to be confident when approaching [potential sexual partners] if you are unsure whether you’ll be able to perform.“

“It’s hard to have relationships if you can’t have sex.“

How common is erectile dysfunction as a symptom of Post-finasteride Syndrome?

While there are estimations of incidence for erectile dysfunction as a side effect of finasteride, there is limited data with which to estimate the prevalence of erectile dysfunction in PFS. Anecdotally however, it is one of the most common symptoms. 

Research findings on erectile dysfunction in PFS 

Two separate studies have found an overexpressed androgen receptor in affected tissue from PFS patients (Di Loreto et al. 2014; Howell et al. 2021), and in addition one of them examined for and found concurrent differential expression of several thousand genes (Howell et al. 2021). Notably, there are numerous pathways by which adequate androgen receptor function is necessary for erectile function. 

Other studies of PFS have found penile vascular abnormalities (Khera et al. 2020; Carlisle et al. 2022), penile fibrosis (Rubin et al. 2017), and neuropathy of the pudendal nerve (Melcangi et al. 2017) present in some patients.   

It is essential to note that more research into post-finasteride syndrome is desperately needed. PFS is currently without an accurate animal model, pathomechanistic understanding, and as a result, safe and effective treatment. 

Does persistent erectile function after finasteride go away? Is it reversible?

Some patients have reported improvement in erection quality and other erectile symptoms over time. However, PFS is understood to persist indefinitely, and it is currently without safe and effective treatment. 

Managing and coping with erectile dysfunction

For those who may be struggling with symptoms, here are some general recommendations:

  1. Focus on self-care: Try to find routines and activities that help you personally.

  2. Be practical about your life situation and/or relationships: Try not to think too far ahead and catastrophize. PFS affects individuals to different degrees and some experience improvements over time. 

  3. Familiarize yourself with the scientific literature: Read through previous research into PFS on our website in order to better understand your condition.

  4. Support research: Further research into PFS, based on a theory and/or conceptualization of the condition that is backed by all previous research findings and can plausibly explain all symptoms reported by patients, is the only way toward a treatment.

What about supplements or other drugs to help treat symptoms?

There are currently no evidence-based items recommended for treatment of erectile dysfunction stemming from PFS. In general, patients have reported worsening by attempting to treat their symptoms with anti-androgenic substances. We are obligated to make patients aware as this has preceded patient suicide.  

Next steps 

If you or a family member is experiencing erectile dysfunction from finasteride, there are multiple resources available to you and ways you can help:

Learn more about Post-Finasteride Syndrome 

  • Read our Frequently Asked Questions page.

  • Inform your physician. PFS Network provides resources to help patients discuss PFS symptoms with their clinicians. Not sure about how to start the conversation? Start here.

  • Read about previous studies of PFS. 

  • Experiencing other symptoms? You can find information on other persistent side effects from finasteride here.

Help us fund research 

  • Consider donating to help fund our research projects. The best and easiest way to support research into PFS is through a monthly recurring donation. Every amount matters. 

    Learn more about our ongoing research projects.

Report your symptoms

  • Refer to your country’s pharmacovigilance organization by reviewing our regulatory list, or by consulting the World Health Organization’s (WHO) list of reporting resources here: https://who-umc.org/ (Scroll to the bottom to select your country from the map provided).

Stay up-to-date

  • Sign up for our mailing list to stay up to date on research and news related to PFS: Email sign-up

  • View and subscribe to our YouTube channel. You may also consider appearing on our patient interview series. 

Connect with other PFS patients

  • Follow our Patient Stories & Interviews to hear how others have experienced similar symptoms of erectile dysfunction.

  • Join our community forums. PFS Network operates the largest and longest-running standalone patient forum, propeciahelp.com, where patients can connect with others affected by adverse reactions to finasteride. The charity also operates r/FinasterideSyndrome on Reddit.