Question:
Erectile difficulties from dutesteride and finesteride
Answer:
I am a physician who was the medical director of one the largest
erectile dysfunction/sexual dysfunction clinics in the world. Many of
the treatments for BPH cause erection problems.
Finesteride and dutesteride both block the formation of
Dihydrotestosterone which is essential for normal sexual function and
needed for good erections, for sperm production and ejaculation. These
medications can also shrink an enlarged prostate. Even though only
3-5% of men will have profound erection problems when they start these
medications the majority of men using them will have a significant and
very real decline in the quality of their erections. Spontaneous
erections and mornming erection will become less frequent and
eventually stop which are one of many signs that a man's sexual
functionis being weakened while on these medications. These changes
that happen gradually and very few doctors know the correct questions
to ask to detect these problems. But once erections have started to
weaken it is my experience that these changes are usually irreversible.
Stopping these medications will not restore normal erections again.
Most men who experience erectile problems on these medications it is
irreversible.
I am also sickened by the large numbers of men who are receiving
radical prostatectomies for small or minor elevation of the PSA. There
are many men with no symptoms or signs of BPH but who have only a small
increase in their PSA who are recieving biopsy's of their prostate.
In Canada Urologists make a living doing procedures.
So when a man is referred to an urologist even when the prostate is not
enlarged and their are no symptoms the patients are often told that to
be safe they should have an ultrasound and a biopsy.
Well most men with prostate cancer never find out that they have it and
die from something else. In fact if you did an autopsy on men 60 years
old, 60% will have microscopic prostate cancer, 70% of men aged 70
years old will have prostate cancer, 80% 0f men over 80 will have
microscopic prostate cancer, and 90% of men aged 90 years old will have
prostate cancer but very few of these men will ever die or have
problems from their cancer.
That is why it is dangerous to be doing routine biopsies on men with a
PSA below 10.
Because if you are 70 years old you will have up to a 70% chance of
that test showing that you have cancer, even though their is only less
that a 1/10 chance that that cancer will ever enlarge and cause you
problems. If the prostate is normal only if that PSA goes from below
10 to well over 10 do you need to have a biopsy.
Most men with a positive biopsy within days or a few weeks are having a
radical prostatectomy, which means they will never ever ejaculate
again; they will never ever have a normal erection without using
intra-penile injections. More than 50% will be incontinent of urine
and have to wear diapers for the rest of their lives, and perhaps 20%
will have fecal incontinence.
In fact the majority of men I see who have profound sexual dysfunction
from prostate cancer had no symptoms and the only reason they had the
biopsy was because of a minor increase in their PSA.
Since the introduction of the PSA test Urologists are doing 4 times
more radical prostatectomy's even though their has been no decrease
in the death rate from prostate cancer! Doctors may just doing more
un-necessary surgeries on men who would never have had any problems if
they had been left alone.
If you have a PSA test that is less than 10, wait a few months and
repeat it. Only if the PSA is rising, or you have signifcant
enlargement, reduced or blocked urine flow or asymetry or a nodule
should you consider a biopsy if your PSA is below 10. If you elect to
have a biopsy remember if it is positive you will imediately have the
quality of your life profundly changed in a very short period of time!
Remember erectile problems rarely are caused by the prostate, it is the
tests and procedures such as cystoscopies, biopsies and
TURPS/prostatectomies done by urologists that damage the penis that are
going to ruin your sex life, not the postate itself if it is left
alone. All patients need to be fully informed before they can make an
informed choice about the choices of treatment offered to them.
