Q. My dermatologist prescribed Propecia for hair thinning, but I was surprised to read in the accompanying literature that it is for men only. I take Premarin and wonder if there will be a drug interaction.
A. Propecia (finasteride) has been shown to reverse male pattern baldness in men…to a certain extent. This is no magic wand that will restore a full head of hair in a few days or weeks. It does add hair, but it is not a cure for baldness.
To date, we haven’t seen any studies of its effectiveness in women, though it might possibly work. The FDA makes it very clear in the official package label that:
“PROPECIA® is indicated for the treatment of male pattern hair loss (androgenetic alopecia) in MEN ONLY.”
“Risk to Male Fetus
PROPECIA is not indicated for use in women. Women should not handle crushed or broken PROPECIA tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential risk to a male fetus. PROPECIA tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed.”
The reason the FDA has such a strong warning is that women of child-bearing age must avoid Propecia, as this drug could affect the sexual development of a fetus. Since you are post-menopausal, that is no longer a fear. It is unlikely there would be an interaction between Premarin and Propecia.
There are some other concerns, however. A study published in the Journal of Sexual Medicine (online, July 12, 2012) suggests that some men may suffer long-lasting complications after quitting finasteride. Michael Irwig, MD, recruited young, healthy subjects who had taken Propecia for hair loss. Their average age was 31 and they had not experienced sexual problems before taking this medication. All of the volunteers in this study had complained of erectile dysfunction or other sexual difficulties while taking the drug and for a time after stopping.
The surprising finding from this research is that 96 percent of these otherwise healthy young men were still having significant sexual problems roughly a year after Dr. Irwig enrolled them in the study. He is concerned that in some cases such sexual side effects could be permanent.
Men reported lowered sex drive, reduced arousal, erectile dysfunction, impaired sensation and less satisfaction with orgasm. They also complained of semen quality, penis curvature and decreased testicular size. Some men had more difficulty sleeping or became depressed after taking finasteride.
As far as we can tell no one has looked into the possibility of finasteride causing sexual side effects in women. Over the decades researchers have been slow to study sexual side effects for most medicines. That includes antidepressants like fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and many similar drugs. Hormones like estrogen and progesterone may also have a negative impact on sexuality.
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