T Nation

Finasteride Problems. Wait or Try a Rest?

Hi All-

I seem to have been burned by long-term finasteride use and wondering what you might do in my shoes. I’m thinking to either try a restart, hold tight and wait, or maybe try TRT (which has a bad track record for a lot of people, perhaps due to 5AR / 3a-diol g issues). Some have clearly benefited. Above all, don’t want to make things even worse (hoping to try something intelligent and not turn myself into an experimental lab rat). I read this PCT finasteride recovery story (and similar stuff) which was interesting and had me thinking to post at T Nation. Here’s what I read: https://forum.propeciahelp.com/t/i-think-im-healed-after-six-year-nightmare/35477/2

Background

Right now, I’ve got all the symptoms of hypogonadism (lack of motivation, very patchy beard, lack of libido, watery sperm, depression, anxiety, brain fog, et al). Really, I could live with all that shit, though it sucks. But the one that bothers me above all is very severe ED. Can only get erections under perfect conditions and they go away pretty fast (zero spontaneous erections, no nocturnals, max does Cialis doesn’t really work?). I’m wondering if long term DHT deprivation has degraded things to a point of no return where I’m totally fucked. The details of this recovery story is similar to my situation (he kept on the drug after problems arose, not making the connection), and he recovered naturally after 4/5 years. Many or maybe most don’t recover though: https://forum.propeciahelp.com/t/fully-recovered/3714

Timeline of Notable Events

Almost 9 years ago: Started Propecia and took it continuously for about 7 years.
Noticed watery semen almost immediately. Read online it was “normal” and “reversible” upon quitting and so soon forgot about it. Perceptible sex drive increase noticed, probably from the extra free T and much lower DHT.

About 5 years ago: Had a failed double jaw surgery that added a lot of stress. Pretty clear bone loss for lower jaw to support soft tissues. Would like to eventually sort that out.

About 4 years ago: Unexplainable and noticeable decline in motivation / ambition in life. Major “burnout” that remains today, probably increased over time.

About 2 years and 3 months ago: Noticed slightly weaker erections, thought might be stress related.

About 2 years ago: Losing erections during sex and very high anxiety.

Early September 2018 (About 1.5 years ago): Decided to get off finasteride completely.

To date: Symptoms remain (including watery sperm, severe ED (but not totally impotent), penile rotation on axis, curvature when erect (which isn’t often), maybe some thinning/low temperature. But it’s not typical peyronie’s. Multiple doctors believe I’m “normal”).

Available Labs (as mentioned, completely off Finasteride since early September 2018)

*Elevated IgA - 346 mg/dL; 47 - 310 mg/dL (think it suggests an auto immune which runs in family).

The following lab results aren’t pasting all that great, but some of the issues below are LH - dropped on last test to 2.8. Total testosterone dropped on last test to 355 (150+ point decline in just months), low free t percentage despite normal SHBG / Albumin. Possible elevated thyroid issues, though in range.

||May 2019|August 2019|February 2020|Ranges|
|SA (Prostate?)||1.16 ng/mL||0.00 - 4.00 ng/mL|
|Estradiol||23 pg/mL|21 pg/mL|< OR = 39 pg/mL|
|FSH||4.7 mIU/mL|4.3 mIU/mL|1.6 - 8.0 mIU/mL|
|LH||3.9 mIU/mL|2.8 mIU/mL|1.5 - 9.3 mIU/mL|
|Prolactin||11.0 ng/mL|10.4 ng/mL|2.0 - 18.0 ng/mL|
|Testosterone|444 ng/dL|512 ng/dL|355 ng/dL|250 - 1,100 ng/dL|
|Testosterone, Free|81.7 / pg/mL|66.1 pg/mL|Result Pending|46.0 - 224.0 pg/mL|
|Testosterone Bioavailable||135.9 ng/dL||110.0 - 575.0 ng/dL|
|Sex Hormone BG||35 nmol/L|Result Pending|10 - 50 nmol/L|
|Albumin||4.5 g/dL|Result Pending|3.6 - 5.1 g/dL|
|TSH||2.55 mIU/L|2.59 mIU/L|0.40 - 4.50 mIU/L|
|Free T3|||3.0 pg/mL|2.3 - 4.2 pg/mL|
|Free T4||1.1 ng/dL||0.8 - 1.8 ng/dL|
|Dihydrotestosterone||32 ng/dL|Result Pending|16 - 79 ng/dL|
|Vitamin D||60 ng/mL|64 ng/mL|30 - 100 ng/mL|
|3 Alpha Diol G|||Need to go test||

All CBC / annual physical labs. Nothing notable there.

I take Cialis at night, doubt it’s doing much though.

Your testosterone fluctuates all the time, it’s just a natural daily fluctuation. Your testosterone levels change every day and if you run lab every day you would see different levels each time.

Nobody can tell you what to do, you have to make the decision because it’s your life. Propecia/PFS changes gene expression between target tissues and even shows abnormalities in the brain regions which causes depression and problems regulating sexual arousal and some evidence of neuropathy.

If your doctors can’t diagnose you with disease on a lab testing, they can’t bill your insurance so of course they are going to say you are normal. Post Finasteride Syndrome can’t be diagnosed on lab testing, I mean they can’t run a Post Finasteride Syndrome lab test to see if you have it.

This isn’t the only problem, a lot of doctors still don’t believe Post Finasteride Syndrome exists and just say it’s all in your head or that you had some type of mental breakdown and it was a coincidence that you happened to be on this drug at the time.

You doctors believe your hormones are normal because they are, you’re in range. Now it might not be normal for you, but your being compared to everyone else. If you had a hormone panel done pre-Propecia and you lost half your testosterone post treatment, you could argue your case.

Keep in mind TRT is very individual so many of the guys saying TRT didn’t help doesn’t mean it couldn’t (doesn’t mean it would either). Many men here without PFS have a hard time with TRT for many reasons: they don’t give it enough time, they don’t find the optimal dosage or play around enough to find the right dose, they take auxiliary drugs that effect it’s outcome, they are overweight & don’t exercise or any number of wrong ways to do it. If you don’t have any other options I would try it and my levels were higher than yours pre-TRT.

I would also do a very limited diet where you only eat a select few different foods for a couple months and see how that effects you. If you start feeling remarkably better you can systematically add in more variety. Doing this has helped many folks with things like autoimmune issues than conventional medicine doesn’t help enough with. It can’t hurt.