Do you get Testosterone levels tested at the drop of a hat?
If YES, I have 2 Qs for you-
I have 5 Qs for you-
1. Do you think High Testosterone causes baldness?
2. Do you feel Finasteride decreases Testosterone levels?
3. Does the use of Finasteride decrease muscle mass?
4. Does the use of Finasteride have steroidal effects?
5. Do you think Finasteride can cause permanent sexual side effects?
If any of your answers to these 3 Qs was YES! you need to watch this Video-
Besides its male sexual function and libido, Testosterone is important to our bodies in several other ways like:
1. Bone metabolism
2. Anabolic effects or body building
3. Regulating mood and cognitive effects
4. Proper functioning of heart and vessels
To understand how testosterone is affected by Finasteride, you need to know about how Testosterone is formed and gets metabolized and how it exerts its effects on the body-
The hypothalamus releases GnRH in pulse every 60-90 minutes in order to stimulate the pituitary gland which in turn releases in a pulsatile manner the hormone LH in the bloodstream.
LH binds to LH receptors in the testicular Leydig cells o unleash a cascade of events that convert cholesterol LDL to pregnenolone, DHEA, and then Testosterone. Testosterone secreted by the testes into the peripheral circulatory system by which it reaches its target tissues
It binds to androgen receptors AR to exert its biological effect
It must be converted to DHT by 5AR (typed I, II, III) to bind to AR to exert its effects.
And last in-
Testosterone is converted to Estradiol (E2) through a reaction called Aromatization to bind to E2R receptors to exert its action.
With this knowledge let us revisit the 5 QS. I put to you in the beginning of this video-
Ques. #1 Does High Testosterone causes baldness?
Baldness happens due to excess of DHT.
Also even in those who have excess DHT, baldness happens only if you carry the Baldness Gene.
Ques. #2 Does Finasteride decrease Testosterone levels?
When testosterone hits 5AR, it does not get converted to DHT. So testosterone levels will rise.
This happens by 15% when Finasteride is used and in 25% with Dutasteride. So you have more Testosterone then you had before you started Finasteride.
The Common misconception that Finasteride and Dutasteride lower testosterone is a myth.
This is also corroborated in the Merck Manual on Finasteride where it is clearly stated that there is a 15% rise in hormonal levels.
Ques. #3 Does Finasteride decrease muscle mass?
Finasteride does not decrease testosterone levels, hence it does not decrease muscle mass.
However, it also causes increased levels of circulating Estrogen which can cause some amount of feminization. Hence some body builders use Arimidex to reduce this effect and remain manly.
Ques. #4 Does the use of Finasteride have steroidal effects?
So we have learned that Finasteride increases testosterone levels.
Also, we have more testosterone aromatizing into estrogen. Hence the higher estradiol levels.
Though the levels are higher, they still lie well within the physiological range.
So the use of these DHT blockers does not push you into ‘steroidal use territory’.
Ques. #5 Do you think Finasteride can cause permanent sexual side effects?
Crashing libido is due to androgens going down. This does not happen in the use of Finasteride.
With my experience in managing Finasteride related problems feel it should be initiated only in lean people who are emotionally strong and do not have obsessive or compulsive habits.
This is not to say that normal people who are not obese will not have side effects.
Some obese patients and also people with OCD do tolerate the drug rather well.
However in obese patients, before initiating them to Finasteride, their baseline hormonal levels should be recorded since some may have Hypogonadism.
Reports of persistent sexual symptoms, mood disorders, anxiety, and worrying cognitive complaints in a small fraction of men even after discontinuation of finasteride continue to cause apprehension in the minds of patients. Ongoing litigation and anecdotal patient stories on the internet abound. This has not helped Finasteride even though a vast majority of patients have no side effects whatsoever!
This paper (see the paper clip) evaluates basic pathophysiologic attributes of this condition, such as the hormone levels, body composition changes, cognitive function, mood, and other characteristics of patients, who report persistent sexual symptoms after discontinuation of finasteride therapy for hair loss.
However, this enigma could not be scientifically corroborated and finally has been left to the Courts to decide!
The controversy has, however, led the FDA (Food and Drug Administration) of USA to require that Propecia labels include a warning about persistent libido, ejaculation, and orgasmic problems after drug discontinuation.
If you have any questions just write in the comments section.
I learn as much from your Qs just as you do from my Video.
This stimulus of this video is a patient who mailed me recently and is obsessive about getting testosterone levels done every month every time he feels he has low libido.
But the since the results do not return low levels of Testosterone, so was confounded if whether the generic Finasteride he was taking was working
…..or there was some other reason.
Ignorance about Finasteride abounds since every forum post you read seems genuine.
Hormonal testing can be costly.
So when should you test your hormonal levels when on Finasteride?
I recommend tests only in 5 situations-
1. As a baseline when starting DHT blockers.
2. When a person is obese and I suspect hypogonadism
3. When side effects set in which cause the patient untold anxiety.
4. When switching from generic to branded Propecia or the vice versa to calm the patient.
5. When prescribing Arimidex.
What tests are recommended?
2. Estrogen ( T:E Ratio is important).
3. Blood sugar levels
4. Cholesterol levels
(because heart disease and diabetes can cause erectile dysfunction as well).
5. HIV when indicated since 30% patients with HIV and 50% with AIDS can have erectile dysfunction due to low testosterone levels.
Measurement of DHT levels is not done since the scalp DHT is what matters and there is no standardized way of measuring the levels in the scalp.