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The Daily Tar Heel

Sex and drugs on rocky ground

Ian Dury was very clear at the start of his 1977 punk rock hit, “Sex and drugs and rock and roll is all my brain and body need / Sex and drugs and rock and roll are very good indeed.” But sex and drugs don’t always go so well together, regardless of the influence of rock and roll.

Endocrinologist and internist Dr. Michael Irwig at George Washington University noticed something in the patients he was treating for male pattern baldness. After taking the drug finasteride (brand name Propecia), many of his patients were reporting difficulty with sexual desire, erection and orgasm.

It makes perfect sense. Finasteride works by blocking an enzyme which helps our body convert testosterone into the more potent dihydrotestosterone, or DHT. While DHT does lead to the hair loss characteristic of male pattern baldness, it also may have a role in maintaining sex drive and sexual function.

So even though finasteride was preventing hair loss in Irwig’s patients, it was also impairing their sex lives.

What is surprising is just how prevalent these side effects were. Irwig and his colleague Swapna Kolukula published their findings in the Journal of Sexual Medicine. Out of the 71 patients interviewed, 94 percent reported low libido; 92 percent, erectile dysfunction; 92 percent, decreased arousal; 69 percent, problems reaching orgasm.

And though previous trials have claimed that the sexual side effects of finasteride are usually temporary, these patients reported a persistence of the side effects for an average of 40 months after stopping the medication; 20 percent said for 6 or more years after. It is unclear if the long-term effects can be reversed.

These findings add finasteride to the growing list of medications with sexual side effects, including antidepressants and cancer drugs. These side effects present a serious dilemma: How important is your sexual health? Is sex more important than treating your depression, your baldness, or your tumor?

Many say yes. In a Spanish antidepressants study, 38.3 percent of patients considered the sexual side effects to be unacceptable and to pose a risk for noncompliance.

The good news is that sometimes, you don’t have to choose. You could switch to a different medication or reduce your dose. You might schedule sexual activity right before taking a new dose or take a “drug holiday” if possible. You can even add a new medication, sex practice, or sexual aid that addresses the dysfunction itself.

Whatever the case, it is important for both physicians and patients to acknowledge that sexual health plays an important role in quality of life. In a Japanese study on antidepressants from this year, only 36.6 percent of female respondents and 60.7 percent of male respondents reported their sexual side effects to their physicians.

If we can open up these lines of communication, then patients and physicians can work together to address health issues and maintain sexual satisfaction, and potentially avoid the months and years of sexual dysfunction experienced by Irwig’s patients.

It is possible. You can have your sex. You can have your drugs. Now go rock and roll.

Perry Tsai is a columnist from The Daily Tar Heel. He is a sophomore medical student from New Orleans, LA. Contact him at perrytsai@gmail.com.

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