Men who have an ejaculation disorder frequently have an inability to ejaculate despite prolonged stimulation, and if they do ejaculate, semen volume is much lower than normal.
April 11, 2012: The U.S. Food and Drug Administration (FDA) announced today that it will be updating the label on Propecia to warn of the risk of persistent ejaculation disorders, orgasm disorders, and erectile dysfunction. These side effects may persist for months or indefinitely after a man stops using Propecia. Click here to read the FDA statement.
Propecia (1-mg finasteride) is a drug that millions of men have used to reduce hair loss caused by genetic male pattern baldness. Propecia is manufactured and sold by the pharmaceutical company Merck & Co., and it was approved by the U.S. Food and Drug Administration (FDA) in 1997. Propecia works by inhibiting an enzyme called 5-alpha reductase, which converts the male androgen testosterone into dihydrotestosterone (DHT). Men taking Propecia can expect to see their DHT-levels drop by at least 75%.
Men who have male-pattern baldness have a genetic predisposition to lose their hair after prolonged exposure to DHT. So, by inhibiting DHT, Propecia treats male pattern baldness. Unfortunately, Propecia can also cause severe side effects, such as ejaculation disorders. Even more troublesome, many men are reporting that Propecia ejaculation disorders do not resolve once Propecia is stopped.
During male ejaculation, a coordinated series of events loads semen in the male urethral channel (called “emission”). During climax, this fluid is ejected outside the body. Coordinated neurological signals causes rhythmic contractions of certain muscles in the penis, resulting in ejaculation.
Normally, ejaculate has a volume of at least 1.5-2 mL. During the process of ejaculation, sperm mixes with fluids from the prostate and other glands. Ejaculate is composed of several fluids, including sperm (around 10% of total ejaculate volume), enzymes, zinc, citrate, and fructose. These other fluids help increase the chances that sperm will survive and fertilize an egg.
The finasteride in Propecia was initially developed to shrink enlarged male prostate. The prostate secretions are influenced by dihydrotestosterone (DHT), a hormone that is inhibited by Propecia. Normally, the prostate secretes white or clear fluids that contain enzymes, citrate, and more. These secretions usually compose 20-30% of total semen volume. Many men have reported that after using Propecia, the amount of semen volume decreased significantly.
What are Ejaculation Disorders?
The most common types of ejaculation disorders are:
- Failure of Ejaculation: This occurs when a man reaches sexual climax, but no semen is ejected from the penis.
- Retrograde ejaculation: This disorder occurs when semen is passed into the bladder, instead of into the male urethra. This may cause a man’s urine to be mixed with semen.
- Premature ejaculation: This disorder occurs when a man ejaculates with minimal sexual stimulation, and before he wishes to ejaculate. It is thought to be the most common form of sexual dysfunction.
- Retarded orgasm: This ejaculation disorder is very difficult to treat, and it is one of the ejaculation disorders commonly reported by Propecia patients suffering from sexual side effects. This condition occurs when a man is unable to reach orgasm (ejaculate) within 30 minutes of sexual stimulation. In the most severe cases, a man may be completely unable to orgasm. This symptom may be caused by medications, decreased sensation in the penis, psychological disinterest in sex, and unknown causes. Doctors who treat this condition find that men who have delayed ejaculation are easier to treat than men who have no ejaculation. However, it remains very difficult to treat this type of sexual dysfunction.