A pilot study on the sexual side effects of finasteride as related to hand preference for men undergoing treatment of male pattern baldness

Abstract

E 2 2 1What ' s known on the subject? and What does the study add? Cerebral lateralization/specialization is a neurophysiological feature that has been documented regarding somatic, psychological and sexual functioning and that may be manifested in differences in hand preference, cognitive style, gonadal hormonal effects and possibly even sexual orientation. In this study we investigated a possible cerebral lateralization effect on sexual response for dihydrotestosterone, using fi nasteride as a hormone-blocking compound.The results of this study differ substantially from other studies examining the effects of fi nasteride on sexual response, presumably due to the greater restrictions we placed on defi ning relevant sexual activity, to our alerting patients to both positive and negative sexual effects and to the fact that we assessed the effects separately in right-handed vs left-handed patients. Handedness, as a proxy for cognitive style and possible lateralization of effect/function, appears to be a relevant factor when considering the sexual effects of specifi c gonadal hormones. OBJECTIVE• To investigate the relationships between pharmacologically induced deprivation of dihydrotestosterone, sexual arousal, libido and hand preference, by comparing the self-reported sexual response prior to and during reception of the anti-androgen fi nasteride in men undergoing treatment for male pattern baldness. PATIENTS AND METHOD• In total, 33 sexually healthy Romanian men participated in this study.• Patients prospectively provided information regarding their sexual functioning (over 4 weeks), as measured by the International Index of Erectile Function (IIEF) prior to and after commencing treatment with 1 mg fi nasteride for male pattern baldness. RESULTS• Overall IIEF scores as well as the erectile function, orgasmic function, sexual desire and overall satisfaction subscales showed group, treatment and group by treatment effects.• The intercourse satisfaction subscale showed group and group by treatment effects.• On most subscales, right-handed men showed no effect or lower sexual function whereas left-handed men reported no effect or improved sexual function, primarily. CONCLUSIONS• These results suggest that the sexual effects of dihydrotestosterone deprivation may depend on handedness -a proxy variable that may represent cognitive style -which lends further support to the idea of two distinct neuroendocrine psychosexual axes.• They further suggest that detection of such sexual effects may be enhanced by using research methodologies and communication strategies that increase patients ' sensitization to such effects. KEYWORDS INTRODUCTIONSexual hormones, sexual orientation, cognitive style and handedness may all be interrelated. For example, sexual hormones may be related to an individual ' s sexual orientation [ 1 ] , with androgens possibly operating in gay men and heterosexual women, and oestrogens operating in heterosexual men and lesbian women [ 2,3 ] . Sexual orientation may also, however, be linked to handedn...

A Pilot Study on Tamoxifen Sexual Side Effects and Hand Preference in Male Breast Cancer

“…In order to be directed toward one or to the other neuroendocrine axes (left or right hemibrain), peripheral inputs need to be acted upon by different neuromodulators such that a modulator channeling information toward one axis would not do so toward the other. Indeed, distinct antiandrogenic compounds act exclusively on either one or the other neuroendocrine axes, as demonstrated in previous studies with bicalutamide and finasteride (Motofei et al, , 2013, and now confirmed by the current results with tamoxifen. In our sample, tamoxifen decreased sexual function more in left-handed men, suggesting that the specific relationship between sexual function and estrogens in these men is generally different from that of right-handed men, an effect possibly due to differential processing of visual/sexual information by these two groups.…”

“…In contrast, previous studies suggest predominantly androgen-based sexual activation in right-handed men (Motofei et al, 2013). In order to understand the interrelation among sexual hormones and hand preference, we provide further contextual interpretation of the results taking into account the relevant literature data.…”

“…Consistent with these observations, we previously observed that finasteride, a 5a-reductase inhibitor that prevents conversion of testosterone into 5a-dihydrotestosterone, induces adverse sexual side effects primarily in men (Irwig, 2012a) who are righthanded (Motofei et al, 2013). Consequently, we hypothesized that left-handed men, in contrast, might be more sensitive to the effects of estrogenic modulation on sexual function.…”

“…Similar to previous studies, this instrument was administered with the assistance of a clinician and scored on the following dimensions: erectile function (EF: 6 items), orgasmic function (OF: 2 items), sexual desire (SD: 2 items), intercourse satisfaction (IS: 3 items), and overall satisfaction (OS: 2 items) (Chirica et al, 2014;Georgescu et al, 2013;Motofei, Rowland, Popa, Kreienkamp, & Paunica, 2011;Motofei et al, 2013).Onlypatientsmeetingthecriteriaofnormalornear-normal sexual functioning on all subscales of the IIEF were included in this study (see Results section).…”

Are hand preference and sexual orientation possible predicting factors for finasteride adverse effects in male androgenic alopecia?

“…We have already performed a study in this regard (s3, s4) that confirmed the previous expectation regarding hand preference (2), but the number of homosexual participants in our sample was too small. [6] Thus, we believe a larger study including many participants, a significant number of whom are homosexual men should help clarify (inter) relationships among sexual orientation, hand preference and finasteride adverse effects.…”