Don't doubt the connection, if you are having issues get off the medication and get re-tested.
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Attached screenshot (below) from PAGE 6:
http://www.mhra.gov.uk/home/groups/l-un ... 014027.pdf
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http://www.renalandurologynews.com/Propecia ... le/104651/
Propecia, Infertility Link Suspected
Some subfertile men may experience hormonal changes that result in lower sperm counts
January 1, 2008
WASHINGTON, D.C.—
A handful of cases suggest that finasteride (Propecia), a treatment for male pattern hair loss, may be harming male fertility.
Finasteride, a 5-alpha-reductase inhibitor used to treat BPH, is also available as a 1-mg tablet taken daily by men wishing to prevent hair loss.
It now appears that this dosage can decrease total sperm counts in some men with suboptimal fertility. The treatment does not significantly affect overall semen parameters in young, healthy men.
“
Propecia is widely used in young men who are preventing hair loss, and the reproductive consequences have never been discussed,†said Kirk Lo, MD, assistant professor in the department of surgery at the University of Toronto in Canada. “It may not be an issue in normal, healthy men, but in the subfertile population perhaps there is a change in the hormonal balance.
Propecia may change testosterone and other hormone levels.â€
Stopping drug improves sperm
At the American Society for Reproductive Medicine annual meeting here,
Dr. Lo and his colleagues reported that they observed sperm concentrations improve significantly in two men six months after they stopped taking finasteride. In one of the men—a 34-year-old with azoospermia—the improvements were strong enough to correct the condition and eliminate the need for testicular biopsy. The patient, who had a preliminary diagnosis of obstructive azoospermia and was scheduled for testicular biopsy,
had been taking finasteride 1 mg per day for hair loss for four years.
Several semen analyses over a 12-month period had revealed azoospermia with sperm rarely seen. The man's follicle-stimulating hormone (FSH) level was 3 IU/L, his luteinizing hormone (LH) level was 3.3 IU/L, and his total testosterone level was 23 nmol/L. An examination confirmed normal testicular volume and the presence of bilateral vas deferens.
The man was advised to stop taking finasteride, and 12 weeks after doing so, his sperm concentration was 0.9 2 106/mL. It climbed to 5.5 2 106/mL after six months without the drug. The patient was then told to proceed with other fertility treatments.
In the second case, a 32-year-old male with severe oligospermia had a semen volume of 1.4 mL, sperm concentration of 4 2 106/mL, 14% mo-tility, 5% normal forms, and normal testicular size. He had been taking finasteride 1 mg/day for three years.
Three months after he stopped taking the drug, his sperm concentration improved to 6.6 2 106/mL, which rose to 18.7 2 106/mL after six months.
Dr. Lo said these cases suggest that discontinuing the use of finasteride 1 mg in the infertility population may help improve semen parameters and allow for less invasive fertility treatments.
“We now have five cases in total, and at this meeting we are talking to our colleagues who are reporting two or three cases,†Dr. Lo told Renal & Urology News. “So now we are trying to get everyone together so we can report on a bigger series. It may be an issue all over the world because Propecia use is getting more popular, so physicians need to know about this.â€
Paul Turek, MD, professor of urology at the University of California, San Francisco, called this is a very important issue. “
The FDA does not require fertility studies of these drugs, and it has been the suspicion of most of us in the field that if you take this drug for more than five years then you might consider stopping it because it does look like a player in decreasing spermatogenesis,†he explained.
“But this needs to be confirmed, and it may be a good multicenter-institution study to consider undertaking.â€
Dr. Turek said he has seen six similar cases and he has encouraged his patients to stop using finasteride for treating hair loss.
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http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract
FULL PDF:
http://jcem.endojournals.org/cgi/rapidp ... 2203v1.pdf
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The Effect of 5{alpha}-Reductase Inhibition with Dutasteride and Finasteride on Semen Parameters and Serum Hormones in Healthy Men.
J Clin Endocrinol Metab. 2007 Feb 13
Context: Dutasteride and finasteride are 5alpha-reductase inhibitors (5ARI) that dramatically reduce serum levels of dihydrotestosterone (DHT).
Objective:
As androgens are essential for fertility, we sought to determine the impact of 5ARI administration on serum testosterone (T), DHT, and spermatogenesis.
Design, Setting, Subjects, and Intervention: We conducted a randomized, double-blinded, placebo-controlled trial in 99 healthy men randomly assigned to receive dutasteride (0.5 mg) (n = 33), finasteride (5 mg) (n = 34) or placebo (n = 32) once daily for 1 year.
Main Outcome Measures: Blood and semen samples were collected at baseline, at 26 and 52 weeks of treatment, and at 24 weeks post-treatment, and were assessed for T, DHT, and semen parameters.
Results: Dutasteride (D) and finasteride (F) significantly (P < 0.001) suppressed serum DHT compared with placebo (dutasteride, 94%; finasteride 73%), and transiently increased serum T.
In both treatment groups, total sperm count compared to baseline was significantly decreased at 26 weeks (D -28.6%, F -34.3%) but not at 52 weeks (D -24.9%, F -16.2%) nor at the 24 week follow-up (D -23.3%, F -6.2%).
At 52 weeks, semen volume was decreased (D -29.7%, F -14.5%, significantly for D) as was sperm concentration (D -13.2%, F -7.4%, neither significant).
There was a significant reduction of 6-12% in sperm motility during treatment with both dutasteride and finasteride and at follow-up. Neither treatment had any effect on sperm morphology.
Conclusions:
This study demonstrates that the decrease in DHT induced by 5ARIs is associated with mild decreases in semen parameters that appear reversible after discontinuation.
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Spermatozoa and Chronic Treatment with Finasteride
http://www.informaworld.com/smpp/conten ... 630~db=all
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Finasteride is a specific inhibitor of the 5 reductase enzyme originally approved for the treatment of benign prostatic hypertrophy and also for the treatment of androgenetic alopecia (Androgenetic Alopecia) in men at a dose of 1 mg/day.
We report on three cases of young men recruited at our Centre for Male Infertility who had used finasteride for five years.
Semen quality was investigated by light microscopy to evaluate sperm concentration and motility.
Sperm morphology was performed by transmission electron microscope (TEM) and the data were analyzed.
The presence of Y microdeletions was investigated by PCR. Meiotic segregation was explored by fluorescence in situ hybridization (FISH).
Patient 1 was azoospermic, patients 2 and 3 showed a normal sperm concentration and severely reduced progressive motility. TEM analysis revealed altered sperm morphology consistent with necrosis and FISH data revealed elevated diploidy and sex chromosome disomy frequencies.
This examination was repeated 1 year after the men had suspended the use of finasteride, without receiving any other treatment. A recovery of spermatogenetic process was observed.
Motility and morphology improved whereas the meiotic pattern did not change presenting elevated diploidy and sex chromosome disomy frequency.
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Male Contraception: Views to the 21st
Century, Bethesda, MD, USA,
9–10 September 1999
http://dspace.hsl.washington.edu/dspace ... _Views.pdf
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"...
The tissues of the male reproductive
tract, including the epididymis (and
even the testis), are target tissues for
androgens. However, very little is
known about the mechanism of action
of androgens on these tissues.
Androgens
are found in high concentration
in the epididymal lumen, and the
importance of androgens, particularly
dihydrotestosterone in sperm maturation
is well known.
Indeed, androgen
withdrawal results in apoptotic cell
death along the entire epididymis8.
Thus, it becomes critical to identify the
genes that are controlled by androgens.
In this regard, a murine epididymal
retinoic acid-binding protein, belonging
to the lipocalin family of proteins, was
recently characterized and found to be
androgen regulated and expressed in
the caput epididymidis9.
As dihydrotestosterone
levels are high in the caput
region, it is reasonable to propose that
blockage of 5a-reductase activity with a
compound such as finasteride would
provide an effective means to block the
expression of androgen-regulated genes
that are important for sperm maturation
at least in the caput region.
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Screenshots from FDA Propecia Clinical trials:
From
http://www.fda.gov/cder/foi/nda/97/2078 ... EDR_P4.PDF
PAGE 4, Page 6, PAGE 7
