1. Introduction
1.1 Research Background and Significance
In the field of modern medicine, finasteride, as an important therapeutic drug, plays a crucial role in the treatment of benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA). BPH is a common urinary system disease among middle – aged and elderly men. With the intensification of global population aging, its incidence has been increasing year by year. According to relevant statistical data, the incidence of BPH in men over 60 years old exceeds 50%, and in men over 80 years old, it is as high as over 80%. BPH can cause a series of lower urinary tract symptoms such as frequent urination, urgent urination, and difficulty in urination, seriously affecting the patient’s quality of life. As a 5α – reductase inhibitor, finasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT), reducing the level of DHT in the prostate, thereby inhibiting the hyperplasia of the prostate and effectively improving the patient’s urination symptoms, playing an important role in the treatment of BPH.
AGA is also a common disease that plagues many men, with an incidence rate of 20% – 30% among men. AGA not only affects the patient’s appearance but also has a negative impact on the patient’s mental health, leading to negative emotions such as low self – esteem and anxiety. Finasteride inhibits the production of DHT in the scalp, prevents follicular miniaturization, promotes hair growth, and prevents further hair loss, making it one of the first – choice drugs for the treatment of AGA.
However, while finasteride brings significant therapeutic effects, it is also accompanied by non – negligible side effects, among which the adverse effects on male sexual function are particularly prominent. Numerous clinical studies and patient feedback indicate that finasteride may cause sexual function problems in men, such as erectile dysfunction, decreased libido, and abnormal ejaculation function. Some studies point out that in some patients taking finasteride, the incidence of erectile dysfunction can reach 5% – 15%, and the incidence of decreased libido is approximately 3% – 10%. These sexual function problems not only seriously affect the patient’s quality of sexual life but may also further impact the patient’s mental health and family relationships, imposing a heavy physical and mental burden on the patient.
Therefore, in – depth research on the mechanism of the impact of finasteride on male sexual function is of great significance. From a theoretical perspective, it helps us to more comprehensively and deeply understand the mechanism of action of finasteride, as well as the physiological and pathological processes of the human endocrine and reproductive systems, providing a more abundant theoretical basis for basic research in related fields. In clinical practice, clarifying its mechanism of action can help doctors more accurately assess the risks and benefits of finasteride treatment for patients, and thus develop more personalized, scientific, and reasonable treatment plans for patients. For patients who are hesitant about finasteride treatment due to concerns about sexual function problems, accurate research results on the mechanism can provide them with clearer information, enhancing their confidence and compliance with treatment.
In recent years, in order to reduce the adverse effects of finasteride on male sexual function, topical treatment options have gradually become a research hotspot. Compared with oral preparations, topical finasteride can act directly on local tissues, reducing the systemic absorption of the drug, and thus is expected to reduce the impact on sexual function. At the same time, comprehensive treatment plans such as combining with minoxidil and traditional Chinese medicine conditioning are also being continuously explored. Studying the mechanism of action of topical finasteride and combination treatment plans is of great practical significance for developing safer and more effective treatment methods, improving the treatment effect and quality of life of patients. This can not only provide more treatment options for clinicians but also bring good news to the vast number of patients troubled by BPH and AGA, alleviating their pain and promoting their physical and mental health.
1.2 Research Objectives and Innovations
This study aims to deeply analyze the specific mechanism of the impact of oral finasteride on male sexual function, revealing the internal laws of its action from multiple dimensions. Through a detailed study of the conversion process of testosterone and DHT in the endocrine system, clarify the impact of changes in DHT levels on the development of reproductive organs, nerve conduction, and blood vessel function after the inhibition of 5α – reductase, and then elaborate on the specific physiological and pathological processes leading to sexual function problems such as erectile dysfunction and ejaculatory dysfunction.
In exploring the role and advantages of topical treatment options, this study will focus on the unique mechanism of action of topical finasteride. In – depth analysis of how it can precisely inhibit 5α – reductase in the scalp or prostate locally through local action, reducing the production of DHT, thus achieving the therapeutic effect while minimizing interference with the systemic endocrine system and reducing adverse effects on sexual function.
At the same time, this study will also comprehensively explore the synergistic effects of combination treatment plans. Study the comprehensive effects of traditional Chinese medicine in regulating kidney function, influencing Klotho protein expression, regulating the endocrine system, and improving microcirculation when combining minoxidil with topical finasteride, providing a more targeted and effective treatment strategy for clinical practice.
The innovations of this study are mainly reflected in the following aspects: First, when studying the mechanism of the impact of oral finasteride on male sexual function, not only the traditional endocrine regulation pathway is concerned, but also a comprehensive analysis of nerve conduction and blood vessel function is introduced, broadening the research perspective and more comprehensively revealing the complex mechanism of its impact on sexual function. Second, when studying topical treatment options, the role of traditional Chinese medicine in regulating Klotho protein expression is explored in depth for the first time, combining traditional Chinese medicine theory with modern medical research, providing new ideas and methods to solve the problem of sexual function side – effects of finasteride. Third, in the study of combination treatment plans, through multi – dimensional experimental design and data analysis, the synergistic effects of topical finasteride, minoxidil, and traditional Chinese medicine in regulating the endocrine system and improving microcirculation are systematically studied, providing a strong scientific basis for formulating more optimized treatment plans in clinical practice.
1.3 Research Methods and Technical Routes
In order to deeply explore the mechanism of the impact of oral finasteride on male sexual function and the role of topical treatment options, this study will comprehensively use a variety of research methods to ensure the scientificity and reliability of the research results.
Literature research is an important foundation of this study. By comprehensively searching domestic and foreign authoritative medical databases such as PubMed, Embase, and CNKI, research literature on the pharmacological effects of finasteride, its impact on male sexual function, and topical treatment options in the past 20 years were collected. Set strict inclusion and exclusion criteria to screen high – quality research literature for in – depth analysis and summary. Summarize and compare data on the incidence, manifestations, and influencing factors of the impact of finasteride on male sexual function in different studies, sort out the current research status and existing problems, and provide a theoretical basis and research ideas for subsequent research.
Clinical case analysis is also an indispensable part. Select male patients who visited the urology and dermatology departments of our hospital and used finasteride to treat BPH or AGA as research subjects, with no less than 200 cases. Record in detail the patients’ basic information, including age, disease course, past medical history, medication history, etc., as well as their sexual function status before medication, and evaluate it through professional scales such as the International Index of Erectile Function (IIEF) and the Male Sexual Health Scale (MSF). During the patients’ medication process, conduct regular follow – up, observe and record the changes in their sexual function, such as the occurrence time, severity, and duration of erectile dysfunction, decreased libido, abnormal ejaculation function, etc. At the same time, collect the patients’ blood samples to detect the changes in hormone levels such as testosterone, DHT, and estrogen, and analyze the correlation between these hormone levels and changes in sexual function.
Experimental research will further reveal the mechanism of the impact of finasteride on male sexual function. Use animal experiments, select adult male Sprague – Dawley (SD) rats, and randomly divide them into an experimental group and a control group, with 30 rats in each group. The experimental group is given oral finasteride, and the control group is given an equal amount of normal saline for 8 consecutive weeks. During the administration process, regularly detect the penile erection function of the rats. Induce erection by injecting [specific drug] into the corpus cavernosum, and observe indicators such as the latency of penile erection, the number of erections, and the duration of erection. After the experiment, sacrifice the rats, take their reproductive organs for histological examination, observe the morphological changes of tissues such as the prostate, testis, and penis, and detect the expression levels of related proteins such as 5α – reductase and Klotho protein in the tissues, as well as the contents of signal molecules related to erectile function such as nitric oxide (NO) and cyclic guanosine monophosphate (cGMP), to deeply explore the mechanism of the impact of finasteride on male sexual function from the molecular biology and histological levels.
When studying topical treatment options, in vitro cell experiments will be carried out. Select human prostate cancer cell lines and human scalp hair follicle cell lines, treat them with different concentrations of topical finasteride, and set up a control group and a blank group. Detect the effects of topical finasteride on cell growth and apoptosis through cell proliferation experiments and apoptosis experiments, and study its mechanism of action in local tissues. At the same time, detect the activity of 5α – reductase, the level of DHT, and the changes in the expression of related genes in the cells, and analyze the impact of topical finasteride on local endocrine regulation.
Based on the above research methods, the technical route of this study is as follows: First, through literature research, comprehensively understand the research status of finasteride, clarify the key points and difficulties of the research, and provide theoretical guidance for subsequent research. Then, carry out clinical case analysis, collect the clinical data and samples of patients, conduct preliminary data analysis and correlation research, and screen out the factors and indicators closely related to the impact of finasteride on male sexual function. Next, conduct animal experiments and in vitro cell experiments to deeply explore the mechanism of the impact of finasteride on male sexual function and the mechanism of action of topical treatment options, and verify the results of clinical research from different levels. Finally, comprehensively summarize the results of various studies, summarize the mechanism of the impact of oral finasteride on male sexual function, elaborate on the advantages of topical treatment options and the synergistic effects of combination treatment plans, and provide a scientific basis and optimized plan for clinical treatment.
2. Theoretical Basis of the Impact of Oral Finasteride on Male Sexual Function
2.1 Mechanism of Action of Finasteride
Finasteride, as a specific 5α – reductase inhibitor, plays a unique and crucial role in the human body. 5α – reductase is an enzyme widely present in various human tissues, such as the prostate, skin, hair follicles, and liver. It is indispensable in the process of converting testosterone to dihydrotestosterone (DHT).
Under normal physiological conditions, testosterone is converted into DHT through a series of complex biochemical reactions catalyzed by 5α – reductase. This conversion process is an important link in the androgen metabolism pathway. Compared with testosterone, DHT has stronger biological activity and plays a vital role in the development and function maintenance of the male reproductive system. During embryonic development, DHT is involved in the normal differentiation and development of male external genitalia and the prostate. In adult men, it plays a key role in maintaining the normal structure and function of the prostate, promoting the generation and maturation of sperm, maintaining the normal physiological state of the corpus cavernosum of the penis, and maintaining libido and sexual ability.
The mechanism of action of finasteride is that it can highly selectively bind to 5α – reductase to form a stable complex, thereby inhibiting the activity of 5α – reductase. This inhibitory effect is highly specific. The affinity of finasteride for 5α – reductase is much higher than that of testosterone, effectively blocking the conversion of testosterone to DHT. Studies have shown that the binding constant of finasteride to 5α – reductase is extremely low, enabling it to exert a significant inhibitory effect at a low concentration in the body. When finasteride enters the body, it is rapidly distributed to various tissues and binds tightly to 5α – reductase, making 5α – reductase unable to normally play its catalytic role, thus significantly reducing the level of DHT in the body. In the prostate tissue, after taking finasteride, the DHT level can be reduced by 70% – 90%. In the scalp tissue, the DHT level can also be effectively reduced.
This inhibition of DHT production plays an important role in the treatment of BPH and AGA. In the treatment of BPH, since DHT is a key factor stimulating the proliferation and growth of prostate cells, reducing the DHT level by finasteride can inhibit the hyperplasia of prostate cells, gradually reduce the volume of the prostate, relieve the pressure on the urethra, and effectively improve the patient’s urination symptoms. For patients with AGA, the high level of DHT in the scalp hair follicles can lead to follicular miniaturization and ultimately hair loss. Finasteride inhibits the production of DHT, reduces its adverse effects on hair follicles, promotes the growth of hair follicles and hair regeneration, thus achieving the purpose of treating hair loss. However, this inhibition of DHT production is also an important source of the impact of finasteride on male sexual function. The specific mechanism of its adverse effects on male sexual function will be elaborated in detail below.
2.2 Physiological Basis of Male Sexual Function
Male sexual function is a complex and delicate physiological process that involves the coordinated interaction of multiple systems such as the nervous, endocrine, and vascular systems. Any abnormality in these systems may lead to sexual dysfunction.
In terms of neural regulation, male sexual function is mainly regulated by the autonomic nervous system and the somatic nervous system. The sympathetic and parasympathetic nerves in the autonomic nervous system play a crucial role in sexual function. When sexual stimulation occurs, the parasympathetic nerve is first excited, releasing neurotransmitters such as acetylcholine, which act on the smooth muscle cells of the corpus cavernosum of the penis, causing them to relax, leading to the dilation of the sinus of the corpus cavernosum and an increase in blood inflow. At the same time, the excitement of the sympathetic nerve plays a key role in the ejaculation process. It causes the smooth muscles of the vas deferens, seminal vesicles, and prostate to contract, discharging semen into the posterior urethra, and then triggering the ejaculation reflex. The somatic nervous system is mainly responsible for transmitting sensory information. The penile skin, glans, and other parts are rich in sensory nerve endings. When stimulated sexually, these sensory nerve endings transmit the stimulation signals to the brain through the spinal cord, generating sexual pleasure and sexual impulses.
The endocrine system also plays an indispensable role in male sexual function. Testosterone, as the most important androgen in the male body, plays a key role in maintaining sexual function. Testosterone is not only involved in the development and maturation of male reproductive organs but also enhances libido, promotes penile erection, and maintains normal ejaculation function. Testosterone binds to androgen receptors, regulates gene expression, affects the synthesis and release of neurotransmitters, and regulates the function of smooth muscle cells in the corpus cavernosum of the penis. Studies have shown that when the testosterone level decreases, men may experience sexual function problems such as decreased libido and erectile dysfunction. In addition, other hormones such as gonadotropin – releasing hormone (GnRH), follicle – stimulating hormone (FSH), and luteinizing hormone (LH) also indirectly affect the secretion of testosterone and male sexual function through the regulatory mechanism of the hypothalamic – pituitary – gonadal axis. GnRH is secreted by the hypothalamus, stimulating the pituitary gland to secrete FSH and LH. FSH and LH act on the testes, promoting the synthesis and secretion of testosterone.
The vascular system is also essential for the normal function of male sexual function. The essence of penile erection is the process of blood filling in the corpus cavernosum of the penis, which depends on good vascular function. During sexual excitement, the penile arteries dilate significantly, allowing a large amount of blood to flow into the corpus cavernosum of the penis. At the same time, the smooth muscles of the sinus of the corpus cavernosum relax, accommodating more blood. The penile veins will contract to a certain extent, reducing blood return, thus maintaining the erection state of the penis. Nitric oxide (NO), as an important vasodilator, plays a key role in the penile erection process. When sexual stimulation causes the excitation of the parasympathetic nerve, it promotes the release of NO from the endothelial cells and nerve endings of the corpus cavernosum of the penis. NO activates guanylate cyclase, increasing the level of cyclic guanosine monophosphate (cGMP) in the cells, which in turn leads to the relaxation of smooth muscles, vasodilation, and an increase in blood inflow. If there are lesions in the vascular system, such as atherosclerosis and vascular stenosis, it will lead to insufficient blood supply to the penis, resulting in erectile dysfunction.
2.3 Potential Pathways of the Impact of Oral Finasteride on Male Sexual Function
Oral finasteride has an adverse impact on male sexual function mainly by inhibiting the production of 5α – reductase, reducing the level of DHT, and then affecting male sexual function through multiple pathways. From the perspective of the development and function maintenance of reproductive organs, DHT plays a key role in the development of male reproductive organs. During the embryonic period, DHT is an important regulatory factor for the normal differentiation and development of male external genitalia and the prostate. After men reach adulthood, DHT continuously maintains the normal structure and function of reproductive organs. After oral finasteride inhibits 5α – reductase, the DHT level drops significantly, which may lead to abnormalities in the structure and function of reproductive organs. For the penis, the normal development and maintenance of its corpus cavernosum tissue depend on DHT. A decrease in the DHT level may change the structure and function of the smooth muscles in the corpus cavernosum, affecting its blood – filling and relaxation abilities, and thus leading to erectile dysfunction. Relevant studies have shown that in animal experiments, in male rats treated with finasteride, the smooth muscle cells in the corpus cavernosum tissue of the penis atrophy, and the intercellular connections decrease, resulting in impaired blood – filling function of the corpus cavernosum and a significant decline in erectile function. In terms of nerve conduction, DHT also has an important impact on the development and function of the nervous system. It can regulate the synthesis and release of neurotransmitters, affecting the conduction of nerve signals. In the nerve conduction pathways related to male sexual function, DHT can enhance the transmission efficiency of nerve signals, promoting,For minoxidil – finasteride combinations, you can check https://www.johnsonfoam.us
——Author’s name: Fly tiger
