Deusmaximus
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Irreversible sexual side effects from finasteride are probably rare, since millions of men have taken these medications during the time period surveyed. In well-conducted research trials, sexual side effects occurred in about 4% to 6% of men, and these effects were usually reversible.
Source: harvard health publishing - harvard medical school
Here another Paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/
"A number of studies have looked at the problem of side effects caused by finasteride.[6–11] These studies which are discussed below reveal that sexual adverse effects occur at the rates of 2.1% to 3.8%, erectile dysfunction (ED) being the commonest followed by ejaculatory dysfunction and loss of libido. These effects occurred early in the therapy and returned to normal on stopping or over a time on continuous use of the drug. The only causal relation between finasteride and sexual adverse effects is decreased ejaculatory volume because of predominant action of DHT on prostate.[5]
A comprehensive review of a total of 73 papers on medical therapies for BPH was conducted, with a focus on the effects of different pharmacological agents on sexual function.[6] The review revealed that finasteride is infrequently associated with problems of ejaculation (2.1-7.7%), erection (4.9-15.8%), and libido (3.1-5.4%).
The role of nocebo effect in the causation of ED due to finasteride has been investigated.[7] Nocebo effect refers to an adverse effect that results from the psychological awareness of the possibility of the side effects, but is not a direct result of the specific pharmacological action of the drug. In this study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED, when compared to the group without information.[7] The side effects were completely reversible in 5 days when the medicine was discontinued, confirming that nocebo effect has an influence in causation of side effects and suggesting the role of psychological factors.
Two studies in 1998 and 1999 showed that the incidence of these side effects with finasteride therapy was generally comparable to that observed with the treatment with placebo,[8,9] and there was no evidence of dose dependency or increased incidence with longer therapy out to 12 months. In addition, the side effects ceased in patients even when they continued to receive finasteride.
A long term study showed that drug-related sexual side effects such as decreased libido, ED, and ejaculatory disorders occurred in <2% of men.[10] These side-effects disappeared not only in all men who stopped the drug because of the side effects but also in most of those who continued therapy. The incidence of each side effect mentioned decreased to ≤0.3% by the fifth year of treatment with finasteride. The incidence of side effects were comparable to that of placebo both at one year and at 5 years.
A large prospective study in as many as 17,313 patients was conducted to look into the effects of finasteride and other covariates on sexual dysfunction as part of the analysis of The Prostate Cancer Prevention Trial (PCPT).[11] Sexual dysfunction was assessed in the 17,313 PCPT participants who received finasteride 5 mg during a 7-year period. Finasteride increased sexual dysfunction only slightly even at 5 mg dosage (which is much higher than the 1 mg administered in pattern hair loss) and its impact diminished over time. The authors concluded that the effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride. A recent review of the available literature too arrived at similar conclusions.[12]"
