133 Grey-Scale Penile Ultrasound Findings in Young Men with Erectile Dysfunction (ED) Who Used Finasteride for Androgenic Alopecia: A Retrospective Review

Abstract

ED has been reported following use of finasteride in young men with androgenic alopecia. Animal studies reveal erectile tissue fibrosis after exposure to 5 alpha reductase inhibitors. 8 men (mean age 32) met inclusion/exclusion criteria: potent prior to and developed ED since use of finasteride for androgenic alopecia; less than 40 years old without obvious cardiovascular risk factor exposure; underwent Grey-scale and color duplex Doppler ultrasound (Aixplorer 15.4 MHz transducer) during maximal pharmacologic erection, performed using axial B-mode imaging at multiple gains/multiple locations. Presence/absence of erectile tissue homogeneity or observation of hyperechoic/hypoechoic regions, presence/absence of cavernosal artery atherosclerosis, cavernosal artery diameter, and tunical thickness values were noted. Most patients completed: International Index of Erectile Function (IIEF), Sexual Distress Scale- Revised (SDS-R), Patient Heath Questionnaire (PHQ-9), Perceived Stress Scale (PSS) questionnaires. Patients used finasteride for mean 7.4 years. Other complaints were low libido (63%), orgasm dysfunction (50%), cognitive changes (50%), mood changes (50%). Dihydrotestosterone (DHT) blood test values were low/in lower tertile in 63%. On IIEF, EF domain scores were < 26/30, mean 15; mean scores for desire, orgasm, intercourse satisfaction, overall sexual satisfaction were 5/10, 7.7/10, 6.6/15, 3.2/10 respectively, with mean total IIEF score 37.3/75. SDS-R scores were abnormal with depression and stress noted in 71% and 86%. All 8 patients had lack of homogeneity with obvious hyperechoic/hypoechoic regions in erectile tissue consistent with mild to mild-moderate corporal erectile tissue fibrosis. Other Grey-scale measurements included: absent atherosclerosis in right/left cavernosal arteries, mean dorsal/ventral tunical thickness 1.3/1.2 mm; mean right/left cavernosal artery diameter 1.1/1.0 mm. Color duplex Doppler studies revealed mean right/left peak systolic velocity values 23.2/25.2 cm/sec, and mean right/left end diastolic velocity values 1.5/1.4 cm/sec.