Global Online Interest in Finasteride Sexual Side Effects

Abstract Prior literature has suggested that Propecia or finasteride may negatively impact men’s sexual health. In 2011, the Food and Drug Administration (FDA) provided a warning on finasteride drug labels to include decreased libido and erectile dysfunction. We sought to determine global online interest in finasteride sexual side effects, their penetrance and variation, and how they compared over time. We also sought to evaluate the influence of the FDA communications on internet searches for finasteride side effects. We utilized Google search engine from January 2004 to December 2020 to include trends from web searches of Propecia or finasteride and its side effects compared amongst the United States, United Kingdom, and Australia. We performed join-point regression analysis. We compared the annual relative search volume (ARSV), average annual percentage change (AAPC), and temporal patterns to evaluate for loss or gain of interest in the respective key terms. We determined that average ARSV for “finasteride” was 15% in 2004 and increased significantly to 57% in 2020 (APC: +9.25%, 95% CI 8 to 10.5, p<0.001). Likewise, there was significant interest in “finasteride side effects” (AAPC: +20.7, p<0.001) and “post-finasteride syndrome” (AAPC: +29.2; p<0.001) over time. Finally, when compared trends before and after FDA communications, the average (SD) ASRV of “finasteride”, “finasteride side effects”, and “post-finasteride syndrome” all increased significantly (p=0.001, p=0.014, p<0.001), respectively. Thus, it is evident that there is a global web-based interest in finasteride and its side effects, especially after the FDA warning in 2011. These results demonstrate an increased public awareness, and thus providers should have more detailed and careful discussions with patients prior to starting treatment with finasteride.