Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks very much for your premium question.

I've carefully reviewed your question, as well as your entire previous history of questions on this site, and I think I now have a good understanding of your clinical history. Let me give you some thoughts that should help your libido.

First, I do believe your erectile dysfunction (during sexual intercourse, not during the night and spontaneously during the day as you note) and loss of libido is related to finasteride. You have now been off the medication for more than 2.5 years and are still suffering side effects. Your testosterone is low at 169ng/dl, which is certainly contributing to the problem. Here are my suggestions.

First, get the following tests:
CBC
CMP
TSH
LH
Prolactin
HbA1c

Second, find a doctor who will consider prescribing you testosterone supplementation. In my opinion you should be receiving this.

Third, consider taking a medication for erectile dysfunction during sexual intercourse such as sildenafil (Viagra). There is evidence this helps not only with ED, but also with libido.

Finally, continue your excellent track record of exercise. Exercise increases libido perhaps more than anything else you can do. Also continue a healthy diet, as unhealthy diets have been shown to decrease libido.

Please let me know if you have any follow-up questions!

I see that you have asked many premium questions on this site. In the future, I ask that you ask your question to me directly, to ensure continuity of care. It would be my pleasure to be your private doctor on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers

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Brief Answer:
Followup

Detailed Answer:
I'm very glad to hear your situation is improving. Improvement in erectile dysfunction and libido could certainly be related to exercise, and could also be related to more and more time spent off finasteride.

Let me take just a second to mention Ayurvedic medicine. I know this is popular in XXXXXXX but large-scale independent studies have never shown these capsules to be effective in treatment of any condition. Furthermore, 20% of Ayurvedic U.S. and Indian-manufactured capsules have been found to contain toxic levels of heavy metals such as lead, mercury, and arsenic, which are dangerous to the human body. You are certainly welcome to continue using it, but I just want you to be aware of some of the potential dangers.

Testosterone levels are traditionally collected in the morning, but this doesn't really matter -- even when taken at 5pm, this level is low. Testosterone only rarely negatively affects fertility. I do think you should reconsider supplementation as I believe it could help you.

Finally, yes, I have absolutely had finasteride patients completely improve. This is through a combination of medication (sildenafil, testosterone, among others), being off finasteride for a long period of time, and good health practices like a healthy diet and exercise. Have hope! You can get better. Let me know how it goes.

Dr. Sheppe

tinyurl.com/DrSheppeAnswers

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Brief Answer:
Followup

Detailed Answer:
Testosterone supplementation is not necessarily a lifelong endeavor. It may be that you only need it for a short time while your body recovers from the finasteride.

Clomid is certainly another option. As you say, it acts indirectly on the testosterone system. Direct testosterone supplementation attacks the problem head-on, but Clomid is another option you can consider if you are strictly against testosterone.

Dr. Sheppe

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