So I have had an anal fissure for over a year now. I also have male pattern baldness and my hairline is receding. It's basically caused by high or even moderate levels of dihydrotestosterone (DHT) which is irritating the hair folicles and causing them to die off. I decided to try out generic finasteride which works by inhibiting the production of the 5-alpha-reductase enzyme required to convert testosterone into DHT.

I only took one pill and it totally screwed up my hormonal balance for several months, leading to a number of symptoms including low libido and erectile dysfunction. But one thing that also happened was that my anal fissure symptoms completely disappeared for a few months. Now that things are starting to return to normal the fissure is back once again. Apparently it did not fully heal during this period.

Basically I was still getting erections but they were more difficult to achieve and not as strong as normal, maybe 70-80% of normal. I also noticed that my perineum was very soft when my penis was flaccid, much softer than it is now during flaccid state. Supposedly the ED from finasteride is caused because less DHT can also lead to less nitric oxide production, which is required for erections. But I think it also may have done something to my nerves in that area, which maybe caused the internal spinchter muscle to relax.

I will not be taking any more finasteride as it can cause much more severe and long-term effects to people who have side effects from such a small dose, but just thought I would share this observation.

I am going to try some nerve stimulation, sacral neuromodulation, and see if that helps. I just ordered a Kegel8 V For Men device. If this doesn't work then I'll probably go for surgery.

To many people on here try to diagnose and treat themselves. Go see a professional. Nitro cream "prescribed" got rid of an anal fissure I had, never to of returned.

Yeah I am not diagnosing or treating myself, I am working with my doctors to solve this. This is just an interesting observation I had as to what may be causing the fissure for myself. The sacral nerves control both the spinchter and the penis, somehow when these were affected the spinchter spasms and the rest of my symptoms stopped.