Seriously though, itâs a low percent of guys that get sexual side effects (low libido, and ED are the common ones). For those that get those sides, more than half of them donât have side effects after 2-3 weeks while staying on the drug. For those that get persistent side effects, they can go off, and those side effects will go away in about a month.
There is a lot of fear mongering about ongoing side effects after stopping. There is a lack of good evidence of finasteride causing that. There are numerous studies on finasteride both for hair loss and BPH. Some of these have participants in the 1,000s. Some are from the US, there are some from countries like South Korea. Those studies looked for side effects. Those studies indicate that somewhere around 5% of men will report low libido or ED as a side effect. As I said above, most of those men had those side effects go away after around a month while staying on finasteride. Out of those that had persistent side effects, and had to stop taking finasteride, they returned to feeling like normal after around a month.
What I said above about staying off the internet is relevant. If you think you will have sides, your odds of experiencing them go up (nocebo). There are studies out there where the participants on the placebo pill reported a higher incidence of sexual side effects than the participants actually taking finasteride.
Iâd encourage you to do some independent research. Look at how the studies are performed. There is a marked difference in the âstudiesâ that make a claim for PFS (post finasteride syndrome), and those that donât support it. The former are highly biased (the participants are individuals that already claim to have it before the study began for example).
This type of fear mongering isnât unique to finasteride. People were claiming similar side effects from dental fillings in the 90s before that was debunked for example.
I took it for 10 years. No sexual sides at all, but I did end up on TRT with secondary hypogonadism by 34. I was on Propecia from about 24-34. Coincidence? Probably.
I do know one guy that got initial side effects. He dropped it right away, and was back to normal within a month. I would bet that if he had just stayed on for the month it would have resolved itself. I know about 4 guys that currently take it (or dutasteride) and none of us can tell we are taking anything.
I do believe some do get sexual side effects. Probably from the increase in E2 that these drugs usually cause. I think that is probably why most guys who get sides normalize after a month. They get used to having a bit higher E2 along with a bit higher Testosterone.
I donât believe that side effects from this drug will be ongoing for a long period if one stops. Unless I am unaware of new information there just isnât strong evidence to support it. The evidence that does support it seems to be things like case reports. I donât find that compelling. How would you differentiate between a guy that took finasteride and got long term side effects from it, vs the guy who took it and developed the long term sexual issues all on his own (very common in the age group of men taking finasteride)? In the US there are about 8 million prescriptions for finasteride. There is estimated to be around 1,000 men world wide that claim PFS.
It just seems more reasonable to me that the small amount of men that claim PFS just developed it on their own and claim finasteride did it to them. That explains why the side effects donât go away for them when they stopped vs everyone else who stopped and the side effects went away. Perhaps they are right, but even then it is 1,000 / 8,000,000 = 0.000125, or a 0.0125% chance (about 1/10,000).
I may be ranting a bit, but I think itâs important to understand risks for drugs. If someone thinks a drug has a reasonable chance of castrating them, itâs pretty scary. If it might cause a mild case of ED and slightly lower libido for a month its a completely different thing.
This is a strawman. Firstly, finasteride doesnât âblockâ DHT, it inhibits a percentage of itâs production. We also know it impacts things other than hair (it has been used to treat acne, for example).
What I actually argued was that finasteride causing PFS (ongoing negative sexual or mental side effects after cessation of finasteride) is a claim that isnât supported by high quality evidence. The higher quality studies include 1,000s of men, and produced no evidence to support PFS.
The evidence that supports the claim of PFS has always been low quality. Stuff like case reports (or for the source you linked âeditorials and expert opinionâ, which is at the very bottom).
But the problem is there is also ZERO âhigh qualityâ evidence that finasteride is safe. And the article I posted uses the Merck study lol.
About Merck, you know the producer of propecia/finasteride has been caught multiple times manipulating their own study results in various trials. Most infamous one Vioxx:
The fact is finasteride blocks around 70% of DHT, the most androgenic hormone in your body + multiple neurosteroids. Do you actually believe it will only affect your hair and nothing else? I know people who are balding want to cope and put all their hope in this âwonder pillâ to save them but letâs be serious here, everyone rational doesnât need to read a study to know it impacts much more than just hair by looking at the facts.
SUMMARY: Merck explained to FDA that finasteride lowers levels of one hormone while increasing levels of its precursor. It sounds simple and narrowly targeted. In fact, finasteride disrupts hormonal pathways much more broadly. These pathways have crucial roles in the brain, reproductive system and other organs. Since approval, men who used finasteride have developed severe and lasting dysfunctions linked to the same organs that depend on hormone signaling. Merckâs selective account of the drug mechanism concealed the risks.
It also recently got a red box warning this year in France form the french âFDAâ;
I took it for a few weeks and felt like total crap and the pp went to sleep. Took about 2-3 weeks to get back to normal.
Maybe if I had waited it out things would have normalized a bit, but I had worked for two years at that point to get my hormones dialed in so it was an easy decision to stop. For me, feeling good is more important than an optimal treatment for reducing hair loss. I use Rogaine and a laser hat thing to try to preserve as much hair as I can.
Itâs all a crapshoot in how youâll respond. Same as any other drug.
Every medicine (including natural) has risks (isnât âsafeâ).
I think itâs rational to not believe in something until it is proven to be. In this case, there is an absence of quality evidence to support the claim of PFS. That doesnât mean PFS doesnât exist, just that as of right now it isnât rational to believe it does.
If you look through the sources in the link you posted, the ones that can be traced to Merck donât support PFS.
I am not a Merck apologist. I think a lot of big pharma companies are guilty of data manipulation. That isnât a smoking gun for PFS though. Independent RCT studies havenât found cases of PFS.
No, we know it can impact things like acne, and some men do have sexual side effects while on it. However, I believe that the data supports that cessation of finasteride will cause those sexual side effects to go away rather quickly.
In regards to the neurosteroids. I buy that those neurosteroids are inhibited with finasteride. However, I am not convinced that there is a perceptible difference in mental ability or sexual function for most men on finasteride.
Finasteride was approved by the FDA earlier than 1997, but not for hair loss. It was approved for BPH in 1992 at a dose of 5 mg/day (5X the dose for hair loss). There are RCTs for that FDA approval as well. PFS wasnât observed then.
I try my best to keep a scientist hat on. That meaning if there is compelling evidence against my position, Iâll consider it as fairly as I can.
The question I have for anecdotal reports like this, is: How do you go about attributing it to finasteride? Almost every man will experience reduced libido, some will get ED as they age. Sometimes a noticeable change can happen in a short period of time.
It lacks the ability to show causation. It is objectively only a correlation.
There is also the numbers. There are roughly 8,000,000 prescriptions for finasteride in the USA. There are about 1,000 men that claim PFS. Iâd think if impacting DHT or neurosteroid production was a causing factor to PFS, that more than 1/10,0000 would develop this side effect?
This is believable to me. High quality evidence supports this claim.
While I donât think the drug is side effect free, I donât think PFS is a legitimate side effect. If you stop taking it, you return to baseline in roughly a month.
I believe it is of much importance to sort out the risks and reward as accurately as possible for each drug we take. If one can maintain their hair with a 5% chance of getting temporary low libido or mild ED, that is acceptable to most. If one believes they have a fairly high chance of getting PFS and the reward is saving their hair, that isnât a good trade-off.
Iâm sorry but seems you are not up to date at all. You also ignored that this year the french FDA variant put up a big warning for permanent sexual side effects. That means the top endos, neurologists, etc in France decided there is absolutely enough evidence.
Also do you know why there arenât enough studies being done? It costs a ton of money and of course pharma companies and especially Merck arenât going to shoot in their own foot by conducting more studies about the risks concerning finasteride. You also ignored the fact that Merkc has been caught mutiple times manipulating their trial results. By your logic there is also ZERO evidence that PFS does not exist or that finasteride is safe.
There is alos a meta analysis about all the studies:
Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.
CONCLUSIONS AND RELEVANCE:
Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.
Hell even FDA itself admitted it did not know the long term effects of finasteride in their official approval letter in 1997:
I really doubt you even read the article, itâs about finasteride impacting more than only DHT.
From the article:
Merck knew
In 1990, a paper by a Merck researcher and collaborators noted (emphasis added): âFinasteride-treated subjectsâŠhave global defects that affect both hepatic and peripheral 5É-reductase activities.â8 Yet when Merck submitted its Propecia application to FDA in 1997, it only pointed out reduced DHT and a modest increase in testosterone. A later paper by Merck researchers showed two conversions involving 5-AR in a figure, but the text only mentioned effects on DHT.9 Today, official prescribing information for physicians only mentions effects on DHT.10
Atleast you admit big pharma is guitly of manipulating data. And hey look at thisâŠ
-Merck exaggerated the safety profile of propecia. Merck also omitted the experiences of several subjects who had sexual dysfunction symptoms and didnât include the experiences of men who didnât finish the study.
And what independent RCT studies lol? The only other studies are extremely low quality done by dermatologists with a conflict of interest.
Again if there is no âquality evidenceâ why did the french FDA order a big warning about permantent sexual side effects this year? Seems to them the evidence is more than enough.
Sadly that is not the case, one of the leading theories is saying it causes epigenetic changes. For many hormonal intervention is needed like HCG, TRT,⊠to get them out of the PFS state and for some even that is not enough.
And yes it is a FACT finasteride blocks 70% of DHT and multiple neurosteriods, thatâs not even up for debate.
If you want to see what 5alpha reductase does in regards to neurosteroids:
Read the article friend, Merck hid the fact it does much more than just inhibit DHT. And you do know the only studies used for FDA approval are done by Merck right?
Btw you do know FDA regularly updates the safety profile op meds too right? Look what they did for finasteride a year or two ago; a new warning for hematospermia; https://twitter.com/i/web/status/1421157529875357701
Another interesting fact about the FDA:
Almost one-third of new drugs approved by the FDA ended up years later with warnings about unexpected, sometimes life-threatening side effects.
âThis evidence indicates why we can no longer trust the FDA to carry out its historic mission to protect the public from harmful and ineffective drugs.â
Do you acknowledge that hormones impact things like libido? Then why is it so crazy to think a drug that inhibits the most androgenic hormone; DHT + multiple neurosteroids that are also involved in sexual and the reproductive system could be the cause of his reduced libido, etc?
And hereâs a recent study about PFS being nocebo or not:
Neuropsychiatric Reactions to Finasteride: Nocebo or True Effect?
âSerious adverse effects from finasteride appear to be real and not related to simulated reporting of a nocebo effect.â
Letâs talk about the numbers.
Hereâs what a professor estimates:
Prof. Traishâs latest paper estimates that there would be between 900,000 and 1.6 million men with PFS only from finasteride and dutasteride prescribed for hair loss. The numbers for benign prostate hyperplasia would be much higher.
Skip to 17:20, this endo believes 75% of men will experience side effects.
This doctor believes atleast 1/3 of men will experience side effects:
So MUCH higher than the Merck studies suggest.
And we of course have a TON of anecdotal evidence on the interent with various polls showing a very high side effect profile:
Anyway, we can all agree we need more studies right? But like I said those will only come from patient funding because Merck and big pharma in general have ZERO incentive to do any studies, especially since it will only hurt them if it shows higher safety concerns than their original studies.
I also know many balding guys want to believe itâs safe but itâs absolutely not the case when looking at the biology and what 5alpha reductase inhibitors like finaseride actually impact. Hint: MUCH more than the state of your hair.
Btw, after the Covid debacle everyone should know to not just âtrust the scienceâ I hope. Or did you also get vaxxed multiple times as the âapproved scienceâ suggested?
Can also post much more but like I said, people who are balding put all their hope in this âmiracleâ pill and will ignore the elephant in the room anyway. Most will have to learn the hard way like the guy in the video I posted sadlyâŠ
They will also do this if enough people believe and are vocal about a side effect. Drug manufacturerâs will do the same (list side effects that havenât been seen in trials, but are anecdotally reported). It is a CYA (cover your ass) strategy.
It isnât always the case, but it is common and a reasonable possibility.
The drug is also off patent. Merck isnât making a ton of finasteride like they used to be. Most of the Rx for it are generics.
South Korea has had a few studies on finasteride and dutasteride. This one that was released in 2018 was a 5 year study on finasteride that doesnât have a conflict of interest with Merck.
Again, I am not arguing that there are no negative side effects, but I am arguing that PFS isnât supported. There are several studies where men report low libido and or ED, but all report that these side effects go away shortly after finasteride is stopped.
The drug has been prescribed since 1992. Millions of Rx for it. So far there is a lack of evidence so far to show finasteride causes PFS. There are men that claim it, but as of right now they all have one thing in common. They only have correlation, not causation. In addition to that, lots of men suffer low libido or ED as they age without taking finasteride. Sometimes changes in libido or erection quality can happen fairly quickly all naturally.
But you are right, I canât prove it isnât real. I also canât prove lotâs of things arenât real, but I feel justified in not believing in those things.
There are also anti finasteride funding as well. Groups like the PFS Foundation and Propecia Help fund studies as well. The lead researcher (Dr. Traish) for the paper you linked is financially connected with the PFS foundation.
I did read the paper. That does not support the case for PFS. The only thing directly from a Merck paper is the line:
See my first response in this post.
Should be hypothesis, not theory. They need to show that it causes epigenetic changes, as well as show those epigenetic changes cause PFS. They have not done so.
The reason they need HCG and TRT so often is that for many Low T was the actual issue that they thought was PFS.
Sure, that doesnât mean it causes PFS.
Studies for FDA approval are almost always funded by the drug maker. Who else would pay for that?
Again, I believe it can impact things like libido. I donât believe it can impact people years after theyâve stopped taking it (PFS). It is hard to believe because it hasnât been show to be true, and plenty of people have an incentive to do so.
There are also studies like this:
I mean when you have financial ties to the PFS foundationâŠ
I donât see how that statement adds up either. Millions of men (if including BPH) with these terrible PFS side effects, but only a few really vocal people on the internet complaining.
I like the anabolic doc, but you realize that almost every video recently has an add which he markets hair loss products, right?
I know 6 guys on Finasteride or Dutasteride. All for awhile at this point. 5 of us have had 0 perceptible negative side effects. One had initial mild side effects, dropped it and returned to normal in a few weeks. I know that is only 6, but 0 PFS reports. If it was 75% that get it, even a sample of 5 would very likely produce at least one. The odds of all of us not experiencing it are 0.25 * 0.25 * 0.25 * 0.25 * 0.25 * 0.25 * 0.25 = 0.000244 or 0.024% chance we all donât get PFS. The 75% claim is absurd. If it was 1/3 that we get it the probability that we all didnât get it is 0.66 * 0.66 * 0.66 * 0.66 * 0.66 * 0.66= 0.083 or 8.3%. That could be be, but itâs still pretty unlikely IMO.
Polls on sites like âFinasteride Infoâ, a place for people who believe they have side effects including PFS from finasteride, isnât a reliable gauge of the actual side effects. Iâd rather use RCTs to assess risk.
Oh my friend you really are coping. Why would the french FDA cover the ass of Merck? The french FDAâs mission is protecting french patients from viable risks based on objective data. Countless doctors and endocrinologists have pulled the alarm;
Finasteride has been added to the âlist of drugs to avoid in 2021â by a French Medical Journal
'Finasteride 1mg, a 5-alpha-reductase inhibitor, has a very high efficacy in modest androgenic alopecia in men: it increases hair density only slightly on the top of the head (by about 10%), and only for the duration of the treatment.
It exposes particular sexual disorders (e.g., sexual dysfunction in erection and ejaculation, decreased libido), depression, suicidal ideation and cancer of the breast. When a drug is the chosen option, local minoxidil used with care is less dangerous.â
(Finasteride is on page 6 of the journal)
The journal is called Prescrire, a medical journal that âaddresses developments in diseases, medications, and in medical techniques and technologiesâ and âcontains no advertisingâ.
According to their website their âeditors are healthcare professionals, specially trained in Prescrireâs editorial methods and free from conflicts of interest. Exacting quality control procedures are applied to all editorial content.â
'Finasteride 1mg, a 5-alpha-reductase inhibitor, has a very high efficacy in modest androgenic alopecia in men: it increases hair density only slightly on the top of the head (by about 10%), and only for the duration of the treatment.
It exposes particular sexual disorders (e.g., sexual dysfunction in erection and ejaculation, decreased libido), depression, suicidal ideation and cancer of the breast. When a drug is the chosen option, local minoxidil used with care is less dangerous.â
(Finasteride is on page 6 of the journal)
Hereâs an article written by a doctor from a menâs health clinic (so someone that actually has endocrine knowledge):
âyour best bet is to not take 5α-reductase inhibitors. Itâs a gamble thatâs not worth itâ
Sure thatâs why I said they will never start a new study, they have no incentives at all so studies have to be funded by victims themselves sadly
Lol this is a dermatologist study focused on the affects the pill has on balding, not on risks, there were no blood tests or any serious research. Finasteride is the bread and butter for dermatologists, there is a clear conlfict of interest here. Itâs also just a review of medical records: âWe identified the electronic medical records of male patients with AGA who were treated in a tertiary or a secondary hospital with oral finasteride for at least 5 years between May 2004 and August 2017. Their medical records and clinical photographs were reviewed.â
Lol and even if we take this study serious, it still has 8% reporting sexual side effects, so higher than the official Merck studies.
Luckily PFS is supported by many endos and doctors that take it very serious. Btw did you ever hear about Long covid? There are many meds, etc that can cause long term side effects even after cessation. Especially after long term hormonal treatment like finasteride that is taken for years to try and stop/slow down balding. Hell this forum is also full of men having permanent side effects after a steroid cycle. These things are common sadly.
Again you really believe a drug that inhibits 70%+ of the most androgenic hormone + multiple neurosteroids will only affect your hair? A perfectly healthy male never having ED, sexual problems suddenly gets ED and sexual problems after taking finasteride but you believe itâs probably âjust agingâ? Lol okay then. Thereâs clear causation imo.
Of course you donât want to believe it since youâre taking the drug yourself.
Like I said tell me who will otherwise fund these studies focussed on what finasteride does on a deeper level? And the professors leading these studies donât want to destroy their reputation, the money they get to fund these studies are literally peanuts. Most of the cost of these studies are carried by the universities themselves, PFS is also a very interesting subject for them to study.
It literally shows Merck tried to hide the effects it had on neurosteroids, this could be a possible explanation for PFS.
As far as I know there are studies underway to show the epigenetic angle. Weâll see what the results are.
Here are some studies showing objective differences between PFS patients and the control group:
The ratio of AR positive stromal cells % to serum testosterone concentrations was 2-fold higher in cases than in controls (P?=?0.001). Our findings revealed that modulation of local AR levels might be implicated in long-term side effects of finasteride use. This provides the first evidence of a molecular objective difference between patients with long-term adverse sexual effects after finasteride use versus drug untreated healthy controls in certain tissues.
We also reported abnormal somatosensory evoked potentials of the pudendal nerve in PFS patients with severe ED, the first objective evidence of a neuropathy involving peripheral neurogenic control of erection.
Data obtained on neuroactive steroid levels also indicate interesting features. Indeed, decreased levels of pregnenolone, progesterone and its metabolite (i.e., dihydroprogesterone), dihydrotestosterone and 17beta-estradiol and increased levels of dehydroepiandrosterone, testosterone and 5alpha-androstane-3alpha,17beta-diol were observed in CSF of PFS patients.
Finally, finasteride did not only affect, as expected, the levels of 5alpha-reduced metabolites of progesterone and testosterone, but also the further metabolites and precursors suggesting that this drug has broad consequence on neuroactive steroid levels of PFS patients.
Using novel ultrasound technology, 96% of men with PFS and ED demonstrated heterogeneity in their corporal tissue at maximal pharmacologic erection. This new protocol is able to show that PFS men complaining of ED may have an underlying biologic pathophysiology.
So, three objective differences in men with PFS
Double the androgen receptor expression compared to non-PFS control group
Cerebrospinal fluid readings of PFS patients showed significantly lowered levels of several hormones and neuroactive steroids and âabnormal somatosensory evoked potentials of the pudendal nerve were reportedâ
Ultrasounds of PFS patientsâ genitals showed evidence of a potential biologic pathophysiology
No they probably became hypogonadal because of their finasteride usage.
Would be nice if an actual third party would do independent research focussed on risks, etc. Because the makers of finasteride; Merck have been caught to alter their study results as I linked above itt. In the case of Vioxx another âsafeâ drug from Merck, it caused the deaths of thousands of peopleâŠ
Hereâs a interesting Reuters article you seemed to ignore:
-Merck exaggerated the safety profile of propecia. Merck also omitted the experiences of several subjects who had sexual dysfunction symptoms and didnât include the experiences of men who didnât finish the study.
Cognitive dissonance. You donât want to believe it because youâre taking the drug. Again, countless drugs,etc have caused long term side effects even after cessation. Why would a long term hormonal treatment like finasteride be safe? Or please show me an actual long term finasteride study done by endocrinologistsâŠ
Lol, oh Iâm really happy you posted this joke study, letâs break it apart to just show you how pathetic these studies are:
Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?â
"This article is a case report of one patient that a Swiss hair transplant surgeon (Dr. Ralph TrĂŒeb) saw in his clinic. The title is spectacular â but also deceiving because it doesnât indicate this is a case report:
Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?
Case reports are among the weakest types of medical evidence. This article is mostly speculation and contributes no systematic evidence. From the abstract:
We present the first case of PFS in our 20-year prescription practice of oral finasteride for treatment of male pattern baldness, with circumstantial evidence that PFS may represent a delusional disorder of the somatic type, possibly on a background of a histrionic personality disorder, and with the potential of a mass psychogenic illness due to its media coverage.
The first three authors are all affiliated with Dr. TrĂŒebâs hair clinic near ZĂŒrich, Switzerland. The fourth author lists an affiliation with the Dermatology department of a university hospital in Brazil.
One of the editors is Antonella Tosti, a dermatologist at University of Miami who has a record of defending finasterideâs safety. She has numerous relationships to the pharma industry and took over $82,000 in payments from pharma companies in the past seven years (see OpenPaymentsData). In the past Dr. Tosti has taken payments from Propecia maker Merck (disclosed in her publications).
Dr. TrĂŒeb has written another article that cannot be called a scientific article:
Saint rita of cascia: Patron saint for women with frontal fibrosing alopecia?
[From abstract:] The forehead wound is understood to represent partial religious stigmatization and external sign of mystical union with Christ. In our opinion, it is at the same time reminiscent of the thorn frontal fibrosing alopecia represents to women affected with the condition, and its treatment with intralesional triamcinolone injections along the frontal hairline, much alike the forehead wounds caused by the crown of thorns. Saint rita of cascia: Patron saint for women with frontal fibrosing alopecia? Trueb RM, Dias MF - Int J Trichol
âDr. Ralph TrĂŒeb
The article on post-finasteride syndrome has an attention-grabbing title but contributes no new evidence that would help understand post-finasteride symptoms. Itâs best viewed as a sensational, unscientific opinion piece."
âfinancial tiesâ Lol, like I said why would he put his reputation on the line for the peanuts heâd get from the PFS foundation? Weâre talking about 100k here, you do know thatâs literally nothing in the world of research right? PFS foundation gets a big discount for their studies.
The only corrupt one is Merck, a multi billion dollar pharma company that made your pills and has been caught multiple times manipulating their trial data.
What? Okay then show me a video where he promotes finasteride or dutasteride for hairloss. Or are you confused with google ads that are shown in videos because of the algorithm? You know he has zero control about those ads right?
Nice, I know one friend who also took finasteride. Was fine for a year then got sides and had to quit, still has low libido.
Lol what RCTâs? Merckâs? Please post them. It seems you really trust big pharma, tell me did you also get multiple covid vaccinations?
And you didnât read the article, finasteride info is the site that gathered mutliple polls from various sites, the guy behind the site didnât conduct the polls himself lol.