Old news. I know it may sound frightening to a non medic but if you closely analyse it or understand basic physiology/epidemiology we can largely dismiss it or realise it's up in the air/minor. The "scary stuff" is based on case reports and working hypotheses without consideration for what the clinical trials showed - which were
adjusted for case and control and double blinded. And in those trials it was clear what the risk of temporary side effects was and what they were. After these trials you have phase 4 which involves collecting the results from the millions of men that have used the drug and to see if by some mistake, the efficacy and safety is not correlated to the trials. The drug has been shown to be safe unlike some out there which have led to serious sides. The scare mongering only helped fill the pockets of lawyers and also some people who didn't take it lost their hair.
Look up the 10 year trial which is the largest and most recent one for finasteride, the risk of sides was typically low and happened within the first year - there was no depression or gynaecomastia (though it can cause it). May be they were happy they kept their hair which is obviously a major source of depression especially on this forum so does it matter about the supposed marginal effect on neurosteroids? If you're worried about depression and anxiety on finasteride then you need to worry about everything. Neurotransmitters can go up and down depending on your mood, sleep pattern, diet, genetics, stress, exercise e.t.c. They are never static! Stress and depression raises cortisol for example and that has been proven to effect the immune and cardiovascular system. So a serious worrier (genetically) or over hair will have even changes to their neutrophil levels and cortisol.
What's important is correlating the physiological mechanisms to the clinical symptoms in humans. Otherwise we can all find articles from google which sound smart but really it's only a working theory. The men presenting in a clinic with ED or depression will rarely if ever be due to finasteride. Usually a whole host of other common reasons including placebo, smoking, diabetes, illegal and other notorious prescribed meds. Sure finasteride can cause sexual sides but it's a minority of patients. I'm not just saying because it's kept my hair full with no sides or the fact that some of my friends/colleagues take it just fine and are in demanding top jobs, that's just personal anecdotes but it does actually correlate with the trials. If you have say prior hormonal issues or hypochondria, it may not be the drug of choice but for healthy men it's worth trying and T is the most critical for an erection not DHT. DHT in fact causes hair loss, acne, enlarged prostate and insulin resistance. It's important in a child growing up but beyond that it is mostly disposable as seen in the pseudohermaphrodites. dutasteride may decrease sperm count irreversibly due to it being stronger but again, will it stop a healthy man having a child? finasteride has a better safety profile here admittedly.
As for the prostate cancer thing the explanation is simple. finasteride reduces your prostate size, so later in life you won't suffer from obstructive urinary symptoms due to bph and so you won't see your Dr. This is benign but in some cases they actually have cancer, so rather than finasteride causing cancer it masks the detection till a later stage because the symptoms are not present due to finasteride. Any older man who knows a thing or two about health can just check his PSA yearly and do screening to combat this rare high grade form of prostate cancer. Overall finasteride reduces the risk of all the common type of prostate cancers one may encounter as an older man. It's like when they said the hair counts decrease on finasteride yearly and showed that famous curve - so it only prevents the inevitable for years, it sucks! Well aside from having an extra decade of full hair being truly worth it, the reason the counts went down is the non respondents were the ones who got worse, those who responded stayed the same/kept improving/very mild non cosmetic loss as the trials show. Even the non respondents were benefiting hugely compared to the placebo group - hair count gap keeps increasing yearly between the two groups. Delaying treatment for a year or more also means odds are you can never catch up with the group who took it from the beginning including your hypothetical self and increases chance of no response - so it's not just how bad your hair genetics are but also timimg of treatment.
https://academic.oup.com/jnci/advan...3/jnci/djy035/4925555?redirectedFrom=fulltext
https://www.fredhutch.org/en/news/center-news/2018/03/reducing-your-risk-of-prostate-cancer.html
http://www.bernsteinmedical.com/downloads/Rossi_Finasteride_10Yr_ 2011.pdf
My opinion would not change even if I experienced ED, that's just my luck, the drug is safe and so far there is no
clinically proven relevant interaction with other systems of the body
in humans resulting in serious diseases.
One thing from the report you quoted:
The AUA clinical practice guideline reported erectile problems in 8% and 4% of patients taking finasteride and placebo, respectively
So if you substitute it, that's 4%, which is not dissimilar to the Merck Propecia trial - and the AUA one was in old men over 65.
perhaps then i am just lucky i have a penis that works. just wish i had follicles that worked
That's the main worry (being a non responder) because it makes life very hard since the options are limited at present or other actual risky drugs unlike this candy.