Why Propecia Doesn't Cause Side Effects for Some?

[Fanjeera]

you can't say that for sure. My GP says he's prescribed Finasteride for BPH for many men over the years and has rarely if ever had any complaints over sides

Yes. Why would they complain, if it cures their serious health issue? Minimizing the risk of side effects to treat a problem that's actually not a health problem is a lot more important, because the benefit is a lot smaller. That's why, for example, there's a lot of talk about the contraception pills. There's many more ways not to get pregnant, so people taking pills have to be absolutely sure they get as few side effects as with condoms. There are alternatives to fighting hair loss too and I wish I had went to them right away, but I learned it the hard way. Inhibiting 5-alpha-reductase is not worth for a cosmetical problem.

 

[Wuffer]

Yes. Why would they complain, if it cures their serious health issue? Minimizing the risk of side effects to treat a problem that's actually not a health problem is a lot more important, because the benefit is a lot smaller. That's why, for example, there's a lot of talk about the contraception pills. There's many more ways not to get pregnant, so people taking pills have to be absolutely sure they get as few side effects as with condoms. There are alternatives to fighting hair loss too and I wish I had went to them right away, but I learned it the hard way. Inhibiting 5-alpha-reductase is not worth for a cosmetical problem.

Fanjeera, you say things like this and it makes me wonder if you are really being trained in the medical field? May I ask what you are studying?

This is one of the first things you should learn as a medical professional: the decision to take a medication is a risk/reward process facilitated by the physician to determine if it's worth taking. You say that inhibiting 5AR is not worth it for a cosmetic problem. Have you not been taught that this 'cosmetic problem' causes a large number of men a great deal of distress? It's unquestionably linked to decreased self esteem, depression and suicides. It can greatly diminish an individuals overall quality of life. Obviously if a patient visits his doctor to discuss his hair loss, it's causing him some degree of distress. If you think hair loss is just a simple cosmetic condition that can be dismissed, why do you even post here?

How about a person experiencing depression that isn't related to hair loss? SSRI's are unquestionably much more dangerous than 5ARI's. They cause significantly more side effects, including decreased libido and ED. They are also shown to cause persistent side effects, potentially in a statistically significant number of people. Are you going to tell a depressed person that they shouldn't ever consider an SSRI because there is a risk involved? How is this any different than a man depressed over his hair loss considering a 5ARI?

If a man is experiencing great distress over his hair loss, he should consider taking a 5AR. He should speak with his doctor to discuss the risks and rewards of taking such a medication. These medications are very low risk. The patient should be warned of the possibility of persistent symptoms, but also reassured that the incidence of this is unknown, and assumed to be very rare.

 

[Quantum Cat]

Nope I don't, but i'm fairly interested in science and medicine. I'm taking some medicine courses through Coursera in my spare time. My brother is a doctor though, and I spend a lot of time chatting with him about it all. It's more of a hobby for me!

what does your brother think of the Propecia controversy?

 

[Fanjeera]

Fanjeera, you say things like this and it makes me wonder if you are really being trained in the medical field? May I ask what you are studying?

This is one of the first things you should learn as a medical professional: the decision to take a medication is a risk/reward process facilitated by the physician to determine if it's worth taking. You say that inhibiting 5AR is not worth it for a cosmetic problem. Have you not been taught that this 'cosmetic problem' causes a large number of men a great deal of distress? It's unquestionably linked to decreased self esteem, depression and suicides. It can greatly diminish an individuals overall quality of life. Obviously if a patient visits his doctor to discuss his hair loss, it's causing him some degree of distress. If you think hair loss is just a simple cosmetic condition that can be dismissed, why do you even post here?

How about a person experiencing depression that isn't related to hair loss? SSRI's are unquestionably much more dangerous than 5ARI's. They cause significantly more side effects, including decreased libido and ED. They are also shown to cause persistent side effects, potentially in a statistically significant number of people. Are you going to tell a depressed person that they shouldn't ever consider an SSRI because there is a risk involved? How is this any different than a man depressed over his hair loss considering a 5ARI?

If a man is experiencing great distress over his hair loss, he should consider taking a 5AR. He should speak with his doctor to discuss the risks and rewards of taking such a medication. These medications are very low risk. The patient should be warned of the possibility of persistent symptoms, but also reassured that the incidence of this is unknown, and assumed to be very rare.

I am studying medicine. Definitely, if it's hairloss only that's causing a man big stress, he should do something about it, because there are ways -- better ways than stopping testosterone's effect on the body with finasteride. He should see a beauty surgeon or visit a hair studio.

 

[Quantum Cat]

I am studying medicine. Definitely, if it's hairloss only that's causing a man big stress, he should do something about it, because there are ways -- better ways than stopping testosterone's effect on the body with finasteride. He should see a beauty surgeon or visit a hair studio.

better ways but FAR more expensive ways. We weren't all born with silver spoons in our mouths

also surgery comes with its fair share of risks and problems. And I doubt many would agree with you that a hairpiece is 'better' than retaining your hair with finasteride

 

[Wuffer]

what does your brother think of the Propecia controversy?

I actually gave him a few studies to read, including the Dr. Irwig ones so that he could reach his own opinion. His views are basically in line with mine, in that he believes a large number of cases are psychosomatic... But he is a psychiatrist, so he might be a bit biased

- - - Updated - - -

I am studying medicine.

Care to elaborate? What's your major? I know it's none of my business really, but some things you have said have me questioning this.

stopping testosterone's effect on the body with finasteride.

This is an absolutely prime example of something a person trained in medicine would never say. Doctors are specifically trained NOT to make bold, unsubstantiated statements such as these. There is absolutely no evidence that finasteride stops testosterone's effect on the body, and by the drugs mechanism of action, I can't even imagine a plausible explanation of how this could happen. Did you learn this in school? What studies do you have that back up this statement? You shouldn't be at all surprised that i'm questioning your claim that you are studying medicine. Are you studying medicine at a university to earn your doctorate? Or are you reading about it on the internet and calling it studying?

He should see a beauty surgeon or visit a hair studio.

So you would suggest to a young patient with early stages of hair loss to go spend $10,000 on plastic surgery, when the problem could very likely be resolved for less than $30 per year with generic Proscar? Most hair transplant surgeons won't even operate on a patient unless their hair loss has stabilized. This doesn't happen until the loss has stopped (when they are more or less completely bald), or if the patient has stopped their loss with finasteride. If a young patient got a hair transplant without finasteride, thy will almost certainly require multiple follow-up visits to touch up the spots that continue to thin. This is exposing them to multiple surgeries, which is FAR riskier than taking finasteride.

 

[thiswomps]

Fanjeera can you answer these questions, because I'm curious:

How long did you take if finastride for?

What Side effects did you experience?

Why do you speak in absolutes regarding fins sides when we have a whole topic where people talk about experiencing NO sides?


I'm all for a discussion based on the good and bad but when you're clearly painting this in one color I question your experience.

 

[Fanjeera]

9 days. Reduced, watery and not shooting ejaculate; less and faster disappearing morning erections; penis feels strange often (numb and tends to be shorter; doctor says it's due to stress and too much attention to that body part); saggy scrotum; penis shrinks more than it did before in situations where it's supposed to do that; muscle twitching (this one's probably psychosomatic due to stress). Because when looking at the pharmacodynamics of the drug, I just can't believe it's possible not to get any sides (and my own experience and reading propeciahelp.com and pfsfoundation.org contribute to this).

I actually gave him a few studies to read, including the Dr. Irwig ones so that he could reach his own opinion. His views are basically in line with mine, in that he believes a large number of cases are psychosomatic... But he is a psychiatrist, so he might be a bit biased

- - - Updated - - -



Care to elaborate? What's your major? I know it's none of my business really, but some things you have said have me questioning this.




This is an absolutely prime example of something a person trained in medicine would never say. Doctors are specifically trained NOT to make bold, unsubstantiated statements such as these. There is absolutely no evidence that finasteride stops testosterone's effect on the body, and by the drugs mechanism of action, I can't even imagine a plausible explanation of how this could happen. Did you learn this in school? What studies do you have that back up this statement? You shouldn't be at all surprised that i'm questioning your claim that you are studying medicine. Are you studying medicine at a university to earn your doctorate? Or are you reading about it on the internet and calling it studying?




So you would suggest to a young patient with early stages of hair loss to go spend $10,000 on plastic surgery, when the problem could very likely be resolved for less than $30 per year with generic Proscar? Most hair transplant surgeons won't even operate on a patient unless their hair loss has stabilized. This doesn't happen until the loss has stopped (when they are more or less completely bald), or if the patient has stopped their loss with finasteride. If a young patient got a hair transplant without finasteride, thy will almost certainly require multiple follow-up visits to touch up the spots that continue to thin. This is exposing them to multiple surgeries, which is FAR riskier than taking finasteride.

I have just learned it for 2 years and I'm getting a general practitioner degree or something like that at first. Testosterone works through dihydrotestosterone in many tissues and finasteride blocks this process in many tissues. Of course, in places where there's no 5ar2 or 5ar3 it won't be a problem, for example the muscles, right? But as we can see, it's very widely distributed in the body, not only in the prostate and follicles: http://www.hindawi.com/journals/au/2012/530121/tab3/
And I'm sure we will find many more, if we study every tiny tissue in the body.

 

[Quantum Cat]

9 days. Reduced, watery and not shooting ejaculate; less and faster disappearing morning erections; penis feels strange often (numb and tends to be shorter; doctor says it's due to stress and too much attention to that body part); saggy scrotum; penis shrinks more than it did before in situations where it's supposed to do that; muscle twitching (this one's probably psychosomatic due to stress). Because when looking at the pharmacodynamics of the drug, I just can't believe it's possible not to get any sides (and my own experience and reading propeciahelp.com and pfsfoundation.org contribute to this).

you took Finasteride for 9 days and you claim it gave you all those side effects which still haven't gone away years later?

Not possible.

If you had taken Propecia for years, or even months, I might be more inclined to believe that you're one of the unlucky few who experience permanent persistant side effects... but 9 days?!

It couldn't possibly do that much permanent damage in such a short time. Your DHT levels were only lowered for a week - and you claim that has made your penis permanently shorter/smaller? :doh:

if you want my advice I'd stop reading Propeciahelp and stop reading about/studying Finasteride altogether - your side effects (whether real or not) will never get better unless you do that - it's a self-fulfilling prophecy



- - - Updated - - -

I have just learned it for 2 years and I'm getting a general practitioner degree or something like that at first

that didn't really answer the question at all. Very vague and non-specific.

 

[thiswomps]

Fanjeera first off you too the drug for 9 days. Seriously? How much of those "sides" were there before the drug?


Second, I could print you off pages and pages of side effects regarding many anti depressants and anxiety pills I've taken through out the years. The severity of side effects vary with people, in my case a few anti depressants gave me bad sides, some none - my point is how can you speak in absolute terms about the most severe sides when talking about finasteride? That makes no sense. It seems like you're trying to scare people with no good reasoning. If you can't believe the drug will be free of sides at least don't assume the absolute worst for everyone as fact. That's a bit much don't you think?

Especially when we have many people who come forward and say they don't have ANY sides.

I've been taking finasteride for over a month now - erections are strong, semen is fine (if I don't decide to wank it multiple times everyday, because we all run out of semen - we aren't machines), I've actually been measuring as well and my size is still there... So what does that say?

 

[Quantum Cat]

I would take everything Fanjeera says with a large pinch of salt, to be honest

 

[Fanjeera]

you took Finasteride for 9 days and you claim it gave you all those side effects which still haven't gone away years later?

Not possible.

If you had taken Propecia for years, or even months, I might be more inclined to believe that you're one of the unlucky few who experience permanent persistant side effects... but 9 days?!

It couldn't possibly do that much permanent damage in such a short time. Your DHT levels were only lowered for a week - and you claim that has made your penis permanently shorter/smaller? :doh:

if you want my advice I'd stop reading Propeciahelp and stop reading about/studying Finasteride altogether - your side effects (whether real or not) will never get better unless you do that - it's a self-fulfilling prophecy



- - - Updated - - -




that didn't really answer the question at all. Very vague and non-specific.

2 and a half weeks actually. The suppression of DHT goes on for like 7-10 days after the last pill. So that's like 18 days of DHT deprivation for me which isn't very long luckily, but still enough to have its effect on the reproductive tissues which are very dependent on it.
Oh, and I don't produce that much pre-ejaculate either anymore.

Fanjeera first off you too the drug for 9 days. Seriously? How much of those "sides" were there before the drug?

None of them of course. Otherwise they wouldn't be sides.

 

[Quantum Cat]

well whatever - sounds unlikely, but whether your sides real or not, I would still encourage you to cut down on the reading/studying about Finasteride and PFS - scaring yourself silly won't make the sides go away, if there is a psychological element to your expereince of side effects. And I'm sure reading Propeciahelp is the worst thing you could do

 

[Fanjeera]

http://www.proteinatlas.org/ENSG00000128039
The best overview of 5ar3 localisation. These guys are not studying selected tissues, but making a whole human proteome. Click "More tissue data" to see the full picture. It's a pity they haven't studied the 5ar2 or 5ar1 enough. It's probably because they're working independently. It seems that even the skeletal muscle needs DHT. This again proves that testosterone works through DHT in many-many tissues.

Staining summary	Weak to moderate cytoplasmic positivity was observed in most normal tissues.

 

[Quantum Cat]

how old were you when you took the finasteride, fanjeera?

 

[Wuffer]

It seems that even the skeletal muscle needs DHT. This again proves that testosterone works through DHT in many-many tissues.

I'm not quite sure how you reached this conclusion (or any other conclusions regarding DHT being so important), but I have 3 reasons why you are wrong.

First, this: http://jama.jamanetwork.com/article.aspx?articleid=1105045

"Changes in fat-free mass in response to graded testosterone doses did not differ in men in whom DHT was suppressed by dutasteride from those treated with placebo, indicating that conversion of testosterone to DHT is not essential for mediating its anabolic effects on muscle."

Men had their DHT essentially blasted away with dutasteride for 5 months and were given testosterone in different amounts and had their muscle growth measured against men on placebo (instead of dutasteride). There was NO difference in muscle growth between men with normal DHT levels versus men with 5% as much DHT. It really doesn't get more clear than that. To boot, there were no difference between the groups in sexual side effects either, further supporting the fact that DHT has nothing to do with that either.


Second, are you familiar with pseudohermaphroditism? Men with this condition are born with a 5AR deficiency, and they live their entire lives with little to no DHT. Other than the obvious under developed seual organs, they live full, normal lives with virtually no other telltale medical problems. Certainly nothing involving muscles or brain development In fact, these men aren't even diagnosed with the condition until they hit puberty because it causes no other symptoms. You argue how important DHT is to the brain, yet the time where the brain is developing most rapidly in a human's life is during childhood, where their DHT levels are at almost nothing! You mean to suggest DHT suddenly becomes crucial for the human brain only after puberty?


Third and final reason is women. Women live life with less than a tenth as much DHT as men. Again, you think DHT is important to so many tissues, why do women not fall apart from the lack of it? Yes, they do have smaller muscles then men, but the reason for this is testosterone. When women juice with T, we all know how muscular they can get.

 

[Quantum Cat]

do you think DHT supression could concievably cause long-term lethargy/fatigue? Considering it is quite a powerful hormone

 

[Fanjeera]

how old were you when you took the finasteride, fanjeera?

18.

I'm not quite sure how you reached this conclusion (or any other conclusions regarding DHT being so important), but I have 3 reasons why you are wrong.

First, this: http://jama.jamanetwork.com/article.aspx?articleid=1105045

"Changes in fat-free mass in response to graded testosterone doses did not differ in men in whom DHT was suppressed by dutasteride from those treated with placebo, indicating that conversion of testosterone to DHT is not essential for mediating its anabolic effects on muscle."

Men had their DHT essentially blasted away with dutasteride for 5 months and were given testosterone in different amounts and had their muscle growth measured against men on placebo (instead of dutasteride). There was NO difference in muscle growth between men with normal DHT levels versus men with 5% as much DHT. It really doesn't get more clear than that. To boot, there were no difference between the groups in sexual side effects either, further supporting the fact that DHT has nothing to do with that either.


Second, are you familiar with pseudohermaphroditism? Men with this condition are born with a 5AR deficiency, and they live their entire lives with little to no DHT. Other than the obvious under developed seual organs, they live full, normal lives with virtually no other telltale medical problems. Certainly nothing involving muscles or brain development In fact, these men aren't even diagnosed with the condition until they hit puberty because it causes no other symptoms. You argue how important DHT is to the brain, yet the time where the brain is developing most rapidly in a human's life is during childhood, where their DHT levels are at almost nothing! You mean to suggest DHT suddenly becomes crucial for the human brain only after puberty?


Third and final reason is women. Women live life with less than a tenth as much DHT as men. Again, you think DHT is important to so many tissues, why do women not fall apart from the lack of it? Yes, they do have smaller muscles then men, but the reason for this is testosterone. When women juice with T, we all know how muscular they can get.

The study is made under the excessive pressure of testosterone supplements, which masks the side effects. Though, there still should be a small supression in the effect of T, but there isn't, so you're probably right about the muscles. I think we should also look at simple nothing vs dutasteride studies. There you get sexual side effects and reduction of prostate 100%.
Pseudohermaphroditism is only lack of 5ar2. The 5ar1 and 5ar3 compensate. Finasteride hits both 5ar3 and 5ar2 and in a random point of a person's life, so that's worse.
Women have less DHT, because they have less T and they are women. We need to be men. AND they still need 5ar-s for other hormones in the body, like tetrahydroprogesterone (allopregnanolone). So their 5ar function is the same.

 

[Wuffer]

The study is made under the excessive pressure of testosterone supplements, which masks the side effects.

But Fanjeera, you said in this very thread that inhibiting 5AR stops testosterone's effect on the body. But now you're saying supplementing testosterone masks the side effects? How is this possible if the hormone has no effect on the body? If taking T supplements cures all the side effects, then why does it work on anyone who takes the drug, or those with symptoms persisting after? It's clearly not so cut & dry as you make it out to be.

Though, there still should be a small supression in the effect of T, but there isn't, so you're probably right about the muscles. I think we should also look at simple nothing vs dutasteride studies. There you get sexual side effects and reduction of prostate 100%.

This study only involved a couple hundred men, and sides are quite rare on both finasteride / dutasteride, so that probably explains why they didn't really show up in this study. But yes, both drugs certainly cause sexual sides and reduce prostate volume. I merely pointed that out to support the fact that sides are rare.

Pseudohermaphroditism is only lack of 5ar2. The 5ar1 and 5ar3 compensate. Finasteride hits both 5ar3 and 5ar2 and in a random point of a person's life, so that's worse.

Yes, you are correct, they only lack 5AR2, but the type of enzyme isn't pertinent to this discussion. You are making the argument that lower DHT levels will cause problems. Psuedoherm's live their lives with significantly lowered DHT levels; IIRC to similar levels as taking dutasteride. What do you mean that type 1 and 2 compensate? If they compensated, they would have normal DHT levels, but they don't. If the enzymes automatically compensated, then they would compensate in people taking finasteride too, since it doesn't completely inhibit the enzymes.

Women have less DHT, because they have less T and they are women. We need to be men. AND they still need 5ar-s for other hormones in the body, like tetrahydroprogesterone (allopregnanolone). So their 5ar function is the same.

"we need DHT because we are men" is the same argument I've been hearing forever, and it's simply not true. You have shown us that these enzymes exist in many tissues in the body. Yes, this is absolutely true. But you are jumping to the conclusion that because of this, inhibiting it will damage these tissues. This is a massive leap, and you have no evidence to support it. It's simply not true until it's been proven and demonstrated, which it has not.

 

[Fanjeera]

As it seems, dutasteride's dose wasn't high enough in that study to block the whole effect of such great dose testosterone. That's why no reduce in prostate and sexual side effects. You take more dutasteride and block more receptors -- there's no place for testosterone, so you don't see that effect anymore.
They're not compensating fully of course, otherwise pseudohermaphroditism wouldn't be a disease at all. No, resistance doesn't evolve with taking finasteride via upregulation of enzyme synthesis, otherwise the drug wouldn't have an effect in the same dosage after years. I guess there still is some, but it's not comparable with pseudohermaprodites who can still freely use their 5ar3 and 5ar1, upregulated or not, unlike finasteride takers. Perhaps that's the reason why finasteride is given in such a high dosage: to be sure all the newly and faster synthesized enzymes are also blocked and therefore eliminate the chance of resistance onset.
The enzymes are there for a reason. Everything is.