Finasteride [5ARI] Induced/Associated Effects

[Michael Scally MD]

Finasteride in the Treatment of Female Pattern (Androgenic) Alopecia

Oliveira-Soares R, JM ES, Correia MP, Andre MC. Finasteride 5 mg/day Treatment of Patterned Hair Loss in Normo-androgenetic Postmenopausal Women. Int J Trichology 2013;5(1):22-5. Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women Oliveira-Soares R, e Silva J M, Correia M P, André MC - Int J Trichol

BACKGROUND: There is no consensus on the standard treatment options for female pattern androgenetic alopecia (AGA). Efficacy of finasteride in women is controversial. The purpose of this study was to evaluate the clinical efficacy and safety of 5 mg/day oral finasteride in normoandrogenic postmenopausal woman.

MATERIALS AND METHODS: A total of 40 normoandrogenic postmenopausal women with AGA was enrolled in this study. They were treated with oral finasteride 5 mg/day for 18 months. Efficacy was evaluated by patient's satisfaction and global photograph assessment. All the 40 patients completed 18 months of finasteride treatment schedule.

RESULTS: After 6 months, 22 patients referred significant improvement, 12 moderate improvement, and 6 no improvement. Regarding to global photo assessment, 8 patients showed no improvement, 16 showed moderate improvement and 16 showed significant improvements at the 6(th) month. A slight improvement was observed over time from 6 to 12 and 18 months observation. Maintained libido reduction was referred by four patients and liver enzymes increase was observed in one patient. Older patients were more prone to worse response.

DISCUSSION: Finasteride 5 mg/day is effective and safe for the treatment of female AGA in postmenopausal women in the absence of clinical or laboratory signs of hyper-androgenism.

 

[7895123]

Geez this thread is starting to make paranoid. I've been on propecia for close to 3 months now and I haven't had any issues with it yet. Will all this bad stuff come later on?

 

[johnnyBALLZ]

Geez this thread is starting to make paranoid. I've been on propecia for close to 3 months now and I haven't had any issues with it yet. Will all this bad stuff come later on?

Someone please correct me if I'm wrong. More than likely if you were one of the few unlucky souls you'd probably know by now.

 

[Dr JIM]

It's difficult to say whom the SD sides may effect since the attack rate is only 1-2% of treated patients.

Moreover some patients develop signs and symptoms of SD only upon discontinuation of therapy!

Jim

 

[Michael Scally MD]

Samplaski MK, Lo K, Grober E, Jarvi K. Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil Steril. http://www.fertstert.org/article/S0015-0282(13)02786-6/abstract (Elsevier)

OBJECTIVE: To determine the degree of improvement in semen parameters after finasteride discontinuation.

DESIGN: A prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride.

SETTING: A male infertility specialty clinic.

PATIENT(S): Men presenting for fertility evaluation from 2008-2012 on finasteride.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Semen and hormone parameters before and after discontinuation of finasteride.

RESULT(S): At presentation, 27 (0.6%) of 4,400 men on finasteride. The mean duration of treatment with finasteride was 57.4 months, and mean dose was 1.04 mg/day. There was an average 11.6-fold increase in sperm counts after finasteride discontinuation. Of the men with severe oligospermia (<5 M/mL), 57% had counts increase to >15 M/mL after finasteride cessation. No man had a decrease in sperm count. There was no change in hormone parameters, sperm motility, or sperm morphology.

CONCLUSION(S): Finasteride, even at low doses, may cause reduced sperm counts in some men. In this population, counts improved dramatically for the majority of men after finasteride discontinuation. The hormone parameters, sperm motility, and sperm morphology were unchanged after cessation. Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.

 

[Michael Scally MD]

Collier R. Propecia lawsuits: the lasting effects of delayed drug warnings. Canadian Medical Association Journal 2013;185(10):E455-E6.

If a movie star trips over a poodle outside a sushi bar in Los Angeles in front of camera-ready paparazzi, school girls in Japan would, within minutes, undoubtedly find links to photos of the mishap as they thumb through the Twitter feed on their iPhones. Yet in an age where information moves almost at the speed of thought, an important health warning on a drug in Europe took years to reach labels on the same product in Canada.

And many people in Canada who took that drug aren’t too happy about the delay.

Finasteride is the active ingredient in Propecia, a hair-loss drug, and in Proscar, which is used to treat prostate enlargement but also promotes hair growth. The drug company Merck makes both products.

In 2008, Sweden updated the monographs on these drugs to warn of persistent sexual dysfunction even after men stopped taking them. Italy soon followed suit, as did the United Kingdom. Though labels in Canada warned of possible sexual dysfunction, they were not updated to include the bit about how it could continue “after discontinuation of treatment” until 2011.

“A three-year delay? That’s pretty bad. That’s really pretty bad,” says David Klein, a lawyer in Vancouver, British Columbia. “When you have a three- or four-year time lag between warnings in Europe and warnings in Canada, that’s a serious public health issue.”

Hundreds of men in Canada with lasting sexual dysfunction believe that Merck should have warned them earlier. Klein’s law firm, Klein Lyons, has launched class-action lawsuits against the drug company on their behalf in BC, Ontario and Quebec. “They keep calling us,” says Klein. “These are, for the most part, young men who had no sexual problems before they went on the drug.”

According to Merck, however, the available data do not support claims of a causal link between Propecia or Proscar and persistent erectile dysfunction that continues after going off either drug.

“In these cases, Merck believes that the evidence will show that the company acted responsibly and appropriately with respect to Propecia and Proscar throughout the development, marketing and post-marketing monitoring of these medicines,” Merck says in a statement sent to CMAJ from Lainie Keller, the company’s director of global communications.

“Merck also believes that the evidence will show that pre-existing conditions and other risk factors, not Propecia or Proscar, caused the claimed conditions.”

And according to Health Canada, the agency responsible for pharmaceutical monographs, delays in updating drug warning labels are to be expected because it conducts an independent review when new safety issues arise in other countries.

“This analysis takes into account a variety of domestic factors, such as the pattern of use of the drug in Canada, availability in Canada, Canadian prescribing practices and Canadian treatment guidelines,” Health Canada states in an email sent to CMAJ from media relations officer Leslie Meerburg. “When Health Canada’s assessment of all available data identifies a new health risk with a product, Health Canada takes appropriate action, such as working with the manufacturer to update the product labelling and notifying health professionals and consumers of this change.”

Despite updated warning labels and notifications, there still appears to be many doctors prescribing these drugs to patients without adequately informing them of the risks, says Dr. Michael Irwig, an assistant professor of medicine at George Washington University in Washington, DC. Irwig has written several papers exploring the adverse medical effects of finasteride, including one that showed 61 former users who developed persistent sexual side effects had higher rates of depressive symptoms and suicidal thoughts than 29 men in a control group (J Clin Psychiatry 2012; 73:1220-3).

“If you want to use this medication for your hair, you may grow a little hair, but there are cases of men who have persistent sexual side effects that last a decade after stopping this medication,” says Irwig. “This is some very serious stuff.” — Roger Collier, CMAJ

 

[D12]

The should sue Merck for all they are worth.. especially since they are still trying to blame the patient by saying it is due to how the drug was taken or other pre-existing conditions.

 

[Dr JIM]

Indeed isn't it amazing how some "patients" make remarkable recoveries after being awarded a large settlement! Yea baby.

The known data at present has shown VERY FEW (far less than ONE PERCENT) develop ED BECAUSE of 5ARIs that lasts over one year. Well guess what, that's pretty damn close to the "natural" prevalence of ED!

So you tell us how we should determine causation especially considering ED has both psychobiological AND physical causes?

Answer a longitudinal study over at least TEN years where all factors are considered otherwise we could very well have a repeat of the "silicone breast implant" debacle of yesteryear.

Later a LONGITUDINAL study clearly defined causation,
medical ailments NOT the result of SILICONE except in RARE instances of rupture (and even then the relationship was NOT unequivocally confirmed) or psych issues!

Jim

 

[johnnyBALLZ]

The known data at present has shown VERY FEW (far less than ONE PERCENT) develop ED BECAUSE of 5ARIs that lasts over one year. Well guess what, that's pretty damn close to the "natural" prevalence of ED!

Ha, very true, thanks for pointing that out!

 

[D12]

Re: Help me please -- Finasteride-induced secondary hypogonadism, low T/LH/FSH, high

Finasteride is a water over the dam.
It is in the past, can't change past.

To have a life now, I suggest thorough testing and adjusting what can be adjusted.

Saliva testing only for cortisol?DHEAs
Otherwise use mostly serum and some urine tests.
Stool and hair tests are helpfull.

I publish list of tests that I do for my self, if someone need I can repost.
.
.

I apologize if this has been explained before. But, my docs have only done cortisol and DHEAs via blood tests. Why is saliva better for these tests? And if they are better, why don't docs do them this way and how can I get mine to do them properly?

 

[Dr JIM]

I applaud your Doc for NOT performing unnecessary (those tests which do not alter therapy) tests since what your suggesting is indeed unnecessary.

Perhaps if you looked up the cholesterol / progesterone pathway (that's the metabolic origin of ALL the SEX HOONES) on Wiki you would understand why, rather than believing your own DOC isn't ordering the tests "properly".

Jim

 

[Ticonderoga]

Indeed isn't it amazing how some "patients" make remarkable recoveries after being awarded a large settlement! Yea baby.

I would trade all the money I have or that I could get from a lawsuit to go back to normal again. I took it for about 6 years. I quit and within 6 weeks I was hypogonadal. The only blood test I had before quitting when I was on it showed that I was normal. But the bloodwork is really not the story. I went from feeling normal to feeling like total sh*t. It was more than ED. Maybe the percentage is low of men who are affected, but there is too much anecdotal evidence to say that it is just natural occurrence.

 

[Dr JIM]

Well fortunately science is evidence based so good luck PROVING CAUSATION considering the multifactorial risk factors which are KNOWN to be responsible for ED.

 

[Ticonderoga]

I had three doctors (two uros, one endo) independently tell me the cessation of long-term finasteride use caused my HPTA to crash. I am not a plaintiff. All that I am stating that for a few, this drug is a tremendous problem.
Sometimes evidence, even in court, can be based upon the lack of any other explanation. For example, if you have a 30-year old, non-steriod using, non-smoking, non-overweight healthy individual go from normal hormonal levels to hypogonadal, you seek explanations. When the usual culprits are ruled out, such as a pituitary tumor, steroid abuse, primary hypogonadism, injury, etc. it leaves little but common sense to realize that the most logical and likely explanation is the one hormone-altering chemical that is no longer in your body. You actually don’t need a study to prove that. Yes, ED can have a multi-factorial cause, so can a loss of libido, depression and prostate cancer. Fact is, science (even Merck) has acknowledged that a small percentage of users have these results. That was based upon science. Why my HPTA crashed, which is much more dynamic than ED and loss of libido, points to one place.
Dr JIM, particularly with your medical training and background, can you help offer me any solution as to what multi-factorial considerations I could explore for why I became hypogonadal 6 weeks after quitting without another pathology? Thanks.

 

[D12]

I applaud your Doc for NOT performing unnecessary (those tests which do not alter therapy) tests since what your suggesting is indeed unnecessary.

Perhaps if you looked up the cholesterol / progesterone pathway (that's the metabolic origin of ALL the SEX HOONES) on Wiki you would understand why, rather than believing your own DOC isn't ordering the tests "properly".

Jim

As I am not a doctor, I did not know what pathway to look up. If that makes my question offensive to you in some way, so be it. If you will look at my question, I was responding to someone else's mentioning of saliva possibly being better than blood tests. I only asked the question IF that was true, and if it was then why is it not done by docs. I never assumed one was more proper than another, only asked the question based on others experiences and knowledge on this forum.

You can applaud my docs for not doing those tests if you wish, and I applaud them too if what they are doing is correct. My questions, and the reason I am on this site at all, is because I have taken prescription drugs and had nasty side effects that my neuro, endo, and uro cannot fully explain. Often they do not agree as to what course to take to deal with clinical symptoms that they admit are legitimate. I would think anyone could understand that specialists not understanding what is going on with a person and disagreeing on how best to treat, if at all, can leave the patient confused and questioning who is right and what else can be done.

That is where I am, and that is why I ask the questions I do.

 

[Dr JIM]

Welcome to the Pinnacle of medical understanding DT!

 

[D12]

When you get desperate enough, a person will look anywhere and everywhere for any information he can find.

 

[jonyoung]

Ok quick question I have never taken finasteride or properica or anything of that nature and I have a lot of the same symptoms I believe from improperly using the dht gel andractim ( I was young, dumb, desperate for penis growth, and no idea of the side effects) well fast forward 3 years later I'm awaiting dht results from body logic ( I have an appointment this Friday) and am currently on on clomid have been since June of 2012

though I wonder how to get my penis size, my testicle size, and my sex drive back to what they were prior to andractim,

So basically what I'm asking is dht pretty much the main culprit in all this mess?

 

[Dr JIM]

Fella Meso is not a Dr Phil and Oprah choreographed TV show so if you honestly believe ANYONE can post an informed, reliable and medically sound reply to your questions ABSENT a formal evaluation, your either naive, foolish or have been watching to much Oprah!

Obtain a medical assessment of your condition including a complete history, physical, and labs tests as deemed necessary and THEN post a synopsis.

Anything short of these suggestions is pure conjecture and a waste of time IMO.

 

[jonyoung]

Ok Dr Jim I just ask because I am going to the dr a body logic clinic on Friday and I feel as if andractim the dht gel could of been the reason for all this,

The dr I believe will have my blood and urine tests , I just wanted to know people's thoughts and opinions because I obviously want this cured