Any patients of Ralph Michel Trueb / Center for Dermatology and Hair Diseases?

Dr. Ralph Michel Trueb spoke of the need for unbiased investigation into PFS in a 2018 publication,

…then, in an article published this April, discusses what you could imagine as psychologically abusing his “first” apparent PFS patient because said patient inquired about PFS before beginning treatment with dutasteride.

When the patient reported that he believed he was suffering from PFS, he was immediately called in for a consultation to check out the issue. Beforehand, he had consulted three urologists who did not find any organic or endocrinological abnormality explaining the symptoms reported by the patient. Throughout the conversation, the patient expressed his belief in suffering from PFS with unusual persistence, despite all rational argumentation against it, and was humorless and oversensitive about his concern. Every attempt to challenge his conviction aroused a strong emotional reaction, with irritability and hostility. He expressed a heightened sense of self-reference, and the atmosphere surrounding his belief was highly charged. He denied both a history of depression or a current depressive episode

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and Provides some “Novel Insights”

  • 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.

  • PFS demonstrates analogies to controversial “mystery syndromes” as amalgam illness, multiple chemical sensitivity, Morgellons disease, and Koro: the symptoms cannot be adequately explained biologically, and the frequency of consultations for the respective condition parallels the media coverage, which points to a high degree of suggestibility.

  • PFS has obviously become a problem that has to be dealt with, preferentially not on a nonprofessional public platform. There are no predictive factors for the risk of development of the PFS. Nevertheless, it would seem appropriate to ascertain a history of preexisting mental health issues, such as depression or histrionic personality disorder, with a strict selection of patients before starting treatment with finasteride. Also, management of PFS should be focused on the underlying psychopathological disorder.

Sounds like the kind of guy who would kick someone’s crutches out from under them because they were “faking it”.

It would be great if a member of this forum could share any interactions with him or his clinic, especially regarding PFS.

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What a shill I’d love to give him my piece of mind, but I’ll hold off. Lmao this guy is a pimple popper doctor diagnosing people with mental health disorders I think he’s in the wrong field.

You can’t make up muscle wastage, ED, genital shrinkage, cognitive impairment, fatigue ect.

I honestly hope Baylor is honest with their findings so we can at least prove this guy wrong.

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He’s not the only moron out there. There’s plenty of them that believe the same thing. Just because they can’t prove it yet with blood work, they think it doesn’t exist. When I told my urologist almost 19 years ago now what it did to me, all he said was “It shouldn’t do that”. That just shows you how uneducated doctors are on the prescriptions they just loosely hand out like candy. I called the dermatologist that gave me the pills the day after my first crash and told her what had happened. She was completely flabbergasted and when I asked her how long I should expect these side effects to last she said they should go away within a couple of days. Maybe she said a couple of decades and I just misunderstood her. If that’s the case, I’ve only got one more year. :thinking:

I used to think that it would not be proven in my life time, but I’ve changed my mind about that. I think they’ll blow the lid off of this thing in the next 10 years.

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He is probably not even aware of severely lowered nuerosteroids as well as glutathione levels.

But yet will go on the soapbox to call PFS patients narcissistic.

It’s not often I think to myself “I hope he gets PFS” but I kinda hope that. I’m a bad person.

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i definitely hope he gets pfs. but maybe he is not at risk because he is mental healthy :stuck_out_tongue_closed_eyes:

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Indeed. If only I had been mentally healthy, then my SHBG and Progesterone wouldn’t be sky high and my penis wouldn’t have changed.

I’ll sing a Mary Poppins song and cheer up, that’ll fix it all.

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I just exchanged the following emails with him…

Dear Dr.

I am severely disappointed in many of your statements regarding PFS. I won’t get into my personal story because I believe you to be too apathetic to care, I will let you know that calling patient groups names and implying that they are lying about PFS or trying to get attention is repulsive. I don’t know if you are aware that studies have shown Finasteride to severely lower key nuerosteroids as well as glutathione levels, its not just DHT. I ask that re-evaluate your stance on PFS and the damage it can cause.

https://sci-hub.tw/10.1007/s11930-018-0163-4

Dear Mr (Moonman)

Thank you for your e-mail. I am not aware of having ever called patient group names, or having implied that they were lying or seeking attention. Please take your time to read my publications on the topic carefully. I acknowledge the existence of the PFS , though with a somewhat different standpoint than neuroendocrinologists, and urologists. Together with my colleagues in dermatology prescribing oral finasteride with success for more than 20 years, not until recently have I experienced any case of PFS. It is noteworthy, that after over 20 years of practice and experience with finasteride and when PFS was not an issue, the first and only case I have encountered was clearly associated with the media coverage on PFS and respective Internet fora . My patient developed symptoms after only 6 months of oral finasteride, after cessation of therapy, and following a coverage on the PFS on national television.

Best regards,

Ralph M. Trüeb

PS: I have forwarded your mail in copy to other Professors in dermatology who have commented on the PFS less favourably than myself. You might find that helpful.

The following statements are what have bothered me, as it is very clear you are basically saying that PFS very well may be psychosomatic in nature. I do believe you may have and continue to see more PFS patients due to media coverage of it, but I see this as a benefit. I can tell you that I developed PFS from taking Saw Palmetto and went 4 years without having any idea what caused my myriad of symptoms because there is very little information or knowledge on the harm that a subset of individuals develop from 5ar-inhibitors. Certain forums and “internet fora” may have very well saved my life. While it may be true that some (even many) men are “delusional, histrionic, etc” thinking they might have PFS - I found the following comments to overall be condescending and regressive for the thousands of individuals that are truly affected by it. I truly, truly would never wish this syndrome on my worst enemy.

  • 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.
  • PFS demonstrates analogies to controversial “mystery syndromes” as amalgam illness, multiple chemical sensitivity, Morgellons disease, and Koro: the symptoms cannot be adequately explained biologically, and the frequency of consultations for the respective condition parallels the media coverage, which points to a high degree of suggestibility.
  • PFS has obviously become a problem that has to be dealt with, preferentially not on a nonprofessional public platform. There are no predictive factors for the risk of development of the PFS. Nevertheless, it would seem appropriate to ascertain a history of preexisting mental health issues, such as depression or histrionic personality disorder, with a strict selection of patients before starting treatment with finasteride. Also, management of PFS should be focused on the underlying psychopathological disorder.

Best,
(Moonman)

Dear (Moonman)

I am fascinated by your case history, and am always ready to learn. Please do not misinterpret the psychiatric diagnoses, they are not judgemental, but are my acknowledgement of the problem, while my colleagues ridicule the PFS and its authors on the occasion of our scientific meetings. What fascinates me most in your case, is that Saw palmetto was the culprit, ant that you developed the symptoms without knowing about the PFS. Please keep me updated, and thank you for the article link. With more evidence, I will be the first to be ready to revise his opinion in public. I do care for my patients.

Best,

Ralph M. Trüeb

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Same thing happened with me with saw palmetto. Took two years to solve the puzzle before I was even aware of this Syndrome.

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I thought his reply was genuine, and he was willing to share his response with his colleagues which goes to show he cares about second opinions. My personal view on debating online with naysayers is that you should present all the evidence we have available against them. Our anecdotes are powerful and define us, but that doesn’t get across to anyone through a computer screen. Shoutout to @moonman1 for being professional and creating a good argument for us, man! Using the papers showing ED scores, lowered neurosteroids, etc. is the only way we have a chance against these MDs. I don’t think harboring a us vs. them mentality will be productive.

In addition, medical professionals are going to and have inevitably viewed our forum. Wishing PFS against people and making emotionally centered responses against these doctors will further polarize them against us. It’ll only add to their perspective that we’re simply “crazy and this is pyschogenic.” I’m not saying we can’t rant and be angry, but we have an uphill battle… and that is convincing professionals that something is truly wrong with us. We won’t win that battle by pissing off MDs. I learned that lesson the first time I got into an argument with an endocrinologist… I didn’t bring any good evidence with me besides my symptoms and he genuinely thought I was crazy.

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I just re-posted and then deleted a link to the crazy paper not realizing the original post had it (because there is no PubMed box about it). I may extract the full text of the paper again and post it here.

The other thing I wanted to say is that I find his reaction to Moonman’s email interesting. I still think he is a monster who is entirely driven by self-interest, but it might be fun to stir up his conscience just a little bit by writing more letters to him.

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Perhaps there’s a different cohort worthy of consideration with regards to the presence of personality disorders, then. That doesn’t sound like a very nice or reasonable thing to be doing at scientific meetings, particularly considering the conclusion of every literature review on the subject outside of dermatology.

Having read this publication in full yesterday, I would not recommend others do so as it is likely to be upsetting. A charitable assessment would be it comes from a place of ignorance, and as moonman’s exchange might suggest, indicates a lack of familiarity with thousands of “fascinating” cases - all of whom are human beings, and some of whom are no longer with us. Having read this entire forum now, I can assure there is as diverse a selection of personalities as you’ll find anywhere.

I strongly advise against sending emails to this man out of upset at perceived derision. Moonman has clearly made a point as adequately as is needed. Rise above it, as @Jaime suggests. Awor and I will address it in a paper of our own in any case. The truth is not on the side of this publication. The best way to react to such a thing is to focus on what we can do. Most of all, to be kind, understanding and supportive to those suffering, and bear in mind not everyone’s experience will be the same or to the same degree.

My mother taught me that it doesn’t matter what others do, we have a choice as to what we do.

Love to you all :slight_smile:

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I wouldn’t go as far as to call him a monster, but he did sound nearsighted and didn’t reference any studies showing altered bio markers. He just used evidence that was convenient for him (other psychiatric conditions that were once thought to be medical) without looking into our evidence.

I liked @moonman1 approach. Send him articles of evidence showing things have been shown to be wrong with us. Then tell him how that’s impacted us. The doctor was open to a new viewpoint after that, which is huge.

a modern parallel of this is Jon Snow saying there are white walkers coming. Everyone thinks he’s insane. Now, unfairly, the burden of proof is somehow on him… It sucks cause we’re the victims having to prove our suffering.

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I have no doubt that such emails would accomplish nothing at all as I do believe his position is not one of ignorance but of self-interest. However, a well-written email exposing this kind of monstrous depravity and posted here would be a public condemnation that has some value, if small.

You have an idealistic view of human nature. I used to be like you. :slight_smile: (Please forgive me if this sounds patronizing, that’s not my intention at all.)

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haha! Maybe I’m too naive, who knows. I know you’re a good person and a fighter like the rest of us, and PFS won’t take that away from you.

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I would just like to share something here, after reflecting on both this publication and @moonman1 sharing that certain people, apparently professionals, are given to “ridicule” this condition at their “scientific meetings”.

The following are extracts from Ritterman, J’s 2017 commentary “To Err is Human: Can American Medicine Learn from Past Mistakes?” which suggested a greater need for professional humility in medical science. He suggests notable historic mistakes be integrated into medical education to encourage this, owing to the great failure of humility he perceived across the profession.

This problem of mistaken ideas persisting despite scientific evidence to the contrary has been present since the onset of the scientific method…This problem is of particular concern in medical science, where outmoded ideas translate into excess morbidity and mortality.

Humility is both a personal virtue and a professional necessity. Personal humility is essential for good doctoring.52-55 Professional humility promotes the questioning of medical dogma, leading to the scientific testing of hypotheses. William Osler,56 considered by many the father of American Medicine, addressed the question of humility in a 1906 lecture to medical students at the University of Minnesota:

In these days of aggressive self-assertion, when the stress of competition is so keen and the desire to make the most of oneself so universal, it may seem a little old-fashioned to preach the necessity of this virtue, but I insist for its own sake and for the sake of what it brings, that a due humility should take the place of honour on the list [of virtues] …since with it comes not only reverence for truth, but also proper estimation of the difficulties encountered in our search for it. …[T]his grace of humility is a precious gift.

The more humble the medical profession is, the more likely we will avoid costly errors.

Food for thought :slightly_smiling_face:

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I wonder if this goof Trueb is aware of the Reuter’s article now.

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@moonman1 Would you be willing to send him a quick email with the Reuters article and just let him know that you thought he would like to read that? I would do it myself but I think it will have slightly more impact from you as you have already reached out.

This particular dermatologist seems particularly dense so I don’t think there is a high likelihood that you will get through to him but it is worth spreading around.

Ironically, I thought he sounded a little autistic or Aspergers after reading about his interaction with the PFS patient and his correspondence with MoonMan. He published an article this year about “Autistic-undisciplined thinking” in trichology.

http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2019;volume=11;issue=1;spage=1;epage=7;aulast=Trueb

EDIT: Reading it again, he most definitely has Aspergers. Ralph is so disrespectful to his patient, accuses him of being irrational and doesn’t understand why the patient is “humorless”. I wonder if he was trying to make jokes? Completely ridiculous.

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