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
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.