Dr Alan Jacob's "theory" on treating PFS with Finasteride

If you guys remember I posted something a while back about an idea I had about curing PFS with Finasteride, I had been thinking that somehow that might be possible due to people’s recovering for a bit when going back on only to get worse later. Well, when I spoke to Dr Jacobs today, he told me he had just got off a long conversation with some PHD in something involving this field, I am sorry but I forget, but this guy had PFS (and had an impressive title).
Anyway, long story short, they were discussing a theory that PFS is caused by abrupt cessation of finasteride use. The concept was that the brain gets used to Finasteride, when you quit abruptly you then have a surge of DHT as the body is used to it being blocked, then a crash. So the theory is to taper off extremely slowly and gradually, he did not say he had any plans for this or doing this, it was just a theory.
I thought it was worth mentioning, it is interesting that when PFS sufferers go back on finasteride they have typically a short period of improvement followed by getting worse. I wonder if there is anything to this, this is one experiment I would probably not be the guinea pig for lol. Has anyone here ever gone back on and tapered off very slowly? I think the idea was EXTREMELY SLOWLY over a lot of time.
Please spare us the general comments about how much we all hate Merck, we know that, this isn’t about politics, this is about science and finding a solution to a problem. You know, it makes me think, I had been quitting Lexapro, I tapered down to 5mg and then just stopped taking it altogether, I started having problems with my dick! Then I found out about Post SSRI syndrome! So I went back on 2.5mg (which is so small it is not even considered a dose), and the problem reversed itself. I do not want to be on Lexapro, but now I am afraid to ever stop.
I thought because it came from Dr Jacobs it was worth posting, but he DID NOT SAY to do this, it was just something he was discussing in theory with a scientist.

JustQuitDut, don’t forget that you have also taken Accutane. You’ve basically taken a holy trinity of drugs which are thought to fuck up peoples’ sex drive: Propecia, Accutane, Lexapro. Or: finasteride, isotretinoin, SSRI.

Earlier this year, this article was published in the International Journal of Risk & Safety in Medicine. It was released by a team organised by Dr Healy, a professor at the University of Bangor in Wales, UK.

One hundred and twenty cases of enduring sexual dysfunction following treatment.

BACKGROUND:
There have been reports for over a decade linking serotonin reuptake inhibitors, finasteride and isotretinoin with enduring sexual dysfunction after treatment stops.

OBJECTIVE:
To explore the clinical pictures linked to all 3 drugs.

METHODS:
We have selected 120 reports to RxISK.org reporting the problem and mined these for data on age, gender, drug of use, and impact of the problem.

RESULTS:
The data make it clear that the three drugs show extensive overlap in symptom profile, regardless of sex or country of origin.

CONCLUSIONS:
The availability of 120 reports from over 20 countries add to the case for the validity of the syndrome. This is severe and enduring condition can result in death. An understanding of its physiology and an approach to treatment are needed.

KEYWORDS:
SSRIs; erectile dysfunction; finasteride; genital anesthesia; isotretinoin; loss of libido

ncbi.nlm.nih.gov/pubmed/24902508

Bullshit. Some of us crashed on the drug.

JustQuitDut, as with many of your “new” discoveries, this particular hypothesis has been discussed many times already. In fact, it was one of the very first. Had you bothered to use the search function - as many have already suggested to you - you would know this already. Furthermore, this hypothesis doesn’t account for people like myself, who couldn’t tolerate the drug and crashed while on it. Going back on the drug, and slowly tapering off, has also been discussed. I believe a couple of members have tried this already, with no success. The rest of us simply aren’t willing to take such a big risk.

While I commend your willingness to explore many treatment options, and act as a guinea pig for them. I can’t help but notice how persistently egocentric your posts are. You appear to suffer from some sort of impulse control that not only leads you to believe your personal “insight” is greater than the combined members of this forum - many of whom have seen Dr. Jacobs - but it also prohibits you from thinking before posting.

I don’t wish to censor you, but I am going to encourage you, once again, to be a little more receptive to the pre-existing information available on the forum. There is plenty of it, make good use of it. Stop using the forum as a platform to broadcast your disparate thoughts as and when they occur to you.

Also, your initial post only highlights how behind the times Jacobs is with regards to syndrome onset. Sounds like he has not advanced his understanding of the problem since he first started seeing patients.

Yea, I crashed while on it. No fucking way more of it will help.

Its like treating a gunshot wound with more bullets huh?

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I could say this maybe being effective on sufferers like myself. I had very few side effects while taking finasteride, and even when I took dutasteride. In fact, I often look back and wonder if I would be better off now had I tapered my usage off very slowly.

The path leading up to my initial crash happened almost in slow motion. I quit taking finasteride (cold turkey) and for a few weeks I was OK. I then began noticing that my erections were weakening and required more physical stimulation to keep going. At the same time, I also noticed that my semen went from clear and watery back to thick and white, just like it was pre-finasteride. Oddly enough, while my erections were getting weaker, I started to get them spontaneously – albeit rarely – but this never happened while on fin.

Due to the weakened erections, I occasionally took Cialis and even a 5 mg dose kept me going multiple times throughout the day. After a few months of gradual worsening, I finally plummeted one day began having massive panic attacks, random crying episodes, and extreme fatigue. On that same day, I could not get any form of erection, and Cialis did nothing for me. This period lasted for approximately a week until I began to feel slightly more energetic and was once again able to get erections.

After all that, I’ve been at my baseline for several years now. I’ve been hopeful for a natural recovery with time, but I can’t say I’ve seen any measurable improvements. In fact, the only time I felt better following my crash was when I decided to take finasteride for a week just to see what it would do to me. My mood improved, erections improved, and lethargy was not as bad. I stopped it abruptly and experienced a small crash again. No erections, and extreme fatigue.

Unfortunately, it’s too late for me to test out this theory, but depending on how fin affects the particular user, it could be a viable option as a cessation plan.

What about all of the people who get PFS while they are still taking the drug?

The “I stopped taking Propecia and then got PFS” story is a subset of the PFS stories.

Exactly, I’m surprised JQD didn’t point that out to Jacobs. In JQD’s thread he said he tried fin again and re-crashed.

Let me answer you all here in one post, look, I am focused on trying to resolve this, I am giving Dr Jacobs a chance, so far he is the only doctor with experience in this and he is a neuro endo, I don’t want to bash the guy till I give him a chance. I mean I just paid $650, also, I may not have completely paid attention to what he was saying about tapering off finsteride. I believe he was saying extremely slowly and over a long period of time, but it was just a theory in conversation. I just thought I would post it here so you guys could have access to the info I am paying for, that’s all. Remember that I am on a protocol which has reversed PFS 100%, let’s not forget that, still now, 2 weeks and PFS is still in reverse. When the Masteron and Arimidex wear off PFS starts coming back. I am hoping that perhaps Dr Jacobs can refine my protocol or offer me some help. I see it counter productive to criticize and attack the guy before I give him a chance and after I paid him. He hasn’t even done anything yet, we haven’t even discussed anything yet, he was just asking me about my situation and history.
Yes, I was on Accutane many years ago, then Finasteride for 13 years, then Avodart, plus an SSRI, and I managed to reverse PFS 100% with this protocol I am on. I am doing so well that my dick gets hard even when I am not horny, it is like I am on Viagra all the time, that is a side effect of Masteron. I encourage you guys to try to be more positive, I know you have suffered for years with this, but be open to the fact that I am someone new, with new perspectives and experience. So far no one has ever come here with a background in anti-aging medicine, anti-aging medicine encompasses a different array of protocols that endo’s are unfamiliar with (including Dr Jacobs).

I experienced a similar crash. I stopped cold turkey and was back to 100% for almost two months before the CRASH. This theory has always been interesting to me…the only problem I see is getting small enough doses later in the taper…its hard to accurately cut pills down that small…

I would never go back on it. I crashed while on fin and then, after finding this group attempted to wean off due to fear of getting even worse. There was a week (during Hurricane Sandy) that I ran out of meds for a few days. When I got my scrip back I tried to continue the “wean.” Starting again caused me to hit the bottom- profound depression and brain fog. After that I just stopped. I know some people have had some improvement on it but I can’t endorse it based on my own experiences. Search the forums, you’ll find lots of stories about that.

I will say that an “assisted” wean sounds like a good theory, if one could actually measure the 5-AR inhibition of things like SP, green tea, etc. I’ve read about many people weaning off SSRI’s and using 5-HTP to help. If there were a way to calculate the appropriate dosage of a natural 5-AR inhibitor so that you VERY slowly raised DHT in the body perhaps that’s worth a try.

For me it was mostly just diet, exercise and TIME.

I have to echo this - use the search function, do your homework.

I got nothing against your zeal in fixing this (actually that is very important), nor do I agree with SA et all aggressive bashing of experimental treatment protocol’s (i know you lot just changed your nick, you dirty fox! lol),

but I do think you are a little over-eager in making big bold statements like this topic. You’d be suprised what kind of information you find when you dig around, you should be able to do this since you got so much focus in you.

I haven’t read the topic properly but if it’s the idea of trying finasteride again to eg. slow wean, then DON’T!! no matter what any expensive doctors says (unfortunate for your wallet lol).

That is just really obvious. Something like this happened last year or so, a user claimed that he was definitely recovering his PFS now with finasteride itself (with his disappearance of symptons while on it and increasing highs), then he crashed DOUBLY as hard after it.

If you really need a safe experience with how PFS symptons are altered with 5-ai, then take some coconut oil/cream or forest/common mushrooms and pay attention how your symptons act in next couple of days.

Maybe I misunderstood you but, I never had another name on here but this one, never changed my name, but yea I am going to be more careful what I post. I do have PFS reversed with Masteron (synthetic DHT) Testosterone, and a high dose of AI’s, I am just still working out the protocol. I am trying to find the perfect protocol to help others here.
As for going back on Finasteride and tapering off, that is one experiment I shall not be the gunniea pig for lol. For the record, the doctor did not suggest it, he just said it in theory.

I was talking about a different member (SecondAmendment) in that sentence, otherwise the whole post was directed to you. That’s a relief to hear (that you aren’t going to go back to it).

RE: using DHT hormones and AI’s, you can read member -JN- 's topic.
He did the same but found that while it reversed the symptons, he had to increase the dosing over time to get the same results and started to feel that it wasn’t the real recovery. Then he dropped Proviron, read about hypothyroidism & adrenal fatigue issues and moved on to using T3. He got massive improvements from that over time, i think he also used cortisol (would avoid that for as long as possible), then fixed his diet, then recovered. Shortly after became an advocate of parasite theory and all.

So you know, not to rain in your parade but just throwing that possibility out if things stop working with supplied hormones (only if). You could then start doing his topic’s protocol, for example.

I spoke to Dr Jacobs again the other day and he clarified the experiment going on with Finasteride to cure PFS. It isn’t his theory, a scientists who has PFS has a theory that PFS is caused by rapid cessation of Finasteride, and that slow gradual tapering could recovery PFS. I don’t mean any gradual tapering we could do on our own, he is literally using some kind of micro scale to taper it at the micro level, this is what I didn’t catch onto last time I spoke to him.
This is an interesting experiment, but one I won’t be the guninea pig for lol, but I wanted you guys to know it is going on. I think it is great that different approaches are being tried anyway. This is just an experiment by one scientists who happened to get PFS, I forget what kind of scientist he is, but it is a relevant field to this study.

And for those of us who crashed while on it?

It isn’t my theory and I didn’t want to waste my time with Dr Jacobs discussing it, I was paying for the call, he had mentioned it to me a couple times. The guy that is doing this is some kind of impressive scientist for pharmacological chemicals or something, I don’t know. Again, it isn’t my theory, it isn’t dr Jacob’s theory, so my bad there, but it is an experiment 1 scientists is conducting.
I am sure he knows many crashed while on it and has an explanation for it, he can’t be that stupid, I am not interested in why this occurred, only resolving it. I figured out a key aspect of this condition and a protocol that will over time induce recovery, and in the short time reverse the symptoms, I hope you try it as well Mark.

Hi, I’m the medical doctor and PhD in neuroendocrinology that Dr Jacobs was talking to who has had problems with finasteride.
I attach a draft of his new blog outlining my thoughts (mostly accurately) on this topic and will start a new thread outlining it.
I should say straight off that I don’t think it will help anyone with post-finasteride syndrome (except perhaps understanding where the syndrome originates from) and will only really be helpful to people on the drug who have side effects who want to stop and minimise the chance of side effects after stopping.
However, I am very keen to spread the word to people who might be in this situation (as well as to conduct research to confirm the hypothesis).
mark%2520horowitz%2520letter%2520pdf.pdf (64.3 KB)

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I just want to clarify - after reading the posts on this page more carefully - that there appears to have been confusion in repeating the theory: there is no utility in people who have PFS going back on the drug and tapering off. That makes no sense.

Another point to emphasise is that it is very, very difficult to taper off the dose because of the potency of the drug at low doses. I was only able to do so because I have access to a university laboratory allowing me to measure out doses of the finasteride down to 0.01mg.

There are other means to achieve this but the point is that it is very difficult to taper off and I therefore believe few people have truly undergone a tapering regime. Tapering basically involves going from 0.05mg/day to 0.01mg/day over a period of time (or an approximation of this). Quartering or even dividing propecia into eighths will not achieve this. In other words, it is possible that no one has ever tapered off really effectively (although some diligent souls might have achieved some portion of this).