Dr. Crisler talking about Post-Fin treatments, recoveries

[Mew]

Dr. John Crisler has posted on hairlosshelp.com about the following video where he warns against Finasteride use:
viewtopic.php?t=2480

Here are his comments about treating post-Fin side effects, from
hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=84859&enterthread=y&STARTPAGE=2

The video pretty much tells the story: many of these gents come in with all the symptoms of hypogonadism, but their levels are just fine. It’s an awful situation. If you personally have not suffered this horrible problem, I am very happy for you. But you may very well in the future: many of the guys who come to me used Propecia–at 1mg QD–for extended periods of time before the bottom fell out.

I honestly do not know the exact mechanism which causes this problem, but will sleep much better if we can ever figure it out. I probably have treated a couple hundred guys for this (with varying but generally good success), and it is still largely a mystery to me. If anyone has made any progress, please email me with what you have found out.

In the meantime, I have several different protocols I try, one after the other, in hopes one will take hold. In case it helps anyone, first I use one of the HPTA-restart protocols I have developed (like the steroid users employ). If none of them work, we are left with TRT–for life. Of note, and this is a HUGE point, it often takes testosterone levels well above normal range to get these guys feeling right again. Again, I do not know why.

Of note, using estrogen lowering drugs/supplements to increase testosterone is a huge mistake. They are very bad for Lipid Profile, bone mineral density, brain function, endothelial function, etc. That is what happens when you lower estrogen too far.

I hope this information may help someone here. All the best to you.

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Update from Dr. Crisler:
hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=84859&enterthread=y&STARTPAGE=10

Kim (my Exec. Sec.) told me yesterday 4 guys made appointments to become patients, and we sent out 7 more new patient information emails–all because of this very thread.

It would seem there are many more gentlemen suffering finasteride side effects here than first appear.

For the rest of you, PLEASE take note. If you have not started a drug of that class, don’t. The risks are just too great.

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Update from Dr. Crisler:
musclechatroom.com/forum/showthread.php?t=3611&page=8

Most men do just fine on finasteride. If the drug had caused any great falling off of Quality of Life, you would have noticed it.

Having said that, there are patients who have come to me who began suffering the symptoms of finasteride poisoning only after taking it for quite some time. The challenge then is to weed out other causes of these symptoms. It’s tough stuff.

I have no idea why some experience such disastrous side effects from finasteride. After several years of looking at extensive 24 hour urine panels, from many patients who have come to me for this insidious condition, a couple patterns may be emerging, but nothing I feel confident enough to publish.

It would be great if we could come up with a simple test which would weed out the individuals who should not take the drug, just as we do for many other drugs. Problem solved! I should think the manufacturer would appreciate that as well. But think about it: doctors are readily prescribing a drug that lowers a hormone without either testing the baseline level of that hormone, or appreciating the importance and beneficial effects of that hormone.

Certainly a medical condition known as Adrenal Fatigue plays a part in many–but not nearly all–finasteride sufferers’ disease process. Fortunately, that condition becomes relatively easy to treat by the astute medical practitioner. That is the first place I start (while properly and fully evaluating sex hormone status, of course).

Several theories have been proposed on forums which are dedicated to this issue. I am still evaluating them.

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Update from Dr. Crisler:
hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=84859&enterthread=y&STARTPAGE=13

"It’s important to realize and appreciate the 5-AR enzyme affects hormonal conversions well beyond T->DHT. That means many other hormones are affected by finasteride as well. Metabolization of all manner of the body’s components, and even nutrients, are then altered. I suspect interplay between these various hormones is at the real root of the cause of these individuals ill and permanent (unless effectively treated) side effects.

While evaluating these patients, the THF/5-a-THF ratio is the best indicator of actual intracellular 5-AR activity. In many of the finasteride victims I have found there is a disjoint between DHT/T ratio in the serum (and therefore urine, which is how I assess hormonal milieu) and intracellular 5-AR activity. This is unexpected. Compartmentalization seems to be an issue, as is blood/brain barrier. "

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Update from Dr. Crisler:
hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=84859&STARTPAGE=17&FTVAR_FORUMVIEWTMP=Linear

"I’m glad the topic of steroids came up. Got me to thinking.

First, I have seen a number of patients who most likely were hypogonadal all their lives. So the first time they took steroids was also the first time they felt like “men”. No wonder some become “emotionally addicted” to steroids–it’s actually physical need.

It would help if doctors would take THEM seriously as well. AND perhaps not tell them a T level of 300 at 19 yars olf is “completely normal”. Or, worse, “it’s all in your head!”

But more to the point, I’m thinking of the guys who took steroids–even OTC “legal steroids”–for a very short time, yet had their systems completely shut down from same, and did not recover endocrine function even after a long (and painful) period of time.

It’s as if their systems were just ready to “get broken”. Even after sitting for as long as several years, they never came back, and verified by assay. It’s like with the finasteride sufferers. Some lesion in their hormonal pathways erupts, and persists.

This is why I use a HPTA-Restart Protocol, like with the steroid guys, on the finasteride patients. Close monitoring by laboratory analysis increases likelihood for success, and gives valuable insight into the individual’s hormonal milieu (when appropriately combined with subjective report). I often try this even on those gents who present with decent T levels. It works sometimes. Don’t know why yet.

The notion some sort of receptor downregulation is occuring is verified by the fact achieving androgen levels as much as 50% above normal range can be necessary for those who do not find relief using less drastic measures. So we are then talking about permanent TRT. At that point, the choice of TRT modalities becomes important. I deviate from my preference for topical TRT in these cases, to injectable TRT, so as to avoid the increased DHT and estrogen TD’s [transdermals] can bring.

It seems many of these guys show low or low-normal SHBG. My experience is that low SHBG also increases the chance of emotional issues. The more steady daily levels of T the injectable brings seem to more effectively treat their problem. Even though TD’s [transdermals] more closely mimick the hormones of a young man. The injectable TRT is much preferred when low SHBG is concurrently present, less fluctuation as SHBG acts as a “buffer” against wide swings in hormonal levels.

Until we can figure out what causes this, I’m just trying to identify patterns."

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Update from Dr. Crisler:
hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=84859&enterthread=y&STARTPAGE=19

I have noticed something about the finasteride sufferers. They may have high serum/urine DHT, but low intracellular 5-AR activity.

Don’t know why.

… Perhaps because Finasteride is an irreversible, mechanism-based inactivator of the 5AR2 enzyme (even though this effect is supposed to end when you quit the drug).

Even though the body is supposed to synthesize new 5AR2 enzyme when the drug is stopped, per viewtopic.php?t=1053 , perhaps in our cases we did not and those high levels of serum DHT could be from 5AR1.

Furthermore, measurement of the 3a-HSD-reduced DHT metabolite, Adiol-G (3a-diol-G) has been noted to be a good marker of 5AR2 activity in tissue per viewtopic.php?t=761

It is therefore interesting to note that two members who have been tested for Adiol-G have had low results, possibly signifying an issue with the 3a-HSD enzyme itself, which follows AFTER 5AR2, per this diagram:

viewtopic.php?p=7206#7206

Only further in depth testing for 5AR2, 3a-HSD and Adiol-G activity can shed more light.

I have already posted a response here – musclechatroom.com/forum/sho … stcount=18

… with links to the theory about androgen insensitivity, and asked if he knows of any researchers that may be open to conducting a study on us.

======================================================================

[Size=4]UPDATE: JANUARY 19, 2011[/size]

[Size=4]Dr. Crisler has posted comments on Hairlosstalk.com/interact forum. Below are excerpts.[/size]

hairlosstalk.com/interact/viewtopic.php?f=46&t=53882&start=120&st=0&sk=t&sd=a

Of note, we have seen examples of agents from BigPharma engaging in the character assassination on the forums of physicians reporting true clinical experience, and warning others of the dangers of some medications.

With respect to the potential dangers of finasteride, MUCH is coming out of academic medicine lately. Those with an honest interest in the subject may want to tune in.

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Look, I have had far too many new patients sit in front of my desk, depressed and crying, from using finasteride for me to ignore the temporal relationship between its use and their extreme debilitating symptoms. I just want you all armed with true informed consent.

Dr Shippen, Dr. Goldstein, Dr. Traish and I recently held a long conference call regarding this important matter. It was a great conversation, but I am not sure we got any closer to finding the answers. We will continue our work.

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We are making some head way:

December 2010 – Merck USA just updated their official prescribing info to include depression as a possible side effect from Propecia use, as reported during post-marketing use.

• READ DETAILS: viewtopic.php?f=33&t=4666

This confirms what many other researchers and papers have already acknowledged, most recently Dr. Traish’s Dec. 2010 published article “Adverse Side Effects of 5-Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients” (great work Dr. Traish and colleagues!).

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IF there is excessive estradiol, I indeed employ AI’s. But we must keep in mind the whole problem for the patient in these cases is the effect of an endocrine disrupting drug.

IMPO the REAL issue is the effects of the drug on other elements of brain chemistry. Enzymes often work on numerous hormonal pathways. For instance, I gauge 5-AR activity on the ratio of THF/5-a-THF, in 24 hour urinary excretion, not DHT (either urinary or serum).

As I explain in my lectures, hormone ratios as treatment goals are virtually worthless. But, yes! I am treating a living, breathing patient; not ink on a laboratory printout.

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You missed the point.

“Often these guys come in with all the symptoms of hypogonadism, but good testosterone levels.”

This is the dilemma. Our best thought at this point is, for this subset of men, finasteride induces some epigenetic effect which results in some sort of androgen resistant state. For them, therapy may necessitate androgen administration to above normal range testosterone levels.

For those patients who present with low, or low-normal testosterone levels, I administer a HPTA-restart protocol, as with those who suffer ASIH (Anabolic Steroid Induced Hypogonadism).

Whether you, or others, choose to recognize this serious medical condition is of no import, for the finasteride sufferer has no choice but to. But you could at least have the courtesy, and decency, to not insult those who have merely done what you have: seek an effective solution to their hair loss issue.

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You make an excellent point: doctors are administering a powerful drug specifically to lower production of a critical hormone WITHOUT EVEN CHECKING THE LEVEL OF THE HORMONE FIRST. Does that make sense to anyone?

The hormone DHT is most responsible for all things male. Now add the fact the enzyme these drugs inhibit also works on other important hormones in the body as well. And all this to effect a single physiologic function only at the scalp.

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Certainly there is an issue of imbalance at work. But it goes far beyond elevated estrogen (although men who did, or did not, take finasteride can present with elevated estrogen–THAT is an easy one to fix). The imbalances are probably numerous.

It’s common with ANY of the various hormone changes to induce temporary surges in sexual function. It’s weird, but it happens. I wish I knew why this is so.

What’s really tough for the PFS guys–and frankly, kind of cruel–is when they get a few days of great improvement, just to see everything fall off again.

Proviron works to bind Sex Hormone Binding Hormone (SHBG), thus freeing up more testosterone. This causes an effect as if SHBG level is lowered. So the guy feels the benefit of increased Free Testosterone. But within a day or so, the body senses the elevated FT, and responds by lowering gonadotropin output, so he ends up right back where he started.

Zinc, besides being very important for prostate health, also works to control aromatase, the enzyme that converts T to E.

I hope this helps.

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I’ll tell you, this situation really bugs me. We simply must figure out what is going on.

Those of us working at the cutting edge, such as Dr Shippen, Dr. Goldstein, Dr. Traish, etc are now just trying to recognize patterns in this previously unrecognized medical condition. That is the first step to finding mechanism.

We need to produce some sort of screening technique, to determine who should be deferred from drug class 5-AR inhibitors. Why is it this small subset of men will have (sometimes even very short term) use of these drugs irreversibly destroy their health and happiness?

As they say, it may be relatively rare, but if it’s YOU, it’s 100%.

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I regularly see a disjoint between intracellular 5-AR activity (as you have pointed out, measured by THF/5-a-THF, or AN/ET) and serum/urine DHT. A less than normal THF/5-a-THF is indicative of increased 5-AR activity.

You don’t know what your actual estrogen level is unless the assay is a “sensitive” one; the standard estrogen assays are not valid for adult males.

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I can’t work with Proviron, because it is not FDA approved in this country.

He crashed because his body recognized the extra T, and subsequently reduced output, putting him back at baseline.

How a man feels is a function of what direction his androgen levels are moving.

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I’ve yet to take on a PFS patient who had baselines drawn prior to 5-AR inhibition.

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I’m trying to get you to drop this ratio concept. Not doing doing a very good job, I see. There is NO set ratio. The variation across the population, amongst healthy, happy men, is vast.

I do not see a bunch of elevated E from finasteride use. And I have looked at–literally–hundreds of lab printouts from them.

IF it were simply a matter of controlling estrogen (and in the patients who present that way, surely do) it would be a snap. There is something much more ominous going on.

I can control estrogen at will. It’s total level, the amount of a given estrogen, the ratio between different estrogens, Phase I and Phase II metabolism, etc. Thus far no such pattern has arisen.

Good T levels, with E in place, yet hypogonadism symptoms means there is some sort of androgen resistance at work.

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DHT metabolism is but part of the picture. Consider the other hormones 5-AR acts on, especially the psychoactive ones.

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Yes, absolutely I see complaints of fatigue, exercise intolerance, and even muscle wasting with PFS.

But for sure, make sure you address any hypoadrenia issues you may have. That is critical.

Of note, when restorative efforts fail (or the patient divulges he just plain can’t take it any more) and TRT is administered, I use injectable test cyp; not my usual preference for transdermals. That is because I know I will probably need to go above the top of "normal range " (whatever that means) and I will almost certainly then generate way too much DHT and E with the TD (the enzymes that convert T into E and DHT live in the skin in higher concentration). Then we will also have to employ another endocrine-disrupting drug to control the E. In these patients, we should avoid that where possible.

Twice weekly dosing of the T can help control E as well.

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Yes, it is definitely a genetic predisposition of some sort. Why, and when, it strikes is anybody’s guess at this point.

Our goal is to not only find a way to treat this malady, but better yet also screen for those who will be so adversely affected by it. No one–and certainly not Merck–wants anyone permanently damaged by this drug.

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I have the laboratory printouts from many, many PFS patients. Kindly remember, I probably have as much clinical experience in this area as anyone ever has.

Once again, it does not matter how high your T is, if E is too abundant, you are tanked (in the face of excellent T/E ratio). All this emphasis on T/E ratio is nearly meaningless.

I know Dr. Shippen well, and am quite familiar with his work. He does not portray this magical T/E ratio as you are trying to.

IF “libido and erections are so damn sensitive to the testosterone/estradiol ratio”, as you claim, then why would it be often men can have wicked sexual function after missing a dose of a TD–when T is tanked and E is soaring? Mere changes in hormone levels–in any direction–can profoundly affect sexual function–in either direction.

I could give you a testosterone troche of 100mg, which would jolt your serum Free T–and kill your sexual function.

Finally, you are attributing the negative side effects of finasteride to hormone levels which are not borne out in actual clinical practice. In short, “feeling like” a given hormone level is not the same as actually possessing that hormone level. I have–literally–hundreds of 24 hour urine panels which prove you are not really on the right track. But I applaud your sincere desire to solve these issues.

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What your Endo really is saying is that he really doesn’t know anything about this stuff, but is still trying to sound like an expert. LOL

Those of us actively engaged in solving the PFS riddle (not to belittle its importance, of course) are trying to find patterns; patterns which will lead us to solutions. The metabolites mentioned are included in the 24 hour urine panels those of us at the cutting edge regularly run. THAT is how we have noticed this trend. But it is also text book knowledge that the 5-AR affects many other hormones than just testosterone–and these must be investigated as well.

I am beginning to believe the REAL issue is not sex hormone metabolism at all. It is instead other brain hormones.

Please read though the multiple posts already in this thread addressing the cortisol issue.

In an intact system, with negative feedback in place, you really cannot affect free T levels for more than a short period of time.

Yes! Absolutely Vit D plays a role in this. It plays a role in EVERYTHING. But specifically, perhaps with respect to its actions at the megalin receptor on the cell surface, where the T/SHBG complex binds.

I discussed this very topic with Dr. Eric Ding, from Harvard, in Sao Paulo, Brasil some weeks ago. We had lunch together, then sat at the same table for dinner that night. He thinks it is VERY important.

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[b]I have never stated this situation in irreversible. Not here; not anywhere.

We just haven’t found the solution–or solutions–yet[/b].

The notion that HCG “jumps starts” the HPTA is found all over the Boards. In fact, the result is exactly the opposite.

The extra testosterone production induced by HCG administration actually is inhibitory to the system, other than the testicles.

A Total T that low means you should have your prolactin tested, and probably an MRI of the pituitary. Thats because it is REALLY low.

I have found success in some patients using one of my HPTA-Restart protocols, even in the face of decent T levels. Not sure why–we’re just getting results.

The fact men can present with decent T levels, but all the subjective complaints of hypogonadism, leads me to think it’s more a brain hormone issue of some sort.

I am actually encouraged by your low T–it means we have acquired a target.

“Dr. Crisler. Do you believe the 2% side effects are true or is it all BS. How many men who take propecia, do you think, suffer from sexual side effects, it must be more that 2%”

My view is skewed because ALL the guys who present to me have them.

For the vast majority, they subside on their own. We are trying to figure out why the rest of them have their lives demolished.

[ScaredMale30]

Hey

I just posted in the same place, asking Dr John if he might elaborate on the success he’s had using high-dose TRT in post-Fin men.

If he’s had guys feeling better by taking their T up above normal range, that is huge. Hope he comes back.

[3pm]

Well Mew that’s good. Anyway I guess nobody remembers that these symptoms have demonstrated they can be treated with Xyrem, so I responded to Dr. Crisler’s inquiry of any success in treating the condition via e-mail.

Of course, the sooner these labs are conducted the better we all are, so I urge everyone in this community to read, know and closely follow this effort of investigation, and offer a hand if possible to push this forward. Let’s get focused.

[ScaredMale30]

Getting high on Xyrem won’t help much.

3pm, you recently posted that you’re losing muscle. We know that testosterone mediates muscle growth. How is a sleep medicine going to help?

I’m guessing your first answer might be: by causing me to produce more testosterone, or something similar. But we’ve seen enough now to know it doesn’t work like that for post-Fin guys. Thanks to Tamoxifen my T is now at 28nmol, range 10-30. I’m losing muscle just the same as when it was at 12nmol, same lab. Awor has taken his T up to supraphysiological levels, without any anabolic or androgenic effect.

It’s not T production that is impaired, it is response to T.

The only solution is some form of androgen replacement that works to partially overcome the impaired response. That is what I’m working on with my Endo in London. And that is why Dr Crisler’s line about having success with high-dose TRT is so significant.

We need to get androgens exerting their effects in our bodies again. You can take all the Xyrem you want, and maybe feel better, but you’ll still have osteoporosis in 40 years if we don’t make that happen.

[3pm]

Well, I say this is because there was no wastage or issues in my muscles at all. It was legitimately my balls working again, my body demonstrating anabolic improvements which I have not seen since before I first tried Propecia, and my brain fog eliminated. As far as my condition then, there were no I REPEAT NO problems with my body using testosterone.

There are peripheral problems at hand here, too., so let’s keep our minds open.

You guys are on a complicated and long-term quest for something specific and very hard to accomplish. In light of this event corroborated by multiple members here, you should in the least mention it (instead of expel your inward sadism and frustration towards others, and take the easy route of calling it a recreational excursion). We have differing beliefs on the matter and there’s no need to further engage it, but for the love of God, maybe listen to what I’m saying without dismissing every word. I know this current investigation matters - I’m only broadening the database.

[oh_bloody_hell]

We need to get androgens exerting their effects in our bodies again. You can take all the Xyrem you want, and maybe feel better, but you’ll still have osteoporosis in 40 years if we don’t make that happen.

Probably optimistic by a couple of decades. I have a vision of androgen insensitive guys hobbling about with frames getting gene therapy injections for ed every few months in 10 years.

Not wishing to be downbeat but is it not a bit premature to put this in the Recovery section when we don’t know of anyone who has got better this way? Especially when the doc told Boston he’d treated about 50 guys with ‘some success’.

[anonnn1]

clinicaltrials.gov/ct2/show/NCT00802321

There is a study going on To monitor the inhibition of 5a-reductase (5AR) enzyme activity at 1, 3, 7, 14, 21, 28 and 42 days following administration of a single dose of dutasteride (2, 3, or 4 mg) by measuring the change in blood levels of 3a-androstanediol glucuronide (3a-diolG) and the ratio of dihydrotestosterone (DHT) to testosterone.

That’s for duterside which inhibits 5ar gene I and II…Age group is 21-55 …

I think we’re getting to bottom of this… Solon your input is much appreciated…

I think our ratios got goofed up with taking propecia…thus causing these problems. Amazes me how these pharmeceutical companies get away with inaccurate data. Yet a drug gets approved and their stock price shoots through the roof…Corporate greed. …This company never bothered to help me out or anyone in this group…1000+ members now…Only getting bigger…When I started in 2002-2003 there was only 3-5 of us. The scientists created this drug, they understand it, and they should be able to help rectify our situations. I’m surprised nobody blew the whistle yet…Where are the whistlerblowers when you need them?

When we get better, which I think we will once the problem is isolated, I think we should all celebrate.

Disclaimer:

What I say is my sole opinion. I’m exercising my freedom of speech and in no way is defaming anybody.

[boston]

Just a warning: Don’t too many of you send emails directly to the doctor without being his patient. If you want him to help us, sign up correctly as his patient, then you can email him when u want. We don’t want to drive this doctor crazy now that he is finally sparking some interest and getting a little more enthusiastic here. You don’t want to disrupt his focus while he is actively trying to treat many active Fin-patients. Thank you. And God Bless. We will find a solution! God Bless Dr. Cris! Peace

[boston]

This is great news Mew! It seems he is finally taking an initiative. I am glad we have finally helped him feel he is as important as he is. AND am glad more and more of us are going to him so he has numbers now to experiment and troubleshoot with!
This mess can work itself out. We just have to work together!
Thanks MEW

[boston]

Blam Fellas! BLAAAMMMMM!!! WHO’S ON BOARD NOW! wHO’S ON BOARD NOW!!! sEE, THERE’S A METHOD TO MY MADNESS! iTS CALLED KNOWING PEOPLE!! A METHOD TO MY MADNESS! Thats what my Genetics professor always used to say!
I sat with Dr Crisler and talked with him for over an hour about all you guys on this site. ALL OF YOU GUYS!!
Who’s your daddy!!! WHo’s your fucking DADDY NOW!!! HaHAAA!

[Mew]

Uhm… Boston, appreciate your enthusiasm but please try and keep things at a more “professional” level of speaking… thanks.

[3pm]

@Mew

Uhm… Boston, appreciate your enthusiasm but please try and keep things at a more “professional” level of speaking… thanks.

I don’t think that could have been any politer of a reaction to blatant insanity, haha.

BTW - I will agree and say that Dr. Crisler is probably our, for lack of a better term, ‘champion’ in the endeavor of ascertaining legitimate medical professionals to get us the immense help our community needs, even if he does appear mildly skittish to openly enter these waters. It would be great if we got more and more in this quagmire to see him, as a means to push him to work with us in furthering our needs such as testing and crucial theorizing. Definitely appreciative of this man’s help, as I’m sure he’s a busy doctor.

Boston - without being nuts (lol), can you share any important things he may have had to say?

[Fanjeera]

But what about us, poor eastern europeans?

[Mew]

But what about us, poor eastern europeans?

propeciahelp.com/forum/viewtopic.php?t=2557

[joetz]

Mew, did you look at the wikipedia entry for Finasteride lately? Looks like some of the things Crisler has said about Finasteride have had an impact.

en.wikipedia.org/wiki/Finasteride

In June 2009 the male hormone specialist Dr John Crisler described how he has treated many patients suffering from persistent sexual side effects after Propecia use, and advises against use of Propecia for this reason.

[mystory]

@joetz

Mew, did you look at the wikipedia entry for Finasteride lately? Looks like some of the things Crisler has said about Finasteride have had an impact.

en.wikipedia.org/wiki/Finasteride

In June 2009 the male hormone specialist Dr John Crisler described how he has treated many patients suffering from persistent sexual side effects after Propecia use, and advises against use of Propecia for this reason.

That’s good stuff! How I wish that was written there a little over a year ago and I would have never taken this drug. Hopefully this statement and the comment about the Swedish study will deter people from taking this poison.

[ScaredMale30]

That was me.

I guess that when it comes to preventing other people from taking Finasteride, a few lines on the Wikipedia page is worth a thousand posts in this forum.

So I updated the page on the Swedish Medical Products Agency advice, and on Dr Crisler.

[3pm]

I assume this is what is meant by THF. Here’s a study regarding it’s relevance to 5AR function. Interesting finding.

[anonnn1]

He knows what he is talking about…Whether he can help me get better or not…I don’t care…Atleast putting some effort will do. Nothing to lose right?

[boston]

More people should go to see him NOW.