Some questions about finasteride.

[mah_hong]

Let me start by saying this post is, technically, not in line with the rules and regulations, but I would be very disappointed if it was disallowed because I’m very interested in gaining opinions and evidence from every corner regarding the drug finasteride and its uses/non-uses.

First off I am not or have not taken finasteride, but I am considering it. Now, I appreciate that likely doesn’t sit well with you all, and I’m reluctant to start the drug for exactly the same reasons many of you have such dislike for the drug. The way in which the drug works, the long-term nature of the drug and the reported side effects do not make good reading. I have spent a lot of time discussing the drug with various people, and a lot of people are of course pro-finasteride. What I dislike are not people’s opinions on the drug, but fundamentalism and bias about the drug (both positive and negative). In the spirit of good research and open opinion I wanted to pose some questions on this board to those that are knowledgeable about the drug in the hope of getting some reasoned and useful answers.

To that extent, whilst of course I am worried this post will be deleted, I hope it won’t be and I can learn something from it. I would consider, after all, we’re all interested in the truth about this drug, not necessarily just the infamy that surrounds it, positive or negative. I am not a fan of the propecia=poison argument but I have equal disdain for the “those side effects are all in your head” crowd either. I’m hoping I can find a rational bunch of people right across my research; everybody from pro-propecia users to anti-propecia non-users.

So, in my hope I can learn more about the drug and further inform my opinion on it, I wanted to ask some questions to this side of the spectrum and see what the answers were.

1. I appreciate nobody here endorses or likes the use of finasteride by patients, but would I be right in assuming that the people that experience serious side effects (serious I would define as severe and/or long-term or permanent) are in the relative minority? I’m aware of the <2% of people statistic quoted by Merck, which I personally don’t believe. But, similarly, would I be right in saying that even people on this forum both agree and concur with the statement that the majority of people seem to take finasteride without serious side effects?

2. Theoretically the range of DHT and indeed the balance of hormones found from person to person will be quite diverse, with “normal” ranges not being entirely uniform. Would there be some validity to the argument that people with a higher DHT/testosterone would generally find the drug less damaging than those with low DHT/test? The reason I ask this is, because DHT can vary from man to man, would it not stand to reason that a man with higher DHT that was lowered by finasteride may not experience such obvious or problematic side effects as a man with low DHT or issues with his endocrine system from the outset?

3. This is a shot in the dark, but I’m curious. Is there any evidence or research into ways of making the finasteride formula safer? My understanding (which is fairly basic) is that a big part of the proposed problem with finasteride is its involvement with and influence on other hormones. To that extent is there potentially a way in which the drug could be modified (or used in conjunction with other drugs) to limit side effects and problems? Please don’t mistake this question as me asking “are there any other drugs I can take with finasteride that will make it safer?”. I’m just curious as to whether there has been any amateur or professional research into the possibility of a safer drug that still worked in a similar fashion.

4. In theory, would slowly introducing finasteride to someone’s body be safer (whether marginally or otherwise) than starting off with the suggested 1mg (for hairloss)? I only ask this because most people seem to both start and end finasteride instantly, and without any blood tests or proper medical evaluations. Would possibly “getting your system used” to finasteride in very small doses and building up towards and acceptable dosage (and, conversely, slowly coming off the drug) make any real difference do you think?

5. Would you generally be in agreement that ALL DHT inhibitors and in essence dangerous? Is the theory as simple that inhibiting DHT=bad idea? Or do we believe there are other factors involving finasteride which are primarily to blame for the side effects and problems?

6. I hope this question doesn’t get taken the wrong way, but would there be some merit in saying that people who have bad experience with finasteride may have some problem or difference in their endocrine system responsible for the way the drug changes them? I do not mean this question as an accusation or suggestion that problems with the drug are something wrong with the individual. What I mean is, simply put, lots of men take finasteride for many years without any appreciable change to their libido, personality or physicality. Would it be fair to say that these men either have some sort of stability or aspect to their physicality that limits the negative effects the drug has, and that perhaps there are difference from person to person that cause finasteride to be as damaging as it is?

I hope these questions are allowed to be answered as I mean them in good nature and with genuine curiosity. I am frankly disappointed by fundamentalist arguments either for or against finasteride. Clearly everybody on these forums has taken finasteride or considered it, and these forums are (I take it) meant to be a place to discuss the drug from many different angles. I have spoken with a wide range of people from different backgrounds about finasteride and I wanted to get opinions, suggestions and answers from those who have unfortunately experienced negative issues.

Finally, this is a not a post in which I have come seeking approval to start taking finasteride. My opinion isn’t going to be swayed by any group of people and, indeed, I’m not asking these questions just to broach the dilemma of whether to take finasteride or not. I am genuinely interested in the drugs uses and abuses in hair restoration, and whether there are any other answers.

Thanks in advance for your time and I’m really hoping this post is allowed to remain, in the spirit of good and honest discussion. I have thus far been able to speak about finasteride openly and frankly with everybody from doctors to hair loss sufferers to prostate patients and have been able to ask questions freely about the drug. Whilst I appreciate this forum is not necessarily for “debate” about finasteride, this is an angle I would deeply like to consider and I would hate to think the only way this forum would be useful is if you simply hate finasteride and have no desire to consider the wider issue of how it may or may not be useful or safe.

Best Wishes,
Mah

[Mew]

First off I am not or have not taken finasteride, but I am considering it.

If that’s the case, and despite this viewtopic.php?f=13&t=2275 , then you really have no reason to be posting here. Here are some answers to your questions in the meantime.

would I be right in assuming that the people that experience serious side effects (serious I would define as severe and/or long-term or permanent) are in the relative minority?

Nobody can give you a concrete answer on that because there are no stats on men suffering permanent side effects, yet. However, if you are to believe the manufacturer’s claims that only 2% of men get side effects, then those with persistent issues that continue after quitting would be a subset of those men.

Would there be some validity to the argument that people with a higher DHT/testosterone would generally find the drug less damaging than those with low DHT/test?

Nobody can answer that. We are all individual in terms of genetics and hormonal makeup. Doctors treating men suffering from these issues acknowledge they do not know the exact mechanism as to why it occurs in some men vs others. Similarly, leading researchers acknowledge the mechanism through which Finasteride can alter sexual function and behaviour is unknown. In other words, its russian roulette. If you want to take that chance, that’s your call. But nobody here can tell you wether we are suffering these issues, or why certain guys get sides while others don’t, if its due to DHT, Testosterone levels etc. The fact is, there are no answers to this question yet.

would it not stand to reason that a man with higher DHT that was lowered by finasteride may not experience such obvious or problematic side effects as a man with low DHT or issues with his endocrine system from the outset?

The drug does far more than affect DHT levels, it also inhibits other 5AR-derived hormonal pathways, neurosteroids and related metabolites. Vast majority of men do not get or have baseline hormonal values pre-Fin, and seeing as there hasn’t been a study into this issue yet, we do not know what the predisposing factors are.

would slowly introducing finasteride to someone’s body be safer (whether marginally or otherwise) than starting off with the suggested 1mg (for hairloss)?

1. Nobody cares about hair loss here, do not even bring it up as we have bigger concerns to deal with.

2. Drug has near flat dose response rate so 0.2mg, 1mg and 5mg inhibit nearly same amount of DHT across the board. There is no way to “slowly introduce” Finasteride, it flatlines your DHT production no matter the dose: physics.upenn.edu/facultyinfo/frankel/papers/propeciafda2/

Would possibly “getting your system used” to finasteride in very small doses and building up towards and acceptable dosage (and, conversely, slowly coming off the drug) make any real difference do you think?

No, for reasons mentioned above.

Would you generally be in agreement that ALL DHT inhibitors and in essence dangerous?

Yes. Any substance, wether man made (pharmaceutical) or natural has the potential to cause side effects and possibly, longterm issues from inhibiting 5AR in susceptible men. The problem is there is no test to determine who is suceptible to such inhibition and why, prior to initiating of therapy. Interestingly however, scientists are recommending men be genotyped for 5AR2 enzyme variants and Androgen Receptor CAG repeats prior to initiation of therapy, to determine drug choice and response.

would there be some merit in saying that people who have bad experience with finasteride may have some problem or difference in their endocrine system responsible for the way the drug changes them?

Possibly. It’s probably extremely likely this problem is primarily due to genetics in terms of how certain individuals respond to inhibition of 5AR and resultant blockade of 5AR-derived pathways. Some men’s endocrine systems tolerate this well. Others do not. As mentioned, there is no test to determine which camp you fall into. Knowing this, probably best to err on the side of caution and not risk things.

simply put, lots of men take finasteride for many years without any appreciable change to their libido, personality or physicality. Would it be fair to say that these men either have some sort of stability or aspect to their physicality that limits the negative effects the drug has, and that perhaps there are difference from person to person that cause finasteride to be as damaging as it is?

See reasons stated above. Each individual is different in terms of genetics and hormonal profile, which likely determines their response to inhibition of 5AR.

I am genuinely interested in the drugs uses and abuses in hair restoration, and whether there are any other answers.

If that is the case, hair loss sites are your best bet. Again, nobody here is interested in discussing hair loss protocols.