The $29 Response

[visionquest99]

Found this Q & A online. Not very helpful but I like to post what I find. (I’m glad he got out of the O.R. before replying)

Question:

I take Finasteride 5 mg once a day for BPH. I have been taking it for about a couple of years. Within the last year, my penis has shrunk and the skin around it has become very loose. Would the Finasteride cause these problems? If not, what would? I am 63 years old. I also take Flomax.

[Size=4]Submitted: 12 days and 5 hours ago.
Category: Urology
Value: $29
Status: CLOSED[/size]

Expert’s Answer

Hello and thanks for your question. Please be patient as I respond: I may be in the OR or seeing a patient and will respond ASAP.

Finasteride can cause a decrease in your libido and this can result in a smaller appearing penis. I would recommend stopping the finasteride and giving it a few months and seeing if this improves things. It may very well help a significant amount.

Customer Reply

you said “smaller appearing”. Does it actually shrink the penis?

Accepted Answer

It doesn’t physically shrink the penis, but it blocks the conversion of testosterone to dihydrotestosterone and can affect the hormones which can make the penis more flaccid.

Expert: Dr. R
Pos. Feedback: 98.5 %
Accepts: 3474
Answered: 1/27/2011

Board Certified Urologist

Authored over 25 Book Chapters and Articles, Specializes in male and female voiding issues

Link

[Mew]

yawn.

[martinM]

@Mew

yawn.

exactly. This uro is a douchebag with an evasive answer.

[spstriken]

I could not understand the purpose of posting this, every body knows now 5AR inhibtors do what they have done.

[visionquest99]

Sorry I know this was of negligible value. What shocked me is this doc is an expert yet his answer is completely uninformed. He fails to note so many things incl the life-altering and potentially permanent side effects of fin which this guy may undergo.

[boston332]

Interesting he thinks he doesn’t physically shrink the penis I guess.

[tim1911]

Pay for what you get.

[spstriken]

this Dr is not alone 90% drs think the same way.

[visionquest99]

More bunk from internet doctors and more patients who are left scarred…

@Patient

[b] I took Propecia for 7 months before developing erectile dysfunction over night and a low libido that onset more slowly. I immediately discontinued my use of the drug. Unexpectedly, one year later I still have erectile dysfunction and low libido, and my hairloss has not resumed!

I had my hormone levels tested by a neuroendicronologist and it was found that my DHT levels were far below the normal range for adult males. I had an appointment with a sexual psychologist and she determined it was a physiological issue. Is there anything I can do to restore my body to where it was before I took Propecia[/b]?

@Doctor

[b]I have difficulty believing that you just developed erectile dysfunction (ED) overnight after taking the medication for more than half a year. You need to see an expert in sexual dysfunction. I have seen a few patients who had your symptoms, though none of them with rapid onset and all of them who stopped the drug saw a complete reversal in less than a week.

ED will likely lead to your confidence going down, which in turn causes the gradual of libido… but I do not believe that the ED can be blamed on Propecia if you have been off of it for some time.[/b]

You can see some blog comments at the bottom. See Link

[Frustrated]

Sadly, he does so much to dispel the validity of our claims given he has the ‘authoritative’ position of being a world class hair expert. By referring to our claims as circumstantial and hearsay he is leading patients into making ignorant and uninformed medical decisions.

[Frustrated]

Dr. Rassman has begun to adopt the slightest hint of a conciliatory approach which I consider to be progress since his blog seems to be quite influential in the balding community. He uses a very rough method to estimate that permanent ED can result from Propecia in about 1 in 1,000 or 1,800 patients. Of course there will be many, many more cases that are underreported because it doesn’t make much sense for a patient with ED to consult with a hair specialist.

Also, not that it really matters, but he seems to not be able to grasp the basic ideas of statistical significance and probability.

baldingblog.com/2011/03/04/finasteride-and-erectile-dysfunction-permanence/

[visionquest99]

@Frustrated

Dr. Rassman has begun to adopt the slightest hint of a conciliatory approach which I consider to be progress

First off, I applaud you for continuing to seek answers and getting the word out to influential people like Dr. R.

He seems to be backtracking from his original position, and conceding that fin MAY affect some men in a permanent way.

His statements from his colleagues seem anecdotal and self serving. I suppose he didn’t speak to any well known PFS doctors.

While Dr. R may be well known in the industry, I don’t think he will be spending any time helping any of us find answers.

He seems quite content to attribute our problems to other causes.

[visionquest99]

It really pisses me off that eminent doctors are still misrepresenting the facts to prospective propecia users.

I know we are a “minority” of users, but our “side effects” are ignored, downplayed, misrepresented, and now dismissed as irrational fear-mongering.

Just read this blurb from Jan 2011 from a doctor re questions about fin and reduced fertility:

I’ve had an increasing number of enquiries of late, asking me whether finasteride will affect a man’s chances of reproducing, or even cause impotency. I have been surprised by this sudden interest in a drug that has been used as a treatment for hair loss for almost 15 years. And whilst I’ve not paid too much attention to what’s been said of late, I do feel I must respond to recent comments made by Chris Evans.

Whilst discussing his hair loss with Elton John on BBC 2’s breakfast show, Chris stated he would not be taking the finasteride, believing it would hinder his chances at reproducing, so he could concentrate on starting on a family.

I would imagine that this may have caused concern with many of his listeners, it certainly has with me. I am not aware of any published reports that implicate finasteride in decreasing a man’s chances at reproducing. Scientifically it does not make sense either as finasteride blocks DHT, which is not responsible for fertility. However, in some people you can get decreased semen i.e. decreased volume of ejaculate, which is not the same as say a low sperm count or impotency.

Tests have proved that at the dosage recommended for hair loss, finasteride will not be present in sufficient amounts in your semen to pose a problem planning for a child. This was an issue though at the prostate dose, which is five times the hair dose.

Finasteride has, in a small number of cases, resulted in a decreased libido, yet even in those circumstances, the issue has been resolved by reducing the dosage.

Conceiving a child can be stressful for many people, and it probably won’t be helped if taking finasteride is going to cause you significant worry. If you are contemplating stopping finasteride for any reason, I would recommend adding minoxidil lotion or foam to your regimen for about three months and then stop the finasteride. With minoxidil, you will have the chance to continue arresting your hair loss but you may lose any bulking effect the finasteride might be having. The overlapping is important so that you can begin to experience the benefits of minoxidil before losing those of finasteride.

It’s worrying to see misinformation in the media, particularly when the wrong information seems to spread farther and faster than the facts!

Link

The bolded part is very worrying.

He also adds:

It makes no scientific sense that any side effects could continue as a direct result of the drug use in the long-term beyond the survival period of the drug in the body, which is 30 days. I’ve been prescribing Propecia® or finasteride to hair loss sufferers for over 15 years now, and none of my patients have reported permanent impotence. I have also checked with my colleagues across the world and they report a similar experience.

Link

And it gets worse. In response to a prospective user’s question, the doctor replies:

The main thing that happens after stopping the drug is loss of the benefit of hair retention. This can be expected at 3-4 months after cessation. I have not had anyone report other ‘side effects’ upon stopping it if they did not have them while on it. I always recommend medication such as finasteride or minoxidil if I feel there is potential for ongoing hair loss or if there is weakened hair that can potentially bulk up.

By Dr Bessam Farjo on Feb 1, 2011

And get this:

It is known that the incidence of such side effects is influenced by the manner in which they are explained to the patient at consultation. I emphasise that such side effects can happen due to a variety of reasons and, most commonly, these are psychological. In the original clinical trials conducted on behalf of the manufacturer, two per cent suffered the side effects, but three quarters of those cases were actually on placebo rather than the drug itself.

Link

This doctor is very ignorant and perhaps, willfully blind to outcomes like our own.

He also talks about breast cancer and fin.

I have seen the paper which made the claims about male breast cancer and am not convinced about the risks it implies. What’s important is to compare figures of the finasteride at the HAIR LOSS dose to the general population when it comes to assessing risk. Again, in 18 years of practice and thousands of patients I have not had anyone report male breast cancer to me.

Finally, I’ve never heard of this guy but he apparently is highly regarded:

A recent article to celebrate the 20th anniversary of Esquire magazine named the 20 men who’ll most shape and influence the next 20 years and, rather flatteringly, I made the shortlist!

It’s a huge honour to be placed alongside the likes of Prince Charles but the best part of it all, is that it really goes to show how the world has changed its view of hair loss and transplant surgery.