The finasteride "nocebo" effect

General Discussion
#1

blackwell-synergy.com/doi/ab … 07.00563.x

This is interesting…

“Sexual adverse experiences such as erectile dysfunction (ED), loss of libido, and ejaculation disorders have been consistent side effects of finasteride in a maximum percentage of 15% after 1 year of therapy. Such data could be seen as far from reality, if compared to a higher percentage that may be found in any common clinical practice.”

So basically, when they run clinical trials using finasteride they give both groups either the drug or placebo, but don’t in standard practice tell them anything about the potential side effects of the drug.

On the other hand, in clinical practice, however, patients are in fact usually told about side effects of the drug. This study addresses what effect such disclosure has on patients.

The results are pretty amazing: 43.6% of those told about potential side effects report said side effects, while only 15.3% of those not told about the drug (note: still much higher than Merck’s number) report side effects.

This is probably at least partly why side effects seems so much more common than we were lead to believe (and especially more common than Merck led us to believe).

#2

It completely fails to address the fact that side effects of this nature are significantly under-reported due to the “embarrasing nature involved”. In other words if the side effects were as likely but different, a migrane say, they would be reported at higher levels.

Also many people do not think their is a problem, that they have just changed and do not associate such changes with medication, unless made aware of the possible link.

This absolutely is a failure of double blind placebo based trials, it is something they fail to address.

When people age their libido wains.

Of course this can happen in people who are much younger due to medical treatments. It is quite easy to get used to such a change and to put it down to getting older (even if young) or change of attitude or many other things.

Most people on cancer treatments have a lowered libido due to hormonal chnages. Certainly this was never spoken about to teenagers a number of years ago. I recall at 17 thinking it was normal that I just lost all interest in girls while on chemotherapy.

Of course it was not normal at all, but without being told it was a side effect I just accepted the new me.

People will often do this, if they have no idea of potential side effects.

So you have under-reporting and people not realising the chnages are not normal but a side-effect.

So the information obtained from the trial is still almost certainly going to be way off the Merck :imp:

I recovered my libido post chemotherapy, but it was probably never quite the same. Again I was never informed that could happen and in fact I never realised it had in fact been the case until man, many years later when it occured to me that my libido was in fact greater pre chemotherapy…I went on testosterone replacement therapy and I felt like I had found something that had been missing for man years…It felt like when I was young again, depsite the fact I was ony 28 at the time.

I couldn’t have known exactly what had been lost until it had been brought to my attention and then rediscovered with treatment.