Great article, just a shame about the contributions of urologist Kevin McVary and Jacobs.
Again, from the article:
Urologist Kevin McVary, of Southern Illinois University, also has his doubts. When he crunched FDA data from thousands of reports of finasteride-related side effects, he found that men in their 20s and 30s taking a 1 mg dose for hair loss were far more likely to report side effects than older men taking a 5 mg dose for prostate problems. He finds that “fishy”. “There is no drug in the history of medicine that I am aware of where the risk decreases as the dose increases,” he says. He wonders if perhaps younger men stumble upon a website or magazine article, such as this one, describing the symptoms and “power of suggestion” sets in. (Other doctors, like the neuroendocrinologist Jacobs, suspect older men don’t report symptoms as much because they attribute ED to getting older and never imagine their medication could be the root cause). “What does exist is distressed men. That is real,” McVary says. “But is it causally related to this medication? There is no good evidence.”
Jacobs suspects genetics may be at play in determining which guys react poorly to finasteride. His own research revealed that many of the men who suffer from the syndrome have family or personal histories of emotional disorders, such as anxiety. He wonders: Could some of the same genetic factors that make a young guy bald early and be insecure enough about it to seek medical help also predispose him to reacting badly, physiologically, to finasteride?
If so, “it is a cardinal irony,” says Jacobs. “They have the kind of ego that makes them think that in order for them to get a mate and have a family they need to get their hair to stop falling out, and this ends up making it all much harder. It is a crushing blow.” For now, he advises dermatologists to never prescribe finasteride to a man who suffers from depression and anxiety.
