40% of Men Have Erectile Dysfunction / Impotence In Their 40s And It Is Not From Propecia
This is a comment from our regular reader/ occasional contributor -BiotechMD- (who is actually a medical doctor involved in many clinical trials and research) I thought I’d post a third party opinion since so many readers and patients are concerned about Propecia and sexual side effects and are quick to blame a side effect over a common issue (that they may not want to admit).
While conducted a number of years ago, one of the largest studies of the incidence of erectile dysfunction (reference below) puts the rate at 40% for men in their 40?s. Given the multiple causes of erectile dysfunction (atherosclerotic disease, diabetes, medications, psychogenic) and the increasing risk of these factors with age, this is not too surprising. There is no scientific evidence in the published medical literature that the erectile dysfunction associated with finasteride is of a different “quality” than other types of erectile dysfunction or that the “whole sexual response is diminished”. Decreased sex drive can be a side effect of finasteride in a minority of patients and even fewer still (<2%) will have both erectile dysfunction and decreased libido. Feldman HA, Goldstein I, Hatzichristou DG, et al: Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. J Urol, 1994;151:54–61.
I have followed this blog for the past year or so without much participation but this post contains many false statements and needs to be corrected. I spend time studying post-finasteride syndrome and BiotechMD has repeatedly spread misinformation about the subject.
1. The study was conducted nearly 30 years ago and was regional to Boston – contrary to BiotechMD’s claim it was one of the studies.
2. This is a single study that estimates 40% of men in their 40s have erectile dysfunction (cherry picked to have the highest prevalence). This figure is self-reported and contains any single instance of erectile dysfunction. According to this study (even seen in the abstract), only 5% in their 40s have complete erectile dysfunction, which is what is reported by those suffering from PFS.
3. All other problems aside, looking at a study of 40 year olds is not comparable to drawing conclusions about men in the late teens or twenties who are most likely to take Propecia. Many more studies have shown the prevalence of erectile dysfunction is much much lower in this decade.
4. There are about half a dozen studies that have documented a different kind of erectile dysfunction present in PFS patients, BiotechMD simply ignores this or is naive of this fact. In addition to mechanical problems, the sensation of sexual arousal (or any genital sensation for that matter) has been documented in PFS patients and is available in several publications.
5. People have asked BiotechMD about his background before but he has declined to respond so I will ask again for the public’s behalf. Are you in any way being paid by Merck for any kind of activity? You have almost exclusively published comments defending Propecia, work in some capacity in the pharmaceutical industry, yet have not properly disclosed conflicts of interest. Failure to respond will and should be interpreted as though you are withholding information since you actively participate on this blog.
Merck has been facing lawsuits and a precipitous decline in revenues from selling Propecia after the permanent sexual side effects have become more publicly recognized. In the past, pharmaceutical companies have paid people to spread false or misleading information online for damage control and potential Propecia users should be aware of this when weighing the risks of taking this drug.
Just to be fair: “Researcher” is not using a valid email or a valid IP address when he left the reply above. His IP came up as “anonymous proxy”. According to his IP address entered in Google search “Researcher’s” IP address “indicate the activity is malicious or fraudulent”.
While everyone has a right to post their opinions, to ask for BiotechMD’s validity with a anonymous IP and false email is noted.
BiotechMD’s IP was from Seattle and his email address was valid.
(from Baldingblog moderator)
I beg your pardon, but I have very good reason to exercise my right to anonymity. I have been targeted by Merck in the past and it is necessary to maintain protection for security in the future. Rather than engaging in ‘malicious or fraudulent activity’ I am merely helping educate readers in a manner that is less risky.
While I have merely suggested to readers that they consider certain issues for themselves, BiotechMD has appealed to a sense of authority yet ignored questions about his background.
I completely understand you may believe what I am saying is unusual, but Merck has a history (even recent) of threatning and intimidating individuals who speak out against its drugs or practices. Below are two illustrative examples from respected news sources that explain why I have chosen to remain anonymous. Fortunately advances in technology and social media are enabling people to speak out more freely.
https://www.cbsnews.com/news/merck-created-hit-list-to-destroy-neutralize-or-discredit-dissenting-doctors/
https://www.forbes.com/sites/larryhusten/2014/07/06/merck-uses-legal-threats-to-stifle-negative-advice-about-zetia-and-vytorin-in-italy/
Without a doubt the biggest reason for erectile dysfunction in younger finasteride users is porn.
The reward circuits in your brain rewire overtime (due to the novelty factor watching new people) making it more difficult to reach a state of arousal when it comes to your real sex life.
The science is blatantly clear on this. But keep on blaming your meds.
I appreciate Dr R’s support, and wish to address the accusations above about my prior posts and my identity. It is fascinating that the above commenter who disagrees with my post directs issues to a personal nature, much as was done for many years with Dr R by a specific and disgruntled former blogger (focusing on bogus claims of conflicts of inertest, “payoffs” by Merck, etc).
1. I have spread no misinformation. In the biotech field and as a physician, I am required to be “evidence-based” and that is all that I have asked of others. Pulling information from blogs, anecdotes, etc is understandable but not evidence-based. I have actually never said that a post-finasteride syndrome does not exist but have pointed out that supporters of the theory begin to study it given its large absence in the medical literature.
2. The study I cited in my original post was both dated and local, but remains one of the largest cohorts (and frequently cited studies) of the incidence of erectile dysfunction to date. There are no other studies in the literature to refute this. By the way, the Framingham Heart Study was a long-term, ongoing cardiovascular study of 5,209 residents of Framingham, Massachusetts from 1949 to 1966 and was the basis of major epidemiologic features about cardiovascular disease. But, looking at the forest rather than the trees, my point was to underscore that a large percentage of men in later decades have erectile dysfunction due to many causes – in contrast to the initial blog commenter who raised this idea as farcical.
3. If the commenter believes that “ Many more studies have shown the prevalence of erectile dysfunction is much much lower in this decade”, let him or her cite such well-controlled studies so the readers can look up the reference and make their own determination (by the way, all such studies are generally self-reports). The commenter also misunderstood by point about sexual drive or arousal. My comment – published separately by Dr R – was originally a comment below another’s comment that PFS involves the “entire sexual response” (paraphrasing). It actually doesn’t.
4. And this is where it gets most fascinating (the personal attacks). Not a single person has ever asked me about my “background”. As Dr R knows, I am a physician-scientist (MD-PhD) who is well known in the biopharmaceutical industry and has developed numerous drugs for life-threatening conditions currently on the market, none of which relate to alopecia or finasetride. I have no relationship with Merck. Because I also have been a hair transplant patient, this area fascinates me. I also teach courses at a major university (where I hold a full professorship) in evidence-base medicine, so I try to educate blog readers about understanding the process of interpreting clinical studies, how data is viewed, and encouraging scientific approaches to a field now largely run by lawyers and bloggers. As a side note, most of my comments and “guest blogs” have nothing to do with PFS but have discussed teratogenicity (birth defects), processes of FDA approval, legal off-label use of dugs vs. unapproved, illegal prescribing, and other topics as it relates to finasteride questions.
The threat that (my) “failure to respond will and should be interpreted as though you are withholding information since you actively participate on this blog” is both childish and a smokescreen from rational discussion; it is quite obvious that I am not withholding any conflict of interest and Dr R’s verification of this is confirmatory. I have previously identified myself privately to Dr R so he knows more about me, in contrast to those with anonymous and bogus IP addresses. However, I have intentionally avoided discussion of my identity as it is both irrelevant to the arguments I make and a potential source of harassing e-mails. But, at the end of the day, my identity and “‘qualifications” (which are impressive by most academic standards) have little to do with my arguments, which should be able to stand on their own. Those who often mask their arguments by touting their expertise or who demand qualifications of others (often with the bogus and tiring straw man accusing others of “conflicts of interest”) should actually be the first indicator that the writer has flimsy arguments.
5. Any company can face lawsuits, which are initiated by unhappy consumers and most often attorneys. Lawsuits are won against companies when information they know about is withheld from the public. I see nothing in the Merck label that suggests that.
6. Finally, I have never disputed the existence of PFS. What I have argued for is that there is a certain hysteria surrounding this phenomenon, which should be studied in a rational scientific manner. There are ways to do that, and I have mentioned those in other posts in this blog. Given the almost constant bloggers who write in about sexual side effects (minutes to days after initial ingestion of finesteride), at odd time of onset after finesteride has been discontinued, and with waxing and waning effects, it is also important to note that sexual side effects have many causes (one of which is finasteride). But, at the end of the day, there has to be better science of the existence of PFS than currently exists in the medical literature. I personally belief that PFS exists – but that this area has been littered with tangential issues and an almost complete absence of scientific inquiry into this phenomenon beyond a few uncontrolled, retrospective surveys in “third-tiered” journals.
https://www.pfsfoundation.org/research/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064044/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069023/
Keep on ignoring, you’ll see.
1. You claim to be evidence based yet you are cherry picking a single study that has demonstrated outlier results. These particular outlier results you cite are not even relevant to the average Propecia user who is in his 3rd decade.
2. You are trying to confuse readers. The study you quote is the Massachusetts Male Aging Study based on data between 1987 and 1989, not the Framingham Heart Study which took place over decades. The original one was not one of the largest studies.
3. You are mistaken and have previously ignored or not seen inquiries about your relationships in prevoius posts.
4. https://www.ncbi.nlm.nih.gov/pubmed/16006943
Above is a single international survey with 12x the amount of respondents as in your study of 1,290 respondentsand it found that sexual dysfunction was 14x more prevalent in the highest age group. Notably, Propecia users are going to be overwhelmingly present in the youngest age group.
5. You are mistaken in that you have either ignored or not seen previous inquiries about your professional ties. Anybody can see that my question was just that and not a personal attack. However you do seem awfully defensive. Like yourself, but for different reasons, I have chosen to be anonymous but I have also chosen to remain anonymous but for different reasons. I don’t see how you can criticize me valuing my privacy especially when I am in a particularly sensitive position given my history.
6. These lawsuits were neither initiated by lawyers nor ‘unhappy customers’. They were served by victimized customers whom have been permanently injured and desire justice and compensation for the medical bills and suffering they will endure for the rest of their lives.
Merck has certainly withheld information from the public. Going back to 2010, Merck had updated their product label in Sweden and the United Kingdom to warn of sexual dysfunction that does not go away even if the patient quits the drug. It was only until the FDA forced Merck to do this in the US that the label was changed. The language is currently still very moderate. However before the label was changed in 2012, thousands of patients were injured because they were forced into taking risks that were not disclosed by Merck or prescribing doctors.
6. If you believe in the existence of PFS, you have certainly been very quiet about this very real and catastrophic risk. Potential patients may be very fearful of taking Propecia due to an unlikely risk, but that doesn’t mean they are ‘hysterical’. Since you state you are an MD/PhD you should realize of all people how challenging and grueling the process is to publish scientific research on a rare syndrome and how much time it takes. When they are so many red flags, the Hippocratic Oath itself dictates that doctors should do no harm and properly warn patients of what they may be getting themselves into.
By the way, I would be curious to hear your opinions based on th articles I posted in the last entry. You seem to be very nonchalant about the fact that Propecia’s manufacturer has a history of intimidating, threatening, and destroying the careers of doctors and researchers that have issued public dissent.
Jeremy, is that you?
No I am not Jeremy. I have not seen commentary from anybody named Jeremy in the time that I have been following this blog.