Post Finasteride Syndrome: Androgen Levels and Semen Parameters
Dr, what do you think about the new paper published by Dr. Irwing for Post Finasteride Syndrome: Androgen Levels and Semen Parameters Among Former Users of Finasteride With Persistent Sexual Adverse Effects. Are you still not convinced that PFS is not real?
Let’s put things in to perspective. Just because a study or paper is published does not make things a fact. Many people use the Internet and find their “truth” or “proof” based on simple statements without really looking at what has been done or studied. Few ever think about the study parameters and the limitations of the findings.
The study was conducted on only 24 participants. Participants were recruited from a website forum called propeciahelp.com It is a website that advocates class action lawsuits for people with side effects from Propecia. I don’t know what the readers may think of this, but wouldn’t you think there is a self selection bias here?
The study found low serum androgen levels but the study also admits to no baseline levels to compare this with. This means there is no way to determine if Propecia was a cause.
The paper is not a research paper, but just a letter that was submitted to a journal.
The “Limitations” mentioned on the paper was that it was a “Retrospective study design, small sample size, recall bias”
I believe there are patients out there who are suffering from sexual issues and that they believe it may be from Propecia. They can also be suffering from the same sexual issues irrelevant to Propecia and this is very hard to negotiate with the individual who is convinced that their symptom can only be from the Propecia use. These type of papers only further confuses the issue with no solution or clear explanation of the cause of the problem further propagating the conspiracy theories and frustrations of the people who are suffering from a problem.
I do agree that further research should be done with better methods and sample size.
Hehe, those studies have been done Dr. Rassman. Quite some time ago.
They show a 2% sexual dysfunction rate, with 1% of those recovering from the side effect over a year, leaving 1% who really have problems.
99% are fine.
The rest have cyberchondria!
https://www.yahoo.com/health/15-signs-youre-a-cyberchondriac-93782514533.html
This blog misses the purpose of the study. The purpose of the study was not to definitively prove causality, it was to begin to document these patients in a case series. Case series do not offer irrefutable proof, but they build evidence for a hypothesis.
There really is no recall bias that is relevant here because objective parameters were measured like hormone levels, semen volume, sperm count etc. Many doctors have accused post finasteride patients of suffering from psychogenic symptoms or simply making them up for legal gains. This study takes a small sample and shows a good portion of them actually suffer from problems that are physiologically abnormal. There were many exclusion criteria that made sure patients that could have sexual problems from other causes were not included such as pre-existing health problems, mental illness, or even other medication usage that would put these subjects at risk.
These papers do not frustrate patients who are suffering from a problem because it begins to build a case of legitimacy and validates that what they are suffering from is not “in their head” as is commonly suggested by the hair transplant community. One need only look to a post last week that suggests patients may be entirely making up their complaints.
Dr. Rassman is undeniably one of the best known hair transplant surgeons in the country. It is also undeniable that evidence is building for the existence of post-finasteride syndrome. Even if he doesn’t believe it is likely to be real, I suggest he takes its existence seriously since his credibility and legacy will be shot if he ends up on the wrong side of this issue. Acknowledging the whole set of facts as they stand so far poses no risk.
The recall bias was stated by the authors as a limitation wasn’t it? It’s not Dr Rassman imposing a charge that wasn’t admitted by those involved.
And do we know that these levels were physiologically abnormal? The little I know about androgen metabolism is how easily it is disrupted. Having worked with a lot of perfectly healthy athletes who’ve suffered from various hormonal disruptions despite being young, fit, educated on nutrition and stress control – I’m only clear that there is a lot of work to be done to classify causes and even constant baselines.
This paper had only 3 out of 24 with sub classified ‘low’ testosterone and 3 out of 23 with sub-classified ‘low’ DHT. If this was after excluding patients based on age, other possible causation etc then it isn’t much different to healthy 20 and 30s aged men who are elite athletes.
I’d be very interested to see some original baseline blood panels on serum androgen counts before people took finasteride and after – I voluntarily took my own bloods several times before I started propecia prescription so I’m aware of what my baseline was and how it is impacted by Propecia. Sadly I don’t think many doctors will recommend proper androgen testing for men unless it’s to supply them with testosterone therapy in their 50s onwards.