If Finasteride Leaves the Bloodstream Quickly, How Can People Say Effects Last Forever?
1 – Is it possible that taking finasteride for a certain period of time can alter the proper functioning of the endocrine system of a person?
2 – I’m kind of lost regarding side-effects and the possibility of them continuing after the stoppage of finasteride because from what I understand, the drug only stay in the bloodstream for a somewhat short period of time. How is it possible that the effects last if the drug is discontinued… It’s like saying that if you get drunk one night, you would be drunk for the rest of your life… it’s impossible.
Thanks
1.) There isn’t science that shows finateride permanently alters your endocrine system, as far as I’ve seen. There is anecdotal evidence and claims by lawyers, that may point to this but this is not scientifically based.
2.) The sexual side effect of Propecia occurs in about 2 % of the men who take it. Chances are, you’re probably the in the 98% who never gets a sexual side effect. If you do get the side effect, it will not last if you stop taking the drug, but in some people who stay on it, the sexual side effect lessens or disappaears. The medication is out of your bloodstream in less than 24 hours. That is why you take it every 24 hours (to keep it in the bloodstream). The drug binds to the tissues for up to a week and that is why it is effective after it leaves your bloodstream.
I realize there are Internet posts that report persistent side effects after stopping the drug, but I find this hard to understand/believe myself. In my years of practice, what I’ve seen in real life (face to face) patients is that they do have sexual side effects match the 2% statistics. In the actual patients that I see, the side effects are temporary and they go back to normal after discontinuing the medication.
I do recall meeting one patient who came in for a consultation asking me for advice, because he claimed he has the permanent sexual side effect, so I will keep my mind open, but I still find this hard to understand and this particular patient was not started on the medications by me.
I have seen some patients over the years that have reported permanent side effects so I try to keep up to date with the research on this mysterious syndrome. Recently, a small but illustrative study was published that examines metabolite levels in cerebrospinal fluid and blood serum in healthy patients versus patients that report permanent cognitive or sexual side effects about taking Propecia.
For the lay person, Propecia blocks an enzyme called 5-alpha reductase which breaks down testosterone into its metabolite (byproduct) dihydrotestosterone and progesterone into several neurosteroid metabolites notably chemicals like allopregnanalone (THP), dihydroprogesterone (DHP) and others. As you would expect, medical science does not have a full understanding of these neurosteroids at this point (or finasteride for that matter) but allopgregnanlone in particular is thought to be responsible for maintaining mood stability, sexual functioning, and preventing epileptic seizures. The patients I have seen that complain of having permanent Propecia related side effects report these types of symptoms.
Interestingly, when compared to the control group, the study showed that the sick patients have measurements than the healthy patients to a degree that was statistically significant. We already know that Propecia blocks an enzyme responsible for generating allopregnanalone so when we tested the hypothesis that this steroid was altered in sick patients, it was interesting to see that they had completely undetectable levels in both the cerebrospinal fluid and serum. Other neurosteroids/hormones significantly differed from the control group as well so I suggest interested readers go through the article in its entirety.
These Propecia side effects have been controversial for many years at this point but the scientific community is slowly gaining a better understanding to what is happening and why. This continues to be a topic of interest for researchers but less so for practioners for some reason.
From the recent study, we are unable to infer how often these side effects occur but it does provide evidence confirming the claims that the permanent side effects these men are experiencing is a result of taking Propecia. In contrast to what the blog response said, there is actually scientific evidence that shows finasteride CAN permanently alter the endocrine system but it doesn’t necessarily happen in EVERY case.
https://www.ncbi.nlm.nih.gov/pubmed/24717976
Dr. Rassman, how do you view this journal article? Many times you have said there is no scientific evidence for permanent effects of Propecia but this article is clear evidence. This controlled study confirms what the anecdotes have been saying for a long time.
This is suggestive data but does not show that finasteride can permanently alter the endocrine system. What it shows is that some men with post-finasteride symptoms or signs have physiological changes. Whether these changes are caused by finasteride or reflect changes due to another causal factor (and finasteride is a “correlate”) remains unanswered.
What a surprise, the Propecia mouthpiece is remarkably dishonest when defending his drug of choice.
You are reaaaaaaally stretching it this time. For years, doctors like Rassman have been spouting off about how PFS patients are really hypochondriacs or suffering from psychosomatic ills.
We have always known that finasteride reduces the production of neurosteroids like allopregnanalone in addition to DHT. Now that we have tested a sample of these PFS patients with permanent side effects and found out their allopregnanalone levels are ENTIRELY depleted you are trying to say some other factor could have coincidentally messed up allopregnanalone in every one of these men.
This literally shows nothing would be able to get you to change your propaganda. Any reasonable unbiased doctor would tell you this data is highly suggestive that PFS is a real condition, especially since a very reasonable theory was created before the test was constructed.
Your response is highly suggestive you are a complete shill.
In terms of scientific proof – we rarely find evidence stronger than this. Can you truthfully say you think it is more likely than not that finasteride was NOT the cause of the patients’ complete lack of allopregnanalone?
Pubmed not cheat … Finasteride is becoming a thing of the past …
I feel the way the Dr. Rassman has presented this evidence in the past has not been ethical. He is entitled to his opinion and own interpretation of the facts for this issue.
However, on various occasions like in this particular post he has definitively stated side effects go away (with the implication that this is always the case). He has also said there is no scientific evidence to support the possibility of permanent side effects but even beyond the study I reference above, this is not true. I have spoken a couple other scientists and researchers who have been studying ‘post-finasteride-syndrome’ and will hopefully have results to publish in the next couple of years.
I’m concerned that many people will naively stumble on this blog, take the doctor’s word at face value, order the drug online without consulting a proper doctor and risk doing permanent damage. While trichologists and dermatologists do have medical training and completed medical school, a residency, and internship – they do not have the specialized expertise to offer the most qualified opinions on neuroendocrine matters and frankly I don’t believe they should be the ones prescribing finasteride at all.
Bullets enter the body and leave the body very quickly, yet the damage persists long after it’s gone… Your alcohol analogy isn’t exactly valid. Side effects of propecia despite discontinuing its use is more comparable to chronic liver disease resulting from the use of alcohol — it persists long after the alcohol has left the bloodstream (hence the word “chronic”, conveniently) I am not implying that propecia does any such serious damage to the body as in the examples, I’m just illustrating the possibility of persistent consequences after the root cause is long gone.
“In terms of scientific proof – we rarely find evidence stronger than this.”
I’m glad you aren’t carrying out scientific studies for a living. It’s 3 people, who hadn’t had those levels checked before starting finasteride, who happened to have low levels when tested.
I am not saying PFS is not real, but this is not sound scientific method. Also, your venom directed towards Dr Rassman does not help promote your case either.
The study does not have 3 people so you apparently didn’t read the paper. You are correct in saying that they didn’t have pre-levels tested but you are wrong when you say it isn’t a sound scientific process. For ethical reasons, it is not currently possible to have such a study approved by a research board. You will simply never be able to collect the data you want because it would literally require somebody to violate international human rights law.
Given there was already the theory that allopregnanalone is involved in persistent finasteride side effects and the study measured a sample of patients, the results are highly suggestive Propecia was responsible for these problems.
How I feel or do not feel about Dr. Rassman and the hair surgeon’s community is irrelevant to my case. In this very post, the doctor at best naively neglects to mention there is existing scientific evidence that Propecia can permanently alter one’s brain chemistry and endocrine system. Unfortunately, many young men visit this advertisement for scientific advice and they are led astray. On this very blog people have reported developing these unrelenting side effects after trusting the incorrect advice dispensed here. Some topics are best discussed dispassionately, but this is issue does not fall into that category because it involves doctors concealing or ignoring serious risks to public health.
I found the comments from the ‘researcher’ interesting. I have had some patients report not feeling right while they were on finasteride and they stopped it, with them feeling right after they stopped in within weeks. I will defer to the researcher’s comments as he comes from a very different backgroung. I only can report what I have seen in over ten thousand patients for whom I have prescribed finasteride over my years in practice. I do not profit from prescribing the medication.