My Take on the Propecia Panic
I’ve been asked what it would mean if 2% of the millions of men taking Propecia had suffered sexual side effects, and some lesser percentage of these men’s side effects are permanent. This has been a hot topic that has been discussed at length, but it’s a topic that I wanted to touch on again.
I must have written prescriptions for this drug to thousands of patients and although I have seen reports of decreases in libido and ED in about 2% of patients (as expected), I have not seen one case where these side effects did not go away upon stopping the drug. A larger audience of others like myself were unofficially polled and their experiences echo mine. It is not that I doubt that these problems can persist after stopping the drug, but it seems very rare indeed.
As I’ve mentioned before on this site, one of my son’s is taking Propecia. When he compared the risks to the reward, he concluded that the benefits far outweighed the limited risk. He tells me that he’s experienced no side effects and has been on Propecia for almost 8 years or so.
Clearly, each patient must make his own decision on this matter and my position is to inform my patients of the general risk… but this risk is very, very small. Before I’m asked again, I own no stock in Merck, I am not a paid consultant for Merck, and if I was rapidly losing hair, I’d take this drug to thwart the problem.
Would you know of any Istudies showing hormone changes on propecia (particularly free testosterone). The one you posted recently showed a reduction in free testosterone for every case but I’d like to know if this has been replicated.
I brought up Dr. Rassman’s Balding Blog with a doctor recently and he told me that he has actually spoken with at least one patient who was prescribed Propecia by Dr. Rassman. I don’t know if this particular patient retroactively reported his problems to Dr. Rassman, so what Dr. Rassman is saying may be truthful, but there is at least one man who has been very negatively impacted by Dr. Rassman’s hair loss practice.
So an anonymous doctor told you about what a patient was prescribed by Dr Rassman, and we’re just supposed to take your word. I see. Did this same doctor mention the patient’s entire case history, or did you just connect the supposed dots on your own? You should stick to accusing commenters of working for Merck’s PR agency. You’re quite a laugh.
Dr. Rassman and Dr. Pak are always upfront and honest! They won’t just say something just to say it! They’ve been doing transplants and prescribing medication to there patients for many years, if they believe it’ll help them (there patients) with there hair loss! I’ve been on propecia/proscar/finasteride for almost 2 years and it’s really slowed down my hair loss, with no side effects whatsoever. As with everything there’s always people that try to put a doctor down just to make that doctor look bad and tarnish his reputation. For every person that says something bad about propecia, there’s thousands of patients that stand by propecia because it’s helped them not only slow down their hair loss but also maintain the hair that they have!
You don’t need to take my word for it, but the doctor did have access to the patients entire medical history. He/she did not convey the information to me directly, as that would be an obvious violation of HIPAA, but the conclusion was drawn that the problems stemmed from finasteride use. If at all possible, I will try to pass along the suggestion that this patient relays his experience to Dr. Rassman so that he is aware of the results of his prescribing behaviors.
I must say this. All these people claiming that side effects persist after stopping the drug and long after the drug is completely out of your system strongly suggests NOT that side effects were real (physically based), but rather that side effects were IN YOUR HEAD ALL ALONG (psychologically based).
How can a drug that is NOT in your system have any effect on you, positive or negative?
Unless the side effects never depended on the drug in your system, which is now gone, but rather the psychological states that persist long after.
Well that’s a pretty silly comment. As an experiment, you could try drinking enough alcohol so that you get respiratory failure and your brain begins to be starved of oxygen. If you get your stomach pumped just in time you will survive, but weeks after the alcohol clears your system you’ll still have some long-term brain damage. I guess in that case it is literally all in your head though.
There are a handful of theories that doctors have proposed for how the drug could cause long term damage. Ongoing studies will hopefully be able to provide some tips into where we should continue looking for additional clues and understanding.
Dr.,
You dont take propecia? I’ve thought you have had transplants?
Mark –
I am not part of the Propecia hysteria at all. In fact, I have taken the drug for years with no problems. However, your argument is empty on that point. Many drugs are known to cause physiological changes that can persist for months or years after the drug is stopped. That is not debatable.
Andrew – Please see: https://baldingblog.com/2010/11/12/why-didnt-dr-rassman-have-catch-up-loss-when-stopping-propecia/
Even as someone who believes that they were harmed permanently by the drug, I do believe that this is extremely rare.
Mark – Your post makes very little sense. To suggest that a drug no longer in the system could not have had any lasting impact…crazy talk. Of course it could have.
Fine, then don’t take it.
I guess you could drink gallons and gallons of alcohol until you get respiratory failure, but that would be an awfully large dose. It probably wouldn’t be fair to say that alcohol causes respiratory failure from that kind of experiment.
Most people drink a few drinks. Let’s say, 3 or 4 drinks…like a normal type of dose. You get the effect of the drug – the drunkness. Then your system clears the alcohol out of your system. And then you are fine after. That’s how it works.
Sure, there are people who have bad reactions and are allergic to things. This is the case with anything. There is always going to be a small percentage of people who have bad reactions to things. This is not unique to finasteride.
There are some people who are allergic to water. Really:
https://www.dailymail.co.uk/news/article-520329/The-teenage-girl-allergic-WATER.html
But still I, for the most part, don’t worry about this and still have my cups of water.
But now with the internet, and just with life in general, you have all kinds of trendy little crazes that people follow. All these diseases that I think, for the most part, are all in people’s heads.
I live in Brooklyn NY, and the cool thing now is gluten free. Gluten Gluten Gluten. Everybody in Brooklyn is allergic to gluten now. It’s amazing.
Sure, some people have celiac disease, but this is very rare. I think that for the most part this is just a hip new trend that the cool people are following and people trying to feel special. I think it started with the Atkins diet of years ago.
There are so many of these types of crazes these days…
aspartame kills:
https://www.aspartamekills.com/
childhood vaccines cause autism: https://endoftheamericandream.com/archives/vaccines-and-autism-the-secret-that-you-are-not-supposed-to-know
gluten kills:
https://chall-train-smart.blogspot.com/2010/11/12-reasons-gluten-should-be-eliminated.html
Fine fine fine. There’s not much you can do about it. I guess people will believe what they will.
Mark you can’t be serious! Those types of claims don’t even warrant a rebuttal!
A good point was made above that there are many drugs on the market (typically prescription drugs, but not necessarily) that cause, in some cases with extended use, long-term damage that persists after the drug is withdrawn. So that is hardly a novel or bizarre concept. Why that possibility or suggestion is so baffling to the pro-Propecia crowd who get on the bandwagon like snake oil salesmen selling this drug like it’s the be all to end all is beyond me.
I’m all for letting people take their chances with Propecia. It’s just a matter of disclosure. I was prescribed but never took Propecia (fortunately) with essentially no disclosure of risks/benefits, which is unethical from a medical perspective. I had to find the truth myself online about the harm Propecia causes and long-term and permanent sexual side effects it can cause. Again, luckily, I never took Propecia so I have none of these problems. And I have a 3,600 FU strip method transplant scheduled but again I will not take Propecia, ever. I’m sure the results will be fantastic without this drug in my system, which points to the sad fact that no one needs Propecia with transplants available. To all the guys out there who say they want to keep their hair but can’t afford a transplant, and hence opt for a dangerous drug, I say forego the new monster truck and have the hair transplants instead. It’s not worth risking your sex life over taking a drug that merely treats a purely cosmetic problem. And to make matters worse, this cosmetic problem is appropriately and best treated with a simple transplant surgery. Hence, NO ONE needs to be taking Propecia in the first place. It’s unnecessary!
Hmmm the transplants are still crap, taking hair from the back and leaving nasty scars is hardly a proper solution is it. Doesnt give you the option to have hair very short or shaved and what about if you end having to shave it off eventually anyway. No transplants long way off from being good like hair systems. Best to keep your hair by other means.