The most far-fetched theories of post-finasteride syndrome

The two most far-fetched theories of post-finasteride syndrome were proposed by a dermatologist and a hair transplant surgeon. Physicians in these specialties tend to fervently deny that the syndrome is a valid medical condition, pointing instead to co-occurring conditions such as diabetes, anxiety, depression or, according to the theories below, delusions or sleep apnea. Theory … Read more

Reckoning with underreporting—response to Lauck et al, 2024

We do not know if the medical records used in this study are sensitive to sexual dysfunction in healthy men, and especially in men taking these drugs for hair loss. Since the study includes men taking 5-ARIs, the results do not shed light on why sexual dysfunction might persist after stopping these drugs.

Study of depression from prostate drugs loses the signal by including past users

This study fails to assess the risk of depression associated with using finasteride or dutasteride because past users of 5-ARIs were counted as cases. 37% of cases in the 5-ARI group had stopped taking the drug 181 days or more prior to initial diagnosis or treatment for depression. Only slightly more than half of cases were current users at the time of initial diagnosis or treatment for depression. Moreover, the control group was taking ⍺-blockers.

Study of ED risk loses the signal by including past users of finasteride

There is a major limitation: the analysis included past and recent users of 5ARIs, as well as current users. Past users are defined as those who stopped taking a 5ARI at least 91 days before getting diagnosed or treated for ED. Recent users are those who last took the drug 31-90 days before diagnosis or treatment for ED.

Mind the gaps: remarks on the evidence base

This post makes a few not-so-obvious points about the sprawling literature on finasteride and 5-alpha syndrome. If you are new to this literature, consider starting with a brief history of the research and a guide for researchers. Those pages describe what is in the literature, but it is also important to discern what is not … Read more

Temperature check on recent literature

5-alpha syndrome (post-finasteride syndrome) is appearing more regularly in the medical literature. Recent articles show slightly more openness to the syndrome as legitimate, especially in the fields of andrology and sexual medicine. But they continue to recycle old arguments that pin the problem on the patient, such as pre-existing psychological and sexual disorders, a nocebo … Read more

Response to Campbell et al on finasteride-associated suicide and depression in men treated for hypogonadism and impotence

The clear and concerning results in this abstract are statistically significant RORs for suicidal and self-injurious behaviors, anxiety disorders and depressed mood disorders in the finasteride-only group. The suggestion that combination therapy could “decrease” risk or have a “protective” role is unwarranted because the risk ratios are derived from unrelated sets of cases. This study seems to treat pharmacovigilance data as if it were a controlled, prospective study, when the data is uncontrolled and retrospective.

Response to Dr. Ralph Trüeb’s writings on post-finasteride syndrome

A drug-induced syndrome is all in the mind, a Swiss doctor wrote. Editors of the journals had past ties to the drug maker.

How Merck buried finasteride’s full impact on hormone signaling

Merck held that finasteride had a simple and selective mechanism. In fact, it disrupts hormonal pathways much more broadly. These pathways support the brain, reproductive system and other organs. Merck’s selective account concealed risks which would surface in the decades after approval of Propecia.