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.

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

Men’s fitness influencers are raising alarms about finasteride risks

Fitness influencers draw in an audience of younger men who want to be stronger, better-performing, and in some cases more attractive. Some guys worry that hair loss will dim their prospects for dating, sex and relationships—or even professional success. In the era of Instagram, body-hacking and telehealth companies such as Hims and Keeps, young men’s … Read more

Rules of engagement: how sensitive concerns are hidden from drug trials

Alan, a 28-year-old man who experiencing hair loss, is participating in the Propecia clinical trial. Alan brings high hopes that the new drug will stop hair loss. An investigator examines Alan’s scalp and hair, recording figures on a form. She asks Alan if he experienced any side effects. None, he replies. He is then given a form to fill out…

Polls vs. official data on side effect rates

Since online polls are anonymous, there is less risk to disclosing embarrassing side effects. In online polls, the rate of side effects was 6.2x greater than the rate of adverse events in a clinical trial. The clinical setting may suppress safety concerns in sensitive areas such as sexuality and mental state.

From the depths: why finasteride harms took decades to emerge

Physician-researchers blamed growing safety concerns on patients, overlooking social context and weaknesses in safety regime The official view of Propecia, fashioned by Merck at a reported cost of $450 million, is that the drug is safe and effective. Upon approval by FDA in 1997, this view was carried forward by dermatologists, some of whom were … Read more

Context matters: a rebuttal to yet another analysis of adverse events of finasteride

This post responds to a recent research letter: Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: a pharmacovigilance analysis of VigiBase.