Misplaced Pages

Talk:Finasteride: Difference between revisions

Article snapshot taken from[REDACTED] with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.
Browse history interactively← Previous editContent deleted Content addedVisualWikitext
Revision as of 21:17, 8 February 2011 editJfdwolff (talk | contribs)Administrators81,547 edits →Post-Finasteride Syndrome← Previous edit Latest revision as of 17:41, 28 December 2024 edit undoCewbot (talk | contribs)Bots8,029,547 editsm Maintain {{WPBS}}: 4 WikiProject templates. (Fix Category:Pages using WikiProject banner shell with invalid parameters)Tag: Talk banner shell conversion 
Line 1: Line 1:
{{Notaforum}}
{{WikiProject Pharmacology|class=C|importance=Mid}}
{{Talkheader|search=yes}}
{{User:MiszaBot/config
|archiveheader = {{aan}}
|maxarchivesize = 100K
|counter = 8
|minthreadstoarchive = 1
|algo = old(90d)
|archive = Talk:Finasteride/Archive %(counter)d
}}
{{User:HBC Archive Indexerbot/OptIn
|target=/Archive index |mask=/Archive <#> |leading_zeros=0 |indexhere=yes
}}
{{Reliable sources for medical articles}}
{{WikiProject banner shell|class=B|1=
{{WikiProject Pharmacology|importance=Mid}}
{{WikiProject Chemicals|importance=Mid}}
{{WikiProject Medicine|importance=Mid}}
{{WikiProject Women's Health|importance=Mid}}
}}
{{Connected contributor
| User1 = Doors22 | U1-EH = yes}}
{{COI editnotice}}


== Adverse Effects section - exposure and pregnancy ==
==Updated Patient Information Leaflet (PIL) - Reference 12 now has broken link==
The Patient Information Leaflet (PIL) for Propecia has been updated on 2010-03-18. When the new PIL was published by the Swedish MPA the address to it was changed, so the document can no longer be found using the current link in Reference 12. Hence the link should be updated to point to the new PIL.


I wish to propose an addition to the Adverse Effects section. For the comment on contraindication in pregnancy I think it could be improved. The current text is:
The new address is: (http://www.lakemedelsverket.se/SPC_PIL/Pdf/enhumpil/Propecia%20film-coated%20tablet%20ENG.doc)


Finasteride is contraindicated in pregnancy. The Food and Drug Administration advises that donation of blood or plasma be deferred for at least one month after taking the last dose of finasteride.
Can someone please update the reference with the new link address? (This Wiki page is semi-protected so I cannot do it myself) <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 11:45, 13 May 2010 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->


I suggest, based on Refs 36 and 37 (manufacturers' prescribing information as deposited with the FDA), that the above be altered to:
==Finasteride linked with male breast cancer!==
UK medicines regulator The ] (MHRA) did an indepth analysis and found that Finasteride is linked to an increase in incidents of ] among users after 53 men using the drug developed the disease. New warnings will now be added to the packaging of Finasteride informing users of this risk.


Finasteride is contraindicated for women who are pregnant or become pregnant while exposed to it, as it may cause abnormalities in a male fetus. Exposure through skin contact to broken or crushed tablets is identified as a risk vector. The Food and Drug Administration advises that donation of blood or plasma be deferred for at least one month after taking the last dose of finasteride.
Could someone please add this to the article - I cant because its in a state of semi-protection. This news is important. <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 02:19, 4 December 2009 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->


The motivation for this proposed edit is to (i) specify the reason as to why finasteride is contraindicated (abnormalities in the male fetus may be caused) and (ii) to add a comment that skin contact is a risk vector. I think that the latter is important to include as this is important information for someone who may have come into contact with finasteride unwantedly due to the serious consequences.
==this article needs help==

First of all, anyone who's looked on the footnote regarding a "male hormone specialist" can see this does not qualitfy as a reference by WPN standards. It is merely a YOUTUBE video of some guy pushing his own hair-growth formula. Doesn't make thsi drug a health risk. The only correlation is depression and hair loss, that is men with thinning hair tend to be miserable, or at least post this on the "internet groups" referenced in this article. Impotence in about 1% (stats via a controlled study). Certainly not causative regarding PROSCAR, which, incidentally, has been proven to re-grow hair on a man's head (a good thing!), increase testosterone (another good thing!) and reduce risk of prostate cancer (ditto!).

Somebody clean this article up!

] (]) 23:31, 6 October 2009 (UTC)

==poison==
Thanks to whoever deleted the "Beware: Propecia is pure poision..." section... I was about to delete it, but you beat me to it! -cmsmith81 (I am not signed in).

*"In ] discussion groups, some men report side-effects lasting long after cessation of the drug, such as difficulty concentrating, testicular pain, and frequent urination. It is uncertain whether these problems can be attributed to finasteride."

==gynecomastia==
Can anyone confirm this observation? Does gynecomastia really last long after discontinuing Finasteride? As far as I remember, everything else I've read indicates side-effects stop after usage is stopped. That's also what the clinical trials reported. --] ] 08:53, 17 Jun 2005 (UTC)

:Well, gynecomastia is often irreversible. The internet news groups were an attempt at POV by an anon. Feel free to remove it if you can't find the evidence. ]&nbsp;|&nbsp;] 01:21, 19 Jun 2005 (UTC)
____________

"The men who took the finasteride lowered their PSA levels by a full 48%. They literally cut their PSA levels in half, but got almost eight times the cancer tumors!" This is from "young again" web site. I have no idea if it's true but it's worth investigating before you that finasteride for any reason.(User_talk:Berryham) <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 22:15, 28 September 2008 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

==Prostate cancer==
Sfahey, the article now says Finasteride is used to treat prostate cancer, but also increases incidences of aggressive prostate cancer. What was your source for this?--] ] 23:52, 20 July 2005 (UTC)
::I've added this. It is still being worked out, but apparently even though it increases the incidence of the worst type, overall it decreases mortality from prostate cancers. This was demonstrated at the higher dose, the one NOT used for hair loss. ] 01:19, 22 July 2005 (UTC)
:::Thanks. The dosage information, though, isn't in the current reference. Do you have another reference? --] ] 02:06, 22 July 2005 (UTC)
::see journal skinMED (3-4/05,pp 67-68), which can be found at <www.lejacq.com> by searching for article #3978

It says in the Propecia drug leaflet, that Prostate Cancer is less likely whilst taking the drug, but of those who do get it it is more likely to be agressive. I don't think the article makes this clear in the opening section, that this is a downside. <small>—Preceding ] comment added by ] (]) 15:13, 2 December 2007 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

Would need some update, just released study shows clearly a 30 % reduction in all types of cancer (including more agressive ones), it seems the original study found more agressive tumors in the treatment group because of better diagnostic due to smaller prostate gland - its just realeased in the new - looks very promising guys. <small>—Preceding ] comment added by ] (]) 01:40, 15 June 2008 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->


Indeed, references 2 and 3, cited early in the article, cite the later studies showing no higher incidence of more aggressive prostate cancer, while ref 17, cited later, makes the earlier and opposite claim. Internal contradiction is hard on the innocent reader, and this issue could be very significant to those making an important health choice. ] (]) 23:32, 11 September 2008 (UTC)

==Re Par.3..."Further, finasteride increased the specificity and selectivity of prostate cancer detection, thus, a seemingly increased rate of high Gleason grade tumor."==
This statement is inaccurate and critically misleading. A Gleason ''score'' (not "grade") is determined by a trained technician or physician examining, by microscope, tissue samples obtained by biopsy. There is no way a drug (as opposed to a selective stain) can influence this visual evaluation of the "aggressiveness" of cancer cells which are present. Thus, finasteride increases (not "seemingly increases") the probability of a high Gleason score and a prostate cancer's aggressiveness.
<Wolf Lorber (not registered).

What about this - "One hypothesized explanation for this increase is that finasteride reduced prostate volume, leading to detection of more high-grade tumors due to increased sampling density." http://jnci.oxfordjournals.org/cgi/content/abstract/99/18/1366] 15:56, 8 October 2007 (UTC)

== Autoimmune disease ==

Some anon added autoimmune disease as a complication. Not a single study is reported on PubMed. Sounds like a myth. The mechanism is also not explained, nor is there any truth in his assertions that Alzheimer's, heart disease and skin cancer are "autoimmune diseases". ]&nbsp;|&nbsp;] 14:46, 7 June 2006 (UTC)

== Ingestion of semen ==

"It appears that Finasteride can pass into the semen of men, thus, at certain dosages, caution should be used to avoid ingestion of semen during oral sex if a woman is pregnant or may become pregnant."
Well, is this true? So does this actually mean that it can be harmful at conception if used by the male? --] 02:00, 20 June 2006 (UTC)

According to Merck: "Yes, you can take PROPECIA if you and your wife are trying to conceive or if your wife is currently pregnant. Contact with the semen from a man being treated with PROPECIA is not a risk to the unborn child of a pregnant woman."
http://www.propecia.com/finasteride/propecia/consumer/facts/faq.jsp

Available data indicate that the level of PROPECIA in the semen of a man taking
PROPECIA does not pose a risk to an unborn child. Accordingly, a man can take PROPECIA
while conceiving a child with his partner, or have sexual intercourse with his partner
if she is already pregnant.
http://www.propecia.com/finasteride/propecia/consumer/about-propecia/faqs.jsp <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 23:23, 11 March 2009 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->


(Please sign your talk page entries. I didn't write the paragraph above.)
This doesn't actually answer the technical question of "does finasteride pass into semen", but from a fetal-safety point of view, it doesn't seem to be an issue, so I'm going to rephrase that statement in the main page.
-- ] 15:55, 1 March 2007 (UTC)

== Depression ==

Finasteride has been linked to depression, this should be included

http://www.leaddiscovery.co.uk/admin%20gu/files/14467.asp

http://www.hairsite4.com/dc/dcboard.php?az=show_topic&forum=10&topic_id=5980&mode=full <small>—The preceding ] comment was added by ] (] • ]) 14:02, 4 March 2007 (UTC).</small><!-- HagermanBot Auto-Unsigned -->

This could be due to a confounding variable - hair loss.] 10:58, 12 August 2007 (UTC)

The two cited studies describe moderate to severe clinical depression as classified using verifiable tests (see sources) in a majority (!) of examined cases. This is very different from frustration about hair loss. Personally, I have quit Finasteride after only 2 months due to recurring symptoms of depression the like of which I had never even imagined before. I would not have related this to Finasteride if I had not seen other users on internet forums reporting similar experiences. Even if many may use Finasteride without any effect on their mental well-being, depression should not be taken lightly as a possible side-effect, even though the producer's information leaflet does not (yet?) mention it. <small>—Preceding ] comment added by ] (]) 22:27, 29 December 2007 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

You see a lot of claims about alleged Propecia side effects on internet forums. The depression study in question was not a placebo-controlled trial, so does not meet the scientific 'gold standard'.] (]) 14:53, 30 December 2007 (UTC)

== about gynecomastia ==

I removed the little reference that propecia cause gynecomastia. Feel free to revert my change once you can show a serious reference about that claim. ] 04:59, 4 July 2007 (UTC)

: It is a POSSIBLE side effect...it doesn't ALWAYS cause it. It is one of the listed possible side effects when you purchase the medication. That little form the pharmacy gives you with each medication explaining everything about it, it is listed in there. I am taking that med so I can attest that it is listed in that form. I think it deserves mentioning since it is being advised as being a listed side effect by every pharmacy that distributes it.] 14:34, 13 July 2007 (UTC)

It is possible, but the clinical trials showed no difference between the incidence of gyno in the treatment and placebo groups.] 10:59, 12 August 2007 (UTC)

== generic ==
AUROFINA?
There apprears to be a generic vesion of PROPECIA 1mg made by Cipla (India) http://www.mail-rx.com/shop/product.php?productid=16413&cat=251&page=1 This product is sold under the name AUROFINA-1. Code No: MH/DRUGS/KD-19. Does anyone have more information? Should it be added to the generic section?

i believe there is now a generic finasteride, at least for the 5mg. there may or may not also be a generic 1mg (at least in canada?). it woudl be helpful to include this information ]

The Proscar (5mg) patent has expired, and there are now legit generic versions available. The only 1mg generics available are Indian versions. Indian patent law allows local drug companies to copy drugs and sell them in the domestic market.] 11:00, 12 August 2007 (UTC)

Does the generic version that you mentioned above - aurofina-1 actually work as it is not available in the UK, and the hair loss clinic i visited have said that it will probably be ineffective, however, they may just be saying this so i am co-erced into purchasing their £400 propecia. i am very unsure. <small>—Preceding ] comment added by ] (]) 12:49, 12 March 2008 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Prosmin ==

Prosmin is another brand under which finasteride is sold

As per: http://www.unitedpharmacies.com/Prosmin_Finasteride___5mg_30_Tablets_p_188.html

Could someone add this to the article? Thanks ;-)

== ref? ==

In the text a reference is made to a paper Rossi 2004, however, in the reerences list, this is not mentioned. What could it be?

] 20:40, 27 October 2007 (UTC)
:That's probably a reference to the '']''. I'll check the history and see if I can track it down. ]<small>&nbsp;(]·])</small> 01:29, 28 October 2007 (UTC)
::Got it. I couldn't find it because it was from ] in August 2006; ''that'' article, however, didn't have the reference either, because its content had been from ] in May 2005. Thank God for page histories :) ]<small>&nbsp;(]·])</small> 01:36, 28 October 2007 (UTC)

== protection ==

Could a protection template be added to the article, and the reasoning be stated here on the talk page? ] (]) 05:16, 22 November 2007 (UTC)
:OK, I've added the template. This article has been semi-protected to due persistent long-term vandalism. --] (]) 12:04, 22 November 2007 (UTC)

And not just vandalism: spam and junkpiling. ]&nbsp;|&nbsp;] 12:20, 22 November 2007 (UTC)

== Proscar and Pregnancy ==

I am an RN and I am about 9 weeks pregnant. I crushed Proscar, put it into a med cup, added water to disolve it to put it down a peg tube. Before doing so, it settled to the bottom of the med cup and I put my pinky finger into the cup and stirred it so that it would not clog up the peg tube. (Before becoming aware of the risks.) 1 hour after, I began having severe cramping. I am worried. What is the rist of birth defects to my baby, with the med crushed in water? I read it absorbs through the skin. Is my risk greatly decreased since the crushed tablet was disolved in water and my skin is in tact? <small>—Preceding ] comment added by ] (]) 00:35, 9 January 2008 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

You should seek professional medical advice.] (]) 20:32, 9 January 2008 (UTC)

==Typo?==
There appears to be a typo in Finasteride---Brand Names:
Here's the quote: "There is 1 mg of Finasteride in Propecia
and 5 mg in Proscar." I believe the '5 mg' should be 0.5 mg,
that is 1/2 mg, instead of FIVE mg.

No Proscar is a 5 milligram dose, Propecia 1 milligram ] (]) 22:28, 4 March 2008 (UTC)

== Antiandrogen ==

Reference 11 on this page states "Finasteride has no affinity for the androgen receptor and does not act as an anti-androgen, nor does it have androgenic, estrogenic, antiestrogenic, progestational, or other steroidal properties." Clearly this[REDACTED] entry is in error. <small>—Preceding ] comment added by ] (] • ]) 10:40, 3 April 2008 (UTC)</small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

No this statement is made by the manufacturer. Finasteride is a specific 5AR inhibitor rather than a general anti-androgen.] (]) 11:49, 12 April 2008 (UTC)
I am now injecting 250mg of testoviron depot once a week and injesting 50mg dhea daily to try to raise my testoterone level. I am 65 and in general very good health. I have been taking Tamsulsin Hydrochlorde 0.4mg daily for my enlarged prostrate. If I take finasteride 1mg daily for my thinning hair, will it cause any problems in a reaction with my testosterone treatments?Yours, Spacydick <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 09:43, 23 August 2009 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

== What kind of birth defects occur? ==

The article does not go into much detail concerning the birth defects that may result from a woman's contact with ''finasteride'' while she is with child. The article, however, does not go into a lot of detail on which defects occur. Are the birth defects typically intersex conditions such as non-virilization, or some other type of defect?

Please let me know at your earliest convenience. ] (]) 18:45, 11 April 2008 (UTC)

The Proscar product information simply states that if a pregnant woman comes into contact with the drug, "it may affect the normal development of the baby’s sex organs". ] (]) 11:44, 12 April 2008 (UTC)

Please read the following abstract: http://pubs.acs.org/doi/abs/10.1021/jm00161a028 <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 17:24, 7 April 2010 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

== Compounded Finasteride ==

The availability (and abundance) of US-manufactured generic finasteride now allows compounding pharmacists to custom-create finasteride capsules in accordance with physician's prescriptions. Prescriptions may be similar to the Propecia (1mg) dose, higher or lower. While dosages similar to the 1mg are not expected to change the pharmacological properties of the medication (safety, efficacy, side-effects, etc.) it is important because it allows patients access to a Propecia-alternative which is less costly than the name-brand, without splitting pills or risky/illegal importing. It is also possible for the physicain to titrate the dose up or down if it is determined that this may be beneficial for the patient. Anecdotal reports of slight decreases in dosing may decrease side-effects.

This is not considered "Generic Propecia" as Merck's patent is still in effect for at least 4 more years and these capsules are custom-made/compounded on a patient-by-patient basis, not manufactured. Typically, compounded finasteride is approxmately 30% less expensive than name-brand propecia, which is significantly cheaper for patients. Propecia has increased in cost on a regular basis in the 10+ years since FDA-approval. Keep in mind that this medication is not typically covered by insurance, and is typically paid for out-of-pocket by patients.

Preliminary research:

1997 FDA Modernization Act: Compounding Pharmacists are not manufacturing drugs, so are exempt from standard FDA regulation on that basis.

2002 US Supreme Court ruled that the FDA could not restrict pharmacists from advertising or promoting products solely because they were compounded

Sept 2006 -- TX judge rules that compounded drugs are not 'new' and not subject to sanction by FDA.

August 2006 -- FDA warns against purchasing/using prescription drugs from "unreliable Canadian websites" that apparently sell illegal, counterfeit products. FDA found that 87% of meds from "Canadian websites" were actually from 27 other countries

Compounding pharmacy that fills physician's prescriptions for custom-compounded finasteride.

page 45; recent info regarding FDA and compounding.

Obviously, this is an issue which is expected to evolve. ] (]) 18:40, 10 August 2008 (UTC)

== Synthetic? ==

Can it be found in nature? Shouldn't the article specify? Or perhaps it is obvious to the expert?
<br/>--] (]) 23:24, 27 August 2008 (UTC)
:It's synthetic. I'll note it in the article, which is incidentally in serious need of some cleanup. An interesting (and not overly technical) article on the chemistry of finasteride is available , at the ] School of Pharmacy website. ]<small>&nbsp;(]·])</small> 01:38, 28 August 2008 (UTC)

== Hip fracture ==

Finasteride-like drugs don't seem to increase the risk of osteoporosis despite their anti-androgenic effect. Thankyou. http://jama.ama-assn.org/cgi/content/abstract/300/14/1660 ]&nbsp;|&nbsp;] 22:03, 7 October 2008 (UTC)

== Investigation by the Swedish Medical Products Agency ==

This investigation concluded in late 2008. The Agency has issued new guidance on Propecia, including advice that some users may experience persistent difficulty achieving an errection, even after discontinuing use of Propecia.

A copy of the new advice can be found on the Agency's website, here: http://www.lakemedelsverket.se/upload/SPC_PIL/Pdf/enhumpil/Propecia%20film-coated%20tablet%20ENG.pdf

Currently the finasteride article states that this investigation is still underway. Can someone with the power to do so please update the article?

] (]) 16:18, 22 December 2008 (UTC)

The wording should be changed to highlight "PERMENANT ERECTICAL DYSFUNCTION" can be caused by Finasteride. <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 19:04, 22 February 2010 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

The Swedish FDA lists this side effect as 'incidence unknown' and 'based on spontaneous reports.' That should be mentioned. The huge 7 year FCPT and 2 year follow up should count just as much as 'spontaneous reports' with 'unknown incidence'. The take on that 19,000 subject study was: "Now, with ***several studies allaying concerns about the drug’s possible drawbacks, including concerns about sexual dysfunction,*** Thompson believes men should be told routinely about the potential benefits of finasteride when they come to the doctor’s office for a PSA test, in much the same way patients at risk of heart disease are told about the benefits of statin drugs." If anyone can demonstrate actual double blind peer-reviewed research demonstrating persistent (how can we call them permanent) sexual side effects, instead of a governmental agency responding to emails, I'll quickly admit that I was wrong.] (]) 21:41, 10 August 2010 (UTC)

According to private correspondence, there is one case of documented permanent erectile dysfunction:
"Hello,

To answer the question, there is one spontaneously reported case describing erectile dysfunction, in the Swedish database.
Concerning data regarding cases in clinical trials (exposed patients compared to controls) please contact the company.

Best regards;
Cecilia Bergengren
MD, Clinical assessor
Unit for Efficacy and Safety 1
Medical Products Agency
Uppsala"

In response to my question: (paraphrased) how many people in "post-marketing" spontaneously claimed this side effect: persistence of erectile dysfunction after discontinuation of treatment with PROPECIA.
] (]) 15:53, 11 December 2010 (UTC)

== wiil nottaking finasteride bring my semen quantity to normal? how long after? ==
miguel angel
ngel <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 07:07, 8 February 2009 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Finasteride for Tourette's Syndrome ==

Apparently some researchers in Italy have reported excellent results in treating certain instances of Tourette's syndrome .

'A 34-year-old man with a 25-year history of severe Tourette’s syndrome was referred to our service following a precipitation of his clinical conditions. His symptoms included self-injuring motor tics (i.e., glass smashing and knuckle rubbing against rough surfaces), explosive bouts of complex vocalizations, stereotyped coprolalic utterances, ritual behaviors, aggressive and contamination-theme obsessions, cleaning and checking compulsions, and excessive sexual drive. Magnetic resonance imaging and laboratory tests were normal. His current treatment—initiated 2 years before and included pimozide (4 mg/day), clomipramine (37.5 mg/day), chlorpromazine (25 mg/day), and lorazepam (7.5 mg/day)—had only resulted in a transient, slight decrease of motoric compulsions and anxiety. After obtaining informed consent, we added finasteride (5 mg/day) to his current treatment and periodically assessed his symptoms by means of the Yale Global Tic Severity Scale and Yale-Brown Obsessive Compulsive Scale.

Finasteride gradually reduced both motor and phonic tics. Because of a misunderstanding about the regimen duration, the patient discontinued treatment at week 18. Three days later, he called our service complaining of a dramatic exacerbation in Tourette’s syndrome symptoms. Notably, the prompt reinstatement of finasteride led to a clear clinical improvement. After 28 weeks of treatment, finasteride led to a dramatic reduction in Yale Global Tic Severity Scale (Figure 1) and Yale-Brown Obsessive Compulsive Scale scores (obsessive score: 58.3% initial values; compulsive score: 38.4% initial values). The patient also reported a normalized sex drive, enhanced mood and life quality, and no untoward effects.'

Interesting. Anyone care to work a reference into the article? The page appears to be protected. Although, you have to acknowledge that the regimen of drugs that the patient was on is pretty heavy-duty, including Ativan (lorazepam), Thorazine (chlorpromazine), and other psychotropic/neuroleptic medication.
] (]) 06:19, 21 February 2009 (UTC)

:I'm sure the the poor bastard is dead by now: reason one. no real meds were given such as neuro-protecting cannabinoids. reason two. if the chlorpromazine didnt get him, the Finasteride surely would have. The FDA IS the conspiracy and are no less than drugcompany-paid assassins. <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 07:40, 7 March 2009 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

::Yeah right, "neuro-protecting cannabinoids" are (possibly the only) real meds and ] is ]. --] (]) 19:25, 20 August 2009 (UTC)

== reference disapeared ==
Ref number 17 should be changed with this one http://www.fda.gov/ohrms/dockets/dailys/00/jun00/060700/cp00001.rtf <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 13:58, 5 September 2009 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Is a satisfactory article on this subject likely? ==
As an enthusiastic booster of Misplaced Pages for almost any kind of inquiry, I hate to see her verge into areas where her model is not particularly applicable. Detailed pharmacology, even detailed examination of adverse effects, is one such area. Evaluating drug safety, effectiveness, interactions, dosage, adverse effects and so forth can only be achieved (at least at the present time) by long-term prospective studies along with rigorously conducted statistical analysis. Even for the best of such studies, interpretations still vary.

This article is now part rehash of published data, part anecdotal material not much above the discussion forum level. I don't see how Misplaced Pages can realistically do much better in this particularly difficult and unusual realm. <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 17:30, 14 October 2009 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

== Irreversible Side Effects ==

{{tl|editsemiprotected}} there is a number of people who have gotten irreversible side effects due to finasteride. In Sweden they changed the side effects on their manuscript.


It is proven that finasteride can cause irreversible side effects that including erectile disfuntion, brain fog, and low libido. A man named Nicholas Berg speaks about his first hand experience with these irreversible side effects.http://www.propeciasideeffects.com/ http://www.youtube.com/watch?v=2nXWVTStnHs

Also it is talked about many times by dr. John Crisler.http://www.hairlosstreatment.org/dr-john-crisler-permanent-finasteride-propecia-proscar-side-effects/ http://www.youtube.com/watch?v=B8e7HERXA3s <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 22:34, 10 November 2009 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->
:YouTube isn't a ].--] (]) 22:37, 10 November 2009 (UTC)

::YouTube is not a reliable source hence I'm not going to add the requested information into the article. ]] 03:34, 11 November 2009 (UTC)

A Neuroendocrinologist named Alan Jacobs now confirms that men "develop(ed) significant degrees of clinical hypogonadism - low sex drive, erectile dysfunction, reduced sexual sensations and listlessness, fatigue and/or "brain fog" - while either taking finasteride or after stopping the medication, even long after stopping it." http://blog.alanjacobsmd.com/alan-jacobs-mds-blog/2010/04/a-neuroendocrine-approach-to-finasteride-side-effects-in-men.html <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 18:11, 24 May 2010 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

That is a blog, not peer reviewed research, unlike the 5 year Proscar FDA Study (n~=3000), or the FCPT (n~=19,000). The article could mention that the Swedish FDA did add a warning about persistent ED, but it should be noted that the side effect is listed as 'incidence unknown', and based on 'spontaneous reports'. 5.1% of the placebo group had ED in the FDA study, and I'm sure a good portion of those men swear that sugar pills cause ED. The reason I feel it is important to point this out is that those spontaneous reports likely come from a site called propeciahelp.com which links to the FDA-like agencies of various nations, and encourages their user base to contact all of them. The take on the huge (n ~= 19,000) FCPT study says "Now, with several studies allaying concerns about the drug’s possible drawbacks, including concerns about sexual dysfunction, Thompson believes men should be told routinely about the potential benefits of finasteride when they come to the doctor’s office for a PSA test, in much the same way patients at risk of heart disease are told about the benefits of statin drugs." They followed men in their mid 60s for seven years and could not prove persistent ED. In fact, the research is described as 'allaying concerns', not exacerbating them.] (]) 21:35, 10 August 2010 (UTC)

BELOW IS A PEER-REVIEWED ARTICLE THAT STRONGLY POINTS TOWARD EVIDENCE OF 5 ALPHA REDUCTASE INHIBITORS CAUSING PERSISTENT (PERMANENT) ERECTILE DYSFUNCTION. IT WAS CONDUCTED BY DR. TRAISH AT THE BOSTON UNIVERSITY COLLEGE OF MEDICINE AND PUBLISHED IN THE JOURNAL OF SEXUAL MEDICINE. WILL SOMEBODY PLEASE UPDATE THE[REDACTED] ARTICLE PROPERLY TO WARN THE PUBLIC OF THE POTENTIAL RISKS OF TAKING PROPECIA?
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2010.02157.x/abstract <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 21:29, 25 January 2011 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Finasteride vs prostate cancer ==

{{User|Editor182}} has now twice reinserted the claim that finasteride decreases the risk of ], insisting that this was shown by a study published in May 2008. I think this is a typical case of not overemphasising the result of a single study in the ]. Primary prevention of ''any'' disease is difficult (see e.g. the recent ''volte face'' with regards to aspirin in cardiovascular disease), and prostate cancer is no different. It makes little difference whether we state that it is not approved - this is not an accepted use of finasteride. ]&nbsp;|&nbsp;] 17:43, 10 March 2010 (UTC)

:The two interpretations (more high-risk cancers yes or no) of the PCPT data could well be mentioned in the article, provided that no ] is given to either interpretation. I agree with JFW that this doesn't belong in the lead, however. --] (]) 18:55, 10 March 2010 (UTC)

Sadly Editor182 continues to add mention of this in the lead. It sounds like protection may be needed. ]&nbsp;|&nbsp;] 22:12, 11 March 2010 (UTC)

Don't go overboard. If the consensus is to exclude prostate cancer prevention from the lead, there's no need for "protection". I merely thought it was worth mentioning as an off-label indication as it is, afterall, mentional as one of three uses for finasteride. I've had to remove "permanent sexual dysfunction" from the lead a number of times, which I find more inappropriate. This allegation should only be mentioned under side effects. If it weren't for a single citation it shouldn't be mentioned at all. In my opinion, there is far more evidence for the potential of prostate cancer prevention or BPH, than "permanent sexual side effects", which are nonetheless worthy of mentioning, but not in the lead. ] (]) 01:22, 12 March 2010 (UTC)

Here is another study confirming the finasteride cancer prevention study follow up.
http://med.stanford.edu/news_releases/2009/july/prostate.html
It was done by stanford university, so no one can claim bias by Merck or whoever. It seems clear now that there was measurement bias in the first study, as every time the smaller prostate size on fin is taken into account it is confirmed that finasteride lowers the risk of high grade cancer as well. Also, the follow-up study from 2008 is not just a 'new spin' on old data. They pysically examined the excised prostates of men in the study who underwent prostatectomies. If someone knows of a better way to determine the grade of cancer than by physically examining a prostate after it's removed, I'd be curious to know it.
Also, where does the reference for 18% sexual side effects come from? The reference clearly states that in years 2, 3, 4, and 5 of the study, on average, there was no increased incidence of ED or decreased libido between the treatment group and placebo group.] (]) 20:55, 10 August 2010 (UTC)

== Poor quality image detracting from article ==
{{hat|Closing.}}
]
Editor182 is very protective of this image, but in reality it is of '''very bad technical quality'''. It is out of focus, over exposed, and taken with a flash. The box nor the tablet itself is in focus. I suggest this image be replaced as soon as possible with a technically sufficient image. As is his history, Editor182 may enter into an edit war with anyone attempting to update the illustrations. However, poor images like this one are detracting from an otherwise very good article. --] (]) 12:42, 27 June 2010 (UTC)

Do you think anybody is going to agree to removing an image of brand name Propecia? I'm surprised that you originally replaced this image with your illegitimate (Propecia is still patented) generic version of the drug, which may not even have finasteride in it for all we know. Users who contribute something to this article aren't interested in your personal crusade. ] (]) 13:29, 27 June 2010 (UTC)
* Patent laws vary by country - India has legitimate generic versions due to the patent laws in place in that country. Do you understand that? Moreover, many people use Indian generics all over the world. And, finally,''' I replaced your image not because it is branded (which is irrelevent, since the article is on finasteride and NOT Propecia), but because your image is of poor technical quality.''' --] (]) 13:35, 27 June 2010 (UTC)

:You can include both images, I haven't seen any other than the one to the right, but it's really not a big deal.... It's more of the writting that makes an article good, not necessarily the pictures. &nbsp;&ndash; ] ]] 13:51, 27 June 2010 (UTC)

Thank you, my point exactly. When I came in and saw the image replaced, I simply added it back to the article, rather than returning the favor and ''replacing'' the generic image. I hope this case is closed to your satisfaction, Kristoferb, and there's no need for the image here, people can see it in the article. ] (]) 14:17, 27 June 2010 (UTC)
: Your image is STILL of poor quality. Why can't you just take a better picture? No flash, in focus with proper lighting? (Also, stop editing my posts.) --] (]) 14:28, 27 June 2010 (UTC)

I didn't edit your post, this image belongs in the article, not the discussion page, which is for ''discussion''. This dispute is over. ] (]) 14:33, 27 June 2010 (UTC)
: The discussion is ABOUT the image. It is my post - ask me to remove it, don't edit it. The dispute is not over because you say so. Why don't you re-shoot your image properly with some basic level of skill?? --] (]) 14:37, 27 June 2010 (UTC)

::The image above is fine. It could include the pill in more detail, but it's fine for a reader in all honestly. &nbsp;&ndash; ] ]] 15:04, 27 June 2010 (UTC)
::: '''The pill is totally and completely out of focus''': how can that be "fine"? An image of a finesteride tablet where you can't even see the tablet is acceptable in your estimation? I respectfully disagree. I see no pressing reason to set the bar so low when it is relatively simple to take a technically sufficient photo to replace this one with. --] (]) 15:14, 27 June 2010 (UTC)

::::Dude, it's a pink pill, what else do you wanna see? &nbsp;&ndash; ] ]] 17:10, 27 June 2010 (UTC)
:::::To be honest I don't think that this is really a major issue. There was a ], I think that this photo meets the requirements of clearly portraying what it is supposed to.--] (]) 17:17, 27 June 2010 (UTC)
:::::: Do either of you understand what "in focus" means? You can read this if you want to know more: ] --] (]) 17:24, 27 June 2010 (UTC)
*As per ]: If the picture is too dark, too light, '''blurry''', or has other issues that cast doubt upon this recognition, '''the image should be removed from the article, and in some cases, may be deleted.'''
:It's not a ''perfect'' image by any means, but IMO it's better to have this ''reasonable'' photo of a Merck finasteride packet than just an Indian generic or none at all. After all, Merck developed the drug and Propecia is still protected by patent in most countries. If someone with a camera and a packet of Propecia or Proscar can be prevailed upon to take a better pic, then fine. But in the meantime, if you are so concerned about this, you should pursue one of the steps at ].--] (]) 17:32, 27 June 2010 (UTC)
:: My point is that someone should take a new photo that complies with the guidelines of clear, in focus and proper lighting. Editor182 takes this fact very personally. --] (]) 17:35, 27 June 2010 (UTC)
TLDR, but there is no point including any image here that is not crisp, clear and in focus - otherwise, what is the point of having an illustration? The image above is none of these and should be removed. --] (]) 18:37, 27 June 2010 (UTC)
:::I think the point of the picture is to show the brand name, chemical name, the packaging and the pill. Because of the distance, the front is always going to be blurry, unless the camera you used focused on the pill, the background would be blurry. &nbsp;&ndash; ] ]] 20:24, 27 June 2010 (UTC)
:::: That's not true. If done properly and with a little skill, it can all be in focus. Which is also why this should be removed: a good photo is easy to do. --] (]) 20:42, 27 June 2010 (UTC)

], this image has been in the article since December of 2009, why didn't ''anybody'' else discuss this here or on my Talk page, or outright removed it much earlier? I ''could'' have taken another photograph at that time. The image isn't ''perfect'', but it is ''definitely'' not worthy of deletion. Although I do contribute images to Misplaced Pages, far more of my work is focused on contributing to the written content of articles, but that being said, I have ''never'' had image quality questioned on ''any'' article, not before the ''vindictive'' crusade of Kristoferb, who has all of a sudden questioned ''multiple'' images based on their own personal agenda. There is no doubt that the consensus on this image from the majority of established Misplaced Pages editors would not differ from the rationale Tommy and Pondle have already stated. There really isn't more to be said on this. ] (]) 07:22, 28 June 2010 (UTC)
: As ] (]) tells you too, this image is terrible quality. All of your images are terrible quality: which is why they are being replaced. Stop being so sensitive. How does your other edits change the fact that the image is bad? It does not fit the Guidelines and will be deleted as soon as a replacement is found.--] (]) 10:24, 28 June 2010 (UTC)
* If the imperfections (you admit the image is not perfect) are either being blurry or having poor lighting, then the Guidelines tell us we '''SHOULD''' remove the photo from the article. It has already been established that your image is blurry and has poor lighting.''' If we don't remove this image ASAP, we will be contravening the Guidelines.''' You can always re-shoot it properly and try to upload it again.--] (]) 14:17, 28 June 2010 (UTC)
Has anybody had enough? 4 people are in favor of the image, and 2 are against, but feel free to reopen this case if you disagree. ] (]) 07:57, 29 June 2010 (UTC)
'''REPLACEMENT IMAGE:''' ] You can clearly see detail of the tablet in this image. In the image it replaces, you cannot see the tablet clearly. --] (]) 17:56, 29 June 2010 (UTC)

:That's a great image, I re-added the Propecia image with the generic below, as it's mentioned in context with the section. But, as I've said before - Do NOT remove disputed images on your OWN accord. This is exactly what you did on the temazepam article. '''REPLACEMENT IMAGE!!!''' Guess what? As was the case there, the case is here, I don't want your image gone, the article can have two brand name Propecia images from two different English speaking continents. Let me say this once again, and pay close close attention so it just may get through to your head this time; you're not an administrator. Disputes are discussed, you may not implement your decisions before a consensus. ] (]) 21:05, 29 June 2010 (UTC)
:: Well, now that we have a good image, we don't need your image anymore. What is there to talk about? The idea was always to replace your image once a replacement was available. They both show the exact same thing - just yours does it badly. Sorry, but you need to get a grip. '''Now the question is do we keep two images of the same thing - one that meets the Guidelines and one that doesn't? The answer is obviously "no".''' --] (]) 21:29, 29 June 2010 (UTC)

You're well aware that this image '''does''' meet the guidelines, as stated by several other users. You need to get a grip. Your image is there, both of them are, and one of them is closer to the lead, but you can't accept the image being in the article at all. Vindictive much? Both the image and generic are situated in a suitable position in the article. The answer is not "no", the answer is '''UNRESOLVED''', because surprise surprise, nobody made you administrator. '''Wait''' for user input, do you get it? It's not all up to you. '''Stop''' this personal attack. Even if you left and it were up to me, I would leave the layout as it is, because I care about the '''article''', doesn't matter who took what image, and your stance against this being of unacceptable quality is a first. A first on many in the past few days. ] (]) 22:00, 29 June 2010 (UTC)
{{hab}}

== Outside party's image opinion ==

] needs completely removed, it is a bad picture, blown highlights, out of focus. ] is a fine image, can completely replace the first. I also uploaded some other images as alternatives, although I think ] is a fine image. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 08:40, 30 June 2010 (UTC)

<center><gallery>
File:Finasteride_bottle_5mg.jpg|out of focus & low quality, probably not a good choice
File:Finpecia_from_India_is_Cheap_Propecia.jpg|brand name next to an Indian generic
File:Generic Propecia from India, Finpecia.jpg|crop of the Indian generic
File:Propecia Bottle and pills.jpg|crop of the brand name
File:Propecia Bottle closeup.jpg|closeup of a brand name bottle
</gallery></center>

Also suggest that if ] is kept that it be moved further up so it doesn't look weird with the big molecule picture where it is messing with now. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 08:42, 30 June 2010 (UTC)
* Editor182 has done a "new" layout including, again, ]. --] (]) 13:53, 30 June 2010 (UTC)
**Yea I saw where he this whole section too on the talk page... very VERY bad form. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 23:45, 30 June 2010 (UTC)
*** I had not noticed that, thanks for bringing it up. He clearly cannot understand this ''is'' a chemistry page and ''not'' one on the brand Porpecia. There is really no point in attempting to parse his arguments as there is little logic or rationality to them. For example, on one hand he argues to keep three (3) images of the brand but simultaneously argues against keeping two (2) images of the generic finasteride tablets when the page, in fact, is entitled "Finasteride": a chemical not a brand. --] (]) 00:13, 1 July 2010 (UTC)

== Proposed Image Layout ==

]
Can we cut to the chase? Please state whether you're ''for or against'' the current layout which is viewable on my latest edit on finasteride, and compare it to the version proposed by taking a look at the latest version by ]. Votes are tallied by numbers, it's time to put an end to this debate. ] (]) 13:32, 1 July 2010 (UTC)
:We don't vote on Misplaced Pages, we work by consensus. ] needs removed and is redundant behind the far superior image ] and ]. Consensus is against you, and you've WELL gone beyond violating ], so if you manage to not get banned it would be a miracle. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 14:17, 1 July 2010 (UTC)
::Since I've been contacted to contribute here consider my !vote moot. Regardeless, Editor182, we work on ], and you have none. Frankly, you should have been blocked already per ], ], ], and ]. <font face= "arial bold" style= "border:1px solid; border-color:black;">]]</font> 14:57, 1 July 2010 (UTC)
If going light on showing packing is something we want to do, then I suggest ] for the generic image. --] (]) 17:45, 1 July 2010 (UTC)
:We should '''avoid''' packaging and just focus on pills... we don't have any really GOOD closeups of this specific pill, if you have access to them again, I suggest that for a picture... —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 17:53, 1 July 2010 (UTC)
:: I can do that without problem. --] (]) 17:54, 1 July 2010 (UTC)
:::Be sure to upload your images to , if you don't have an account yet, click this magic link: ]. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:02, 1 July 2010 (UTC)
:::: Let me know if it is suitable: ] --] (]) 18:21, 1 July 2010 (UTC)
::::: Looks good... although those are pretty generic pills, no markings what so ever? lol. Do you still have access to the brand name pills as well? —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:24, 1 July 2010 (UTC)
:::::: Well they are what they are... not really our job to judge the subject. (Moreover, as far as Indian generics go, there is a nearly standard packaging of the small foil wrapper with clear plastic on the underside. e.g.:]) I do.--] (]) 18:29, 1 July 2010 (UTC)
::::::: It's relevant for a generic, no doubt, and quality is good. You didn't answer the question about the brand names ;-) —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:31, 1 July 2010 (UTC)
:::::::: I did, actually. I said 'I do'. --] (]) 18:33, 1 July 2010 (UTC)
::::::::: Sorry I missed that. ;-) —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:35, 1 July 2010 (UTC)
:::::::::: So you don't want to marry me? That's highly disapointing. ;-) --] (]) 18:39, 1 July 2010 (UTC)
::::::::::: I think a good quality picture of generic and brand name pills would be more then sufficient for the article, then we can get rid of the trademarked packaging altogether. And no comment on the marriage part, lol. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:42, 1 July 2010 (UTC)
:::::::::::: Very well, I'll see what I can do. In general, my criteria for these technical images is merely to be in focus and on some neutral background. I really dislike these images taken on the kitchen counter with the stove and cupboards in the background. That's not very encyclopaedic. --] (]) 18:46, 1 July 2010 (UTC)
::::::::::::: I agree with the backgrounds. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 18:48, 1 July 2010 (UTC)
::::::::::::::What's wrong with including an image of the packaging? Surely the label an essential aspect of patient information.--] (]) 18:59, 2 July 2010 (UTC)
::::::::::::::: I don't have anything against packaging either, but this is an encyclopaedia not a patient information leaflet. The image is to illustrate, not to provide definitive guidance to users. Moreover, no matter ones view of the aforementioned, ANY image used on Misplaced Pages must meet certain basic technical standards of photographic quality to be considered for inclusion. --] (]) 19:18, 2 July 2010 (UTC)
:::::::::::::::: I think that in at least this case, including the packaging would be helpful. As a comment, I hope I never get my no-name, no-stamp generic finasteride pills mixed up with my no-name, no-stamp cyanide pills. --] (]) 19:26, 2 July 2010 (UTC)
::::::::::::::::: Most Indian generics are dispensed in foil packets of 10 tablets, one used per day or dose. The foil packet contains all the relevent information and the tablets are normally not seperated from the package except at time of use. E.g.:]--] (]) 19:32, 2 July 2010 (UTC)
{{outdent}}
{{Quote box
|quote = Ugh. As an uninvolved Admin -- who also reads articles in the areas I have little expertise -- do we really need images for these drugs at all? What the '']'' does is furnish images of the pills themselves, not their packaging, in case they are separated from their labelled container; I don't see any other need for an image, unless there the packaging is discussed in the article. AFAIK, these pills are identical throughout the world, due to economies in mass production; if they are different in different countries, ''then'' a photo would be of use. We could reproduce that by creating image templates, say <nowiki>{{infobox capsule|size=regular|label="50 mg"|shape=round|color=yellow}}</nowiki>, & then we do the politically correct thing & delete all of these presumably <s>Fair use</s> unfree images.
|source = ] (]) 16:36, 1 July 2010 (UTC)
|width = 85%
|align = center
}}


] (]) 13:56, 31 March 2022 (UTC)
That is the quote I was referring too above from the ]... I tend to agree with him, that we should move the drug articles more along those lines of having clear images of the medications themselves for reference purposes, although the logistics of that might be near impossible for us. The packaging themselves doesn't serve much in the EV realm, imho, since either the patient won't ever see the pharmacy packaging and just get them in a generic pill bottle or for the admin's stated reasoning of needing to identify a lone pill separated from it's packaging. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 19:28, 2 July 2010 (UTC)


:I was amazed that this isn't mentioned in the article. I will something on this on a later date. ] (]) 03:24, 9 December 2023 (UTC)
About 55% of all prescriptions are dispensed with a generic equivalent. This means images of the original brand are, indeed, irrelevant to over half of perspective readers. It is misguided in the extreme to enforce some quai policy of brand name image prominence or exclusivity in articles on chemical compounds. Where brands are significant in their own right, a separate article is created for them (i.e.: ] or ].) Generic drug images play an important and indeed crucial educational role in the article. Without them, readers are given the incorrect impression that the brand name version is the only legitimate formulation, which is plainly false. Omission of illustrative examples of generics casts doubt on their legitimacy by conspicuous omission from an article ostensibly on the generic formulation (i.e.: the chemical compound not the brand). This is an encyclopaedia, not the marketing department of Merk or Pfizer.--] (]) 19:32, 2 July 2010 (UTC)
:I'm not saying that we should include the label for patient information purposes, simply that medicine packaging is supposed to clearly and unambiguously identify the product, therefore IMO is just as relevant to the article as showing pics of the pills themselves. I'm happy to include images of Indian generics including their packets, but we should remember that Propecia is still patent protected in most countries and therefore the brand is (for now) the only legitimate 1mg dose of finasteride on the market outside India.--] (]) 19:40, 2 July 2010 (UTC)


== Recent developments & sources ==
:(ec)I've already read that, and I agree. What I'd personally like to see is a series of high quality images like ] (Without the text) of basically every prescription drug, brand name and dosage and generics, etc... be made available for us. Then we could create those templates and standardize how we present the images on the drug pages. But thats where I tend to think that might be logistically impossible for us.. but it's where I'd like to see the "ideal" illustration go for drug pages. As for packaging, I don't see it having much value to the reader since unless it's an over-the-counter medication or some special medication it MOST LIKELY will be dispensed like ], at least here in the united states thats how almost all medications in pill form is dispensed. Blister packs are I think kinda rare here. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 19:41, 2 July 2010 (UTC)
: Other places produce legal generics of Propecia too. The situation is different depending on the laws of the nation in question. In general, I have no issue with packaging, but I just want to avoid any discussion on from which country it can and cannot be from. It should be recognized from the outset that Propecia packaging is likely to vary by market and showing them all is impossible. It is only illustrative, not a definitive worldwide, constantly updated Propecia packaging database.--] (]) 19:46, 2 July 2010 (UTC)


Editors may want to consider the following for the article.
:: I firmly agree that generics need to be illustrated as favorably as brand names, even if there is no generics available in the primary markets due to patents still active, so Indian generics would be relevant since they are obtainable by people. As for packaging, I think pill pictures are of much greater EV over their packaging, and that would be how i'd rate pictures, having a clear shot of the pill will be more favorable then a nice picture of a box. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 19:51, 2 July 2010 (UTC)
::: If this was a directory of drugs, I would clearly agree with you. But, as you say, I am not sure that is practicable for this type of endeavour. I personally include packaging merely to give an indication of the ''type'' of markings ''likely'' to be on the medication as dispensed by the pharmacy. I think that is the proper ambit for an encyclopaedia of general knowledge (rather than a specialist publication). <small><span class="autosigned">—Preceding ] comment added by ] (] • ]) 19:56, 2 July 2010 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->
::::Probably, and I would think if we did ever acquire the specialized pill pictures to do that project it would be in complement with other pictures in the article which would naturally include packaging for some drugs. As packaging photography, I think it would be important to also include the pill in with the packaging though. —&nbsp;<b><i><font color="#6600FF">]</font></i></b>&nbsp;<sup>(<font color="#0033FF">]</font>&nbsp;|&nbsp;<font color="#00CC00">]</font>)</sup> 19:59, 2 July 2010 (UTC)
::::: No question, I don't think showing just a cardboard box is sufficient. --] (]) 20:03, 2 July 2010 (UTC)


<big>'''1. Regulatory news'''</big>
==New studies of sexual side effects of finasteride==
here is one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840927/
not sure about it's credibility
anyone have others? <span style="font-size: smaller;" class="autosigned">—Preceding ] comment added by ] (]) 12:30, 20 July 2010 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->


'''1.1. Boxed warnings were added to finasteride (1 mg) packaging per ANSM'''
==Side Effects Listed Do Not Match The Reference==
The reference is drugs.com.


France's national regulator ANSM required all manufacturers add a red boxed warning to all finasteride 1 mg boxes, on sexual and psychiatric adverse effects. Organon, the current marketing authorization holder, removed the drug from the market in France.
The Side Effects Listed in the source are:


Source: . ANSM (France). November 30, 2022.
TABLE 2. Drug-Related Adverse Experiences for PROSCAR (finasteride 5 mg) BENIGN PROSTATIC HYPERPLASIA N = 1524 and 1516, finasteride vs placebo, respectively


.


'''1.2. FDA required new disclosure of risk of suicidal ideation and behavior to finasteride (1 mg) label'''
YEAR 1
Impotence- 8.1 vs 3.7
Decreased Libido 6.4 vs 3.4


Source: Levine, Dan. . ''Reuters''. June 10, 2022.
YEARS- 2, 3, 4:
Impotence 5.1 vs 5.1
Decreased Libido 2.6 vs 2.6
http://www.drugs.com/sfx/propecia-side-effects.html#ixzz0vhaRJxr4


The article makes no mention of the fact that there is no significant difference in ED and Decreased Libido after the first year of treatment.
It also, inexplicably, puts the incidence of ED at > 18%!] (]) 04:24, 5 August 2010 (UTC)
:You can be ] and add the reference and data yourself... —&nbsp;<font style="font-family:Monotype Corsiva; font-size:15px;">]]</font> 04:27, 5 August 2010 (UTC)


'''1.3. Health Canada alerting doctors to risk of suicidal ideation and self-injury'''
I can't edit this page, and I don't feel like making an account on the assumption that is the problem.] (]) 09:38, 5 August 2010 (UTC)


:To edit this page you do have to have an account... —&nbsp;<font style="font-family:Monotype Corsiva; font-size:15px;">]]</font> 22:00, 10 August 2010 (UTC)


From key points: “Health Canada's review of the available information found a possible link between the use of finasteride and the risks of suicidal ideation and self-injury..." The agency will update product information and inform healthcare professionals through a regulatory communication.
== Edit request from 128.36.205.2, 20 October 2010 ==


{{tlc|edit semi-protected}}
<!-- Begin request -->
The link to source #13, the Swedish leaflet, doesn't work. The correct link should be: http://www.lakemedelsverket.se/SPC_PIL/Pdf/humpil/Propecia%201%20mg%20tablet.pdf
<!-- End request -->
] (]) 16:00, 20 October 2010 (UTC)
:Done. Thanks. -] (]) 21:22, 20 October 2010 (UTC)


'''1.4. UK Medicines and Healthcare products Regulatory Agency (MHRA) launches a safety review of finasteride'''
==New Study - October 2010==
A new study published in the "Archives of Dermatology" concludes that 1 in 80 finasteride users experience erectile dysfunction. http://www.reuters.com/article/idUSTRE69J3IW20101020 - Could someone please add this new info to the article. ] (]) 01:43, 23 October 2010 (UTC)


Source: Ennals, Ethan. “” ''Daily Mail''. March 4, 2023.
== Environmental persistence? ==


From the description, it appears that this could be considered an ] in women. Once it leaves the patient's body, is it substantially destroyed in the waste water treatment process before release into the environment? If not, is it persistent in the environment such that it could be ingested unintentionally in drinking water? This pattern is believed to occur with certain other endocrine disruptors and is a matter of environmental concern. I don't currently have access to a university library so I can't search the journals for an answer to these questions, but if this topic has been researched it may be notable for the article. ] (]) 07:38, 10 November 2010 (UTC)


<big>'''2. Medical literature'''</big>
== Controversy and Lawsuit ==


'''2.1. New review'''
On January 24th 2010, the law firm Klein Lyons has filed a class action lawsuit against Merck Frosst Canada and its affiliated companies on behalf of Canadian men who used Propecia or Proscar and suffered continuing sexual dysfunction. ] (]) 14:16, 29 January 2011 (UTC)


Leliefeld HHJ, Debruyne FMJ & Reisman Y. The post-finasteride syndrome: possible etiological mechanisms and symptoms. ''Int J Impot Res''. 2023. doi:]
:The lawsuit itself is only worth including in the article once it's resolved, and even then it depends on what happens. It might be worth mentioning the disagreement over whether symptoms actually do resolve on discontinuation, but the sources I'm used to looking at (e.g. ) state that side effects are reversible and a quick web search doesn't turn up anything from a reliable source to put in the article. There's a comment that EU labeling has been modified, but I'm not that familiar with EMEA's website and I can't find it. The MHRA's website has a couple of approvals for generic finasteride at the 1mg and 5mg level, but I don't see anything about this complaint in there. I did find one BBC news blog that mentioned the controversy, but I'm hesitant to include blogs even if news blogs are technically capable of meeting ]. ] (]) 16:24, 29 January 2011 (UTC)


A statement of limitations is relevant: "LIMITATIONS. Scientific literature on the PFS has the intrinsic limitation, by definition, that symptoms can persist or even appear after cessation of the 5ARIs and therefore have been unnoticed and not documented in the literature. The earlier mentioned lack of quality studies has hampered our knowledge of the presence, frequency and duration of the side effects...” ] (]) 23:44, 1 October 2023 (UTC)
== Post-Finasteride Syndrome ==


I think it is imperative that Misplaced Pages has a section on Post-Finasteride Syndrome. I tried to post a section yesterday, however JFDWOLFF removed my posting due to the notion that it was "overblown" and some of the sources were not reliable. First, the idea that Propecia has severe long term side effects should not be surprising as it works as a 5-alpha reductase inhibitor. While Merck does not disclose the following information for obvious reasons, a 5-alpha reductase deficiency (from birth) results in a clinical state called pseudo hermaphroditism. Please see http://en.wikipedia.org/5-alpha-reductase_deficiency


'''2.2. Diagnostic criteria for post-finasteride syndrome'''
Many people ignorantly dispel the ability of Propecia to cause permanent sexual side effects. However there is a forum (Propeciahelp.com) where nearly 2,000 registered users (many in their 20's) describe their cases of having sexual side effects after having taken the drug. This on its own is a statistically significant number that would warrant a serious consideration and there are many other additional victims of Propecia that have not registered for the forum. It really should come as no surprise that this is possible, given the same exact pharmaceutical company concealed thousands of deaths from one of their products in a conspiracy that was uncovered about five years ago.


Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. ''Int J Risk Saf Med''. 2021. doi:]
A considerable number of doctors have begun research into this syndrome and there is published literature that demonstrates evidence for the existence of PFS. Additionally, several European regulatory bodies have conducted studies and concluded that Propecia can in fact cause permanent sexual side effects. This could easily be misconstrued as "overblown" due to the ease at which the media could sensationalize such a story, but it is very devastating for a drug to be effectively chemically castrating its patients in their twenties.


== Sourcing regarding post-drug disorder ==
Without the need for further support, I think it is ABSOLUTELY NECESSARY that this be reported on Misplaced Pages, even if the condition is rare. Many people trust Misplaced Pages as a reliable source for information and know very little about human biology and medicine which can allow them to make dangerously uninformed decisions about their health. Those who see this discussion, please respond if you are against posting this information and exactly why so I can determine the proper way to do it. If I do not receive any substantive responses in the next week, I will assume that it will be considered an appropriate topic to list on the Finasteride page.


I have seen bad-faith behavior by experienced[REDACTED] editors regarding editing of the post-finasteride syndrome section. Specifically, one of the editors inserted a low-quality source, and they seemed to be making arbitrary decisions about the quality of other sources depending on whether those sources supported their view. While I was not directly involved in a conflict, I stopped editing when I realized that the editing process was vulnerable to such abuse.
- Doors 22 <small><span class="autosigned">— Preceding ] comment added by ] (] • ]) 19:00, 2 February 2011 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->
:People feel they can trust Misplaced Pages because we absolutely insist on ] from ] to support claims. No matter how many blogs report it, no matter how many people claim to have credentials and know inside info that is being covered up by a government or company, none of that matters because none of that is a reliable source. If it's important and there is actual vetted public information about it, it will be in scientific journals, mainstream major newspapers, etc. If it's not yet verified from those sources, well, ]--every reader must be able to check for him/herself rather than trusting another editor's word. Even if it's ], it can't be here until it's got an available source. ] is a good page about the level of referencing needed. ] (]) 19:17, 2 February 2011 (UTC)


The source the editor featured is: Trüeb, et al (August 2019). "Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?". ''Skin Appendage Disorders''. ]
::Thanks for your response, DMacks. I will list several sources that should provide substantial evidence for inclusion including an article published in a medical journal, a write-up in the BBC, and links to investigations launched by the Swedish regulatory body (already listed on the article). As mentioned in the section immediately above, a lawsuit has been filed in Canada which I feel is notable. This is really just a start. I'm not proposing to include this is as irrefutable truth as it will be exposed in the near future, but these reports and complaints and certainly warrant a section highlighting the controversy surrounding Propecia. I think it would be worth mentioning the existence of PropeciaHelp.com. Assuming it is entirely fallacious (which is not the point I want to make) it is notable that a movement has organized against the drug in substantial numbers. With the following sources, would you now agree it is worth of inclusion?


It is a case report which does not contribute any systematic evidence. It makes a psychological claim, but the authors are <u>dermatologists without apparent training in psychiatry</u>. There was <u>no formal psychiatric evaluation</u> of the patient. The case summary is very <u>subjective and judgmental</u> (describing the patient as “humorless and oversensitive” — doesn't seem professional for the doctors to put this in an article). From this one case, which lacked a serious clinical investigation, the authors created an elaborate and bizarre theory. The[REDACTED] editor highlighted this article, but overlooked dozens of other articles on the syndrome with a wide range of views. This is the most extreme of the lot, and I do not see how it would meet sourcing standards, given how stringent editors often are about medical sourcing. (I wonder why this was an exception.)
::http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2010.02157.x/full
::http://www.bbc.co.uk/newsbeat/12040303
::http://www.lakemedelsverket.se/Alla-nyheter/NYHETER-2006/Ger-Propecia-nedsatt-sexuell-funktion-efter-avslutad-behandling/
::Propecia Help Dot Com (type into browser because it is blacklisted for some reason) - I do not intend this one to be used as a scientific source, but its existence alone is notable. Additionally, will you help me figure out exactly why this website is blacklisted?


Editors should understand that most of the clinical trial evidence base was sponsored by Merck. The remainder was mostly by dermatologists who do not pay close attention to drug harms—and do not usually have expertise psychiatry or sexual medicine. Some literature that casts doubt on the syndrome from 2014–2020 was authored by physician-scientists who were contracted with Merck to promote Propecia or co-published articles with its researchers. For example, Dr. Antonella Tosti, Dr. Jerry Shapiro, Dr. Kevin McVary and Dr. Steven Kaplan. (By the way, Tosti is co-Editor-in-Chief at ''Skin Appendage Disorders'' where the above article by Dr. Trüeb appeared.)
::If there are problems with these sources or a lack of evidence, please let me know and I will gather some more information. Thanks.
::] (]) 20:25, 2 February 2011 (UTC)


Misplaced Pages is an encyclopedia, not a medical review organization, so I understand it cannot adjudicate on something like this. Nevertheless, editors should understand that this is an iatrogenic disorder (caused by medical treatment). There is a commercial bias built into the medical literature because so much of the evidence base came from Merck-sponsored studies. Meanwhile, as Leliefeld et al pointed out (see previous topic), there is a lack of research on post-drug harms. There is no money for such studies. Drug-related harms are threatening to medicine, so physicians may tend to deny and avoid these conditions. Again, Misplaced Pages can't adjudicate, but it seems a good encyclopedia should account for these circumstances, even when a source meets its criteria. An analogy here would be ], denied for decades as malingering or depression, or ]. Just because there are medical authorities or sources which cast doubt on a disease, that does not mean the disease is invalid.
:::OK, nobody responded with any reasons that the section should not be included. Please do not remove the section since I have already attempted to have a discussion about it on here. If you have problems with the addition, I will be happy to discuss them on the talk page. ] (]) 18:53, 7 February 2011 (UTC)


Experienced wikipedians can be paranoid about ulterior motives of other editors, but they should also understand that conflicts of interest are rampant in medical “research” on pharmaceuticals. ] (]) 00:25, 2 October 2023 (UTC)
:I have a problem with it, and you even posted on my talkpage and I gave you a response. At the moment I can only recommend that you avoid the alarmist language (there is no "controversy" as far as I can see), that you use only the ''J Sex Med'' article after it has appeared in print (because it is the most reliable source available), and that you integrate the content with the present text of the article rather than in a separate paragraph. ]&nbsp;&#124;&nbsp;] 19:57, 7 February 2011 (UTC)


== Additional context for post-finasteride syndrome ==
:: I took the suggestions from your talk page. If you took the time to look at the articles I posted, you would see that it is actually a literature review which is the highest quality of medical evidence according to . The controversy is obvious. There is substantial evidence that Merck has mislabeled the side effects on the PCI which have the potential to truly ruin the lives of those who naively take the drug. The fact that there is a class action lawsuit pending is additional evidence of a 'controversy'. The alarmist sub-section is basically a public service announcement to ensure to those who are properly informed to the possible consequences of taking the drug so they don't naively destroy their lives. I don't see how you have a monopoly on authority to revert my posts, so I request that you edit what you feel is inappropriate rather than take down my work. Prior WIki users have posted on this discussion that the controversy is worth mentioning. You seem to be the only one to have a problem with these edits. I will stand corrected it anybody else decides to opine. ] (]) 21:08, 7 February 2011 (UTC)


Different specialties have different positions on this syndrome.
:This is an encyclopedia, not a forum for public service announcements. I'm not the only person troubled by the tone of your additions; DMacks has done the same. ]&nbsp;&#124;&nbsp;] 21:24, 7 February 2011 (UTC)


Finasteride was first developed for prostate conditions, to be prescribed by urologists (approved in 1992). Then it was approved for hair loss, to be prescribed by dermatologists (approved in 1997). Certain urologists and dermatologists worked directly with Merck as “key opinion leaders” on each effort. Some of these same people have authored articles casting doubt on post-finasteride syndrome.
:From your reinsertion of the same content, without an attempt to follow my recommendations, I deduce that you are not interested in forming any degree of ]. It would not be good if the article was locked, but this will be the next step. ]&nbsp;&#124;&nbsp;] 21:41, 7 February 2011 (UTC)


The specialty that has begun to recognize the syndrome is <u>sexual medicine</u> (a subspecialty of urology): see ] and ]. Recent dermatology articles either omit or downplay the syndrome.
:: If you paid attention, you will see that I made changes including removing non-wiki friendly sources and altering language to a factually verifiable state. I am also not required to follow all of your recommendations. If you continue to unreasonably revert changes without offering a compromise as is required by your beloved ] you will require me to initiate a formal challenge to your administrative status. ] (]) 22:09, 7 February 2011 (UTC)


Dermatology has conflicts of interest since they are prescribers, and Merck worked closely with this specialty to bring it to market. It's also relevant that dermatologists don't typically have special training in sexual medicine or neuropsychiatry. As a result, they are not in a position to recognize the syndrome. ] (]) 01:01, 2 October 2023 (UTC)
:This is a content dispute and has absolutely nothing to do with whether I'm an administrator or not. My recommendations are based on Misplaced Pages policies and guidelines, as I have shown, so you achieve nothing by ] (as indeed you did in ).
:Ah, the "scientists have a conflict of interest with science (when I don't like what they say)" gambit. For Misplaced Pages's guidelines on reliable sourcing for biomedicine, see ]. ] (]) 06:18, 2 October 2023 (UTC)
:At the moment, the content is still very heavily worded ("thousands " etc). I will not remove it again, but I would like you to copyedit it into a format that you would expect from an encyclopedia rather than a human interest article in a magazine or newspaper. It would also be advisable to replace the links to Pubmed with properly formatted references (MEDRS gives some tips ho to do that). ]&nbsp;&#124;&nbsp;] 23:16, 7 February 2011 (UTC)
::From WP:MEDRS: "Case reports and series are especially avoided, as they are uncontrolled."
::See my discussion of the Trüeb article above. ] (]) 13:50, 2 October 2023 (UTC)
:::The only "motives" being called into question are those of "experienced[REDACTED] editors ", "dermatologists" and Merck (by you). Pointing out a line of argument is flawed is necessary to make progress, I certainly agree we don't base ] on case reports. ] (]) 14:00, 2 October 2023 (UTC)


== Long-Term Section - Flaws in studies cited ==
::OK, I can change it if I find something that is mutually agreed upon. PropeciaHelp.com is blacklisted, but I would like to include a sentence or two in the side effects section. It is a discussion forum for the thousands of men whose lives are now ruined due to the unlisted side-effects of taking Propecia. It does not have to sound like a special interest story, but deserves to be in an encyclopedic article for those who are researching the effects (medically and socially) of the drug. Will you please explain to me why Propeciahelp.com is blacklisted from this article. I may be mistaken, but I believe you were the one to have blacklisted it.] (]) 01:57, 8 February 2011 (UTC)


In the study "Sexual dysfunction in men taking systemic dermatologic medication: A systematic review" that is cited in the Long Term section of the Finasteride Wiki. Only level 1 evidence of Finasteride potentially causing long-term side effects is cited. This is very weak evidence and it far from being a double-blinded control study. In addition, there are no double blinded control studies currently that prove that Finasteride causes long-term side effects after the drug has stopped circulating in the blood.
:::Find a decent source first, not some internet chat board. There isn't any reliable evidence of a link that I've seen. External links to support groups will never be acceptable per ] and getting it un-listed is just not going to happen. Misplaced Pages isn't based on what something "deserves" it's based on what we can ] and at this point there isn't much of a case for including it other than gossip and rumors. ] (]) 03:34, 8 February 2011 (UTC)


In fact, in a double blind long-term control study there was no evidence of side-effect continuation after cessation of the drug: https://www.jaad.org/article/S0190-9622(98)70007-6/abstract
::::Unfortunately, I guess there is nothing else I can do on that front. I'm still figuring out the editorial process for wikipedia, but I'm quite disappointed to learn that in reality it is quite a conservative institution that perpetuates the conventional wisdom. I feel this article does wonders to champion the myth that finasteride is an safe treatment for male pattern baldness. For now, I will have to do my best to convey the dangers of taking what is literally a poison. It is a shame that Misplaced Pages is not sufficiently flexible to protect the individual in modern society. Thanks to those who gave constructive feedback. I'll be making some additional minor edits in the near future. ] (]) 05:03, 8 February 2011 (UTC)


"These adverse events (Sexual dysfunction) also resolved in many of the patients who reported them but who remained on the finasteride regimen and continued in the study."
:::The article already contains loads of negative information about finasteride, which is appropriate if it can be supported by reliable sources. It is a lot more detailed and unbiased than any other encyclopedia article in a convential encyclopedia, but to maintain our credibility as a reliable source we ''must'' apply certain standards, and messaging boards are ''so'' fluid and unverifiable that we cannot allow them as a source. You clearly have negative experiences with the drug, which does not make you an unbiased observer. A quick glance at ] might be a good idea. ]&nbsp;&#124;&nbsp;] 07:07, 8 February 2011 (UTC)


" a few men in the current studies experienced reversible impairment of sexual function, but only 11 men receiving finasteride, compared with 8 men in the placebo group, discontinued treatment for this reason, with resolution in all."
:: I have had my experiences with finasteride, but it should not prevent me from upholding Misplaced Pages's NPOV. As you are a Jewish, European, practitioner of western medicine, you are likely to have your own values and perceptions towards finasteride and male pattern baldness. I gather there is a good chance you are either undergoing finasteride treatment or have male pattern baldness yourself. I personally disagree with the utility of discussion boards, especially since Wiki is essentially a glorified discussion board, but will definitely concede it does not fit within the boundaries of Misplaced Pages's acceptable sources. Thank you for your feedback, and I invite you to provide more commentary. If you have a problem with additional edits or tone, please comment or revise rather than initiate a complete reversion which as I am sure you know is a violation of wiki's consensus policy in most cases. ] (]) 19:28, 8 February 2011 (UTC)


In conclusion, I feel that the evidence cited here is extremely flimsy and is contradicted by studies with better methodology, study design and far more subjects. Thus this entry should be removed as there is far stronger evidence to the contrary of what this study and entry claims. ] (]) 19:48, 16 June 2024 (UTC)
:::I find your personal observations about my background unhelpful. I also think you are completely mistaken if you think Misplaced Pages is "a glorified discussion board".
:::If an edit introduces a large amount of "human interest" text that will take ages to copyedit into shape, I prefer to remove it for reconsideration. That is not in contravention of any "consensus policy", but is based on a guideline called ]. I suggest you have a look at that before making further speculations about myself or about Misplaced Pages policy. ]&nbsp;&#124;&nbsp;] 21:17, 8 February 2011 (UTC)

Latest revision as of 17:41, 28 December 2024

This page is not a forum for general discussion about Finasteride. Any such comments may be removed or refactored. Please limit discussion to improvement of this article. You may wish to ask factual questions about Finasteride at the Reference desk.
This is the talk page for discussing improvements to the Finasteride article.
This is not a forum for general discussion of the article's subject.
Article policies
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL
Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8Auto-archiving period: 3 months 

Ideal sources for Misplaced Pages's health content are defined in the guideline Misplaced Pages:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Finasteride.
This article is rated B-class on Misplaced Pages's content assessment scale.
It is of interest to the following WikiProjects:
WikiProject iconPharmacology Mid‑importance
WikiProject iconThis article is within the scope of WikiProject Pharmacology, a collaborative effort to improve the coverage of Pharmacology on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.PharmacologyWikipedia:WikiProject PharmacologyTemplate:WikiProject Pharmacologypharmacology
MidThis article has been rated as Mid-importance on the project's importance scale.
WikiProject iconChemicals Mid‑importance
WikiProject iconThis article is within the scope of WikiProject Chemicals, a daughter project of WikiProject Chemistry, which aims to improve Misplaced Pages's coverage of chemicals. To participate, help improve this article or visit the project page for details on the project.ChemicalsWikipedia:WikiProject ChemicalsTemplate:WikiProject Chemicalschemicals
MidThis article has been rated as Mid-importance on the project's importance scale.
WikiProject iconMedicine Mid‑importance
WikiProject iconThis article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Misplaced Pages talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine
MidThis article has been rated as Mid-importance on the project's importance scale.
WikiProject iconWomen's Health Mid‑importance
WikiProject iconThis article is within the scope of WikiProject Women's Health, a collaborative effort to improve the coverage of Women's Health on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.Women's HealthWikipedia:WikiProject Women's HealthTemplate:WikiProject Women's Healthwomen's health
MidThis article has been rated as Mid-importance on the importance scale.
The following Misplaced Pages contributor may be personally or professionally connected to the subject of this article. Relevant policies and guidelines may include conflict of interest, autobiography, and neutral point of view.
Individuals with a conflict of interest, particularly those representing the subject of the article, are strongly advised not to directly edit the article. See Misplaced Pages:Conflict of interest. You may request corrections or suggest content here on the Talk page for independent editors to review, or contact us if the issue is urgent.

Adverse Effects section - exposure and pregnancy

I wish to propose an addition to the Adverse Effects section. For the comment on contraindication in pregnancy I think it could be improved. The current text is:

Finasteride is contraindicated in pregnancy. The Food and Drug Administration advises that donation of blood or plasma be deferred for at least one month after taking the last dose of finasteride.

I suggest, based on Refs 36 and 37 (manufacturers' prescribing information as deposited with the FDA), that the above be altered to:

Finasteride is contraindicated for women who are pregnant or become pregnant while exposed to it, as it may cause abnormalities in a male fetus. Exposure through skin contact to broken or crushed tablets is identified as a risk vector. The Food and Drug Administration advises that donation of blood or plasma be deferred for at least one month after taking the last dose of finasteride.

The motivation for this proposed edit is to (i) specify the reason as to why finasteride is contraindicated (abnormalities in the male fetus may be caused) and (ii) to add a comment that skin contact is a risk vector. I think that the latter is important to include as this is important information for someone who may have come into contact with finasteride unwantedly due to the serious consequences.

Silverfoil92 (talk) 13:56, 31 March 2022 (UTC)

I was amazed that this isn't mentioned in the article. I will something on this on a later date. Robert Brockway (talk) 03:24, 9 December 2023 (UTC)

Recent developments & sources

Editors may want to consider the following for the article.

1. Regulatory news

1.1. Boxed warnings were added to finasteride (1 mg) packaging per ANSM

France's national regulator ANSM required all manufacturers add a red boxed warning to all finasteride 1 mg boxes, on sexual and psychiatric adverse effects. Organon, the current marketing authorization holder, removed the drug from the market in France.

Source: Finastéride 1 mg (Propecia et génériques) : ajout de mentions d’alerte sur les boîtes pour renforcer l’information sur les effets indésirables. ANSM (France). November 30, 2022.


1.2. FDA required new disclosure of risk of suicidal ideation and behavior to finasteride (1 mg) label

Source: Levine, Dan. FDA requires disclosure of suicide risk for anti-baldness drug. Reuters. June 10, 2022.


1.3. Health Canada alerting doctors to risk of suicidal ideation and self-injury

Health Canada Safety Review, Jan 19 2023

From key points: “Health Canada's review of the available information found a possible link between the use of finasteride and the risks of suicidal ideation and self-injury..." The agency will update product information and inform healthcare professionals through a regulatory communication.


1.4. UK Medicines and Healthcare products Regulatory Agency (MHRA) launches a safety review of finasteride

Source: Ennals, Ethan. “Watchdog launches investigation into hair loss pill...” Daily Mail. March 4, 2023.


2. Medical literature

2.1. New review

Leliefeld HHJ, Debruyne FMJ & Reisman Y. The post-finasteride syndrome: possible etiological mechanisms and symptoms. Int J Impot Res. 2023. doi:10.1038/s41443-023-00759-5

A statement of limitations is relevant: "LIMITATIONS. Scientific literature on the PFS has the intrinsic limitation, by definition, that symptoms can persist or even appear after cessation of the 5ARIs and therefore have been unnoticed and not documented in the literature. The earlier mentioned lack of quality studies has hampered our knowledge of the presence, frequency and duration of the side effects...” Mariedegournay (talk) 23:44, 1 October 2023 (UTC)


2.2. Diagnostic criteria for post-finasteride syndrome

Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med. 2021. doi:10.3233/JRS-210023

Sourcing regarding post-drug disorder

I have seen bad-faith behavior by experienced[REDACTED] editors regarding editing of the post-finasteride syndrome section. Specifically, one of the editors inserted a low-quality source, and they seemed to be making arbitrary decisions about the quality of other sources depending on whether those sources supported their view. While I was not directly involved in a conflict, I stopped editing when I realized that the editing process was vulnerable to such abuse.

The source the editor featured is: Trüeb, et al (August 2019). "Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?". Skin Appendage Disorders. doi.org/10.1159/000497362

It is a case report which does not contribute any systematic evidence. It makes a psychological claim, but the authors are dermatologists without apparent training in psychiatry. There was no formal psychiatric evaluation of the patient. The case summary is very subjective and judgmental (describing the patient as “humorless and oversensitive” — doesn't seem professional for the doctors to put this in an article). From this one case, which lacked a serious clinical investigation, the authors created an elaborate and bizarre theory. The[REDACTED] editor highlighted this article, but overlooked dozens of other articles on the syndrome with a wide range of views. This is the most extreme of the lot, and I do not see how it would meet sourcing standards, given how stringent editors often are about medical sourcing. (I wonder why this was an exception.)

Editors should understand that most of the clinical trial evidence base was sponsored by Merck. The remainder was mostly by dermatologists who do not pay close attention to drug harms—and do not usually have expertise psychiatry or sexual medicine. Some literature that casts doubt on the syndrome from 2014–2020 was authored by physician-scientists who were contracted with Merck to promote Propecia or co-published articles with its researchers. For example, Dr. Antonella Tosti, Dr. Jerry Shapiro, Dr. Kevin McVary and Dr. Steven Kaplan. (By the way, Tosti is co-Editor-in-Chief at Skin Appendage Disorders where the above article by Dr. Trüeb appeared.)

Misplaced Pages is an encyclopedia, not a medical review organization, so I understand it cannot adjudicate on something like this. Nevertheless, editors should understand that this is an iatrogenic disorder (caused by medical treatment). There is a commercial bias built into the medical literature because so much of the evidence base came from Merck-sponsored studies. Meanwhile, as Leliefeld et al pointed out (see previous topic), there is a lack of research on post-drug harms. There is no money for such studies. Drug-related harms are threatening to medicine, so physicians may tend to deny and avoid these conditions. Again, Misplaced Pages can't adjudicate, but it seems a good encyclopedia should account for these circumstances, even when a source meets its criteria. An analogy here would be myalgic encephalomyelitis, denied for decades as malingering or depression, or Long COVID. Just because there are medical authorities or sources which cast doubt on a disease, that does not mean the disease is invalid.

Experienced wikipedians can be paranoid about ulterior motives of other editors, but they should also understand that conflicts of interest are rampant in medical “research” on pharmaceuticals. Mariedegournay (talk) 00:25, 2 October 2023 (UTC)

Additional context for post-finasteride syndrome

Different specialties have different positions on this syndrome.

Finasteride was first developed for prostate conditions, to be prescribed by urologists (approved in 1992). Then it was approved for hair loss, to be prescribed by dermatologists (approved in 1997). Certain urologists and dermatologists worked directly with Merck as “key opinion leaders” on each effort. Some of these same people have authored articles casting doubt on post-finasteride syndrome.

The specialty that has begun to recognize the syndrome is sexual medicine (a subspecialty of urology): see Leliefeld et al, 2023 and Healy et al, 2022. Recent dermatology articles either omit or downplay the syndrome.

Dermatology has conflicts of interest since they are prescribers, and Merck worked closely with this specialty to bring it to market. It's also relevant that dermatologists don't typically have special training in sexual medicine or neuropsychiatry. As a result, they are not in a position to recognize the syndrome. Mariedegournay (talk) 01:01, 2 October 2023 (UTC)

Ah, the "scientists have a conflict of interest with science (when I don't like what they say)" gambit. For Misplaced Pages's guidelines on reliable sourcing for biomedicine, see WP:MEDRS. Bon courage (talk) 06:18, 2 October 2023 (UTC)
From WP:MEDRS: "Case reports and series are especially avoided, as they are uncontrolled."
See my discussion of the Trüeb article above. Mariedegournay (talk) 13:50, 2 October 2023 (UTC)
The only "motives" being called into question are those of "experienced[REDACTED] editors ", "dermatologists" and Merck (by you). Pointing out a line of argument is flawed is necessary to make progress, I certainly agree we don't base WP:BMI on case reports. Bon courage (talk) 14:00, 2 October 2023 (UTC)

Long-Term Section - Flaws in studies cited

In the study "Sexual dysfunction in men taking systemic dermatologic medication: A systematic review" that is cited in the Long Term section of the Finasteride Wiki. Only level 1 evidence of Finasteride potentially causing long-term side effects is cited. This is very weak evidence and it far from being a double-blinded control study. In addition, there are no double blinded control studies currently that prove that Finasteride causes long-term side effects after the drug has stopped circulating in the blood.

In fact, in a double blind long-term control study there was no evidence of side-effect continuation after cessation of the drug: https://www.jaad.org/article/S0190-9622(98)70007-6/abstract

"These adverse events (Sexual dysfunction) also resolved in many of the patients who reported them but who remained on the finasteride regimen and continued in the study."

" a few men in the current studies experienced reversible impairment of sexual function, but only 11 men receiving finasteride, compared with 8 men in the placebo group, discontinued treatment for this reason, with resolution in all."

In conclusion, I feel that the evidence cited here is extremely flimsy and is contradicted by studies with better methodology, study design and far more subjects. Thus this entry should be removed as there is far stronger evidence to the contrary of what this study and entry claims. Zpalmati (talk) 19:48, 16 June 2024 (UTC)

Categories:
Talk:Finasteride: Difference between revisions Add topic