8 ms·

Persistent erectile dysfunction in men exposed to finasteride, or dutasteride

30 points by noshbrinken 10y ago

laichzeit0 10y ago
This study is fucked, to put it bluntly. They're lumping together Fin and Dut and people taking 5mg Fin. Most people taking Fin for MPB take 1mg Fin, for example. You can actually not draw any conclusions from this paper other than, don't use Dutesteride unless you're male to female transitioning and don't go above 1.25mg finasteride if you want to keep your hair and your dick. But it just confounds everything together, it's a terrible study.
- throwaway6111 10y ago
  0.8% of a 4000+ sample size had PED with the regular dosage for baldness treatment. That's absurdly low and pretty much confirms that though the risk is there, it's highly unlikely. Its even more ridiculous that 1.4% of the ENTIRE sample size (over 11,000 people) taking less than or equal to 1.25mg of fin, greater than 1.25mg of fin, and dutasteride reported persistent ED. As a fin user I actually find this data to be re-assuring.
  - laichzeit0 10y ago
    The criterion of PED is also vague. It's basically asking people do they think their dicks are broken. There's enough guys going on Noporn/Nofap routines because they couldn't get it up one night with a girl because they're so used to watching porn and jerking off that real sex is too weird, and one bad experience and now they're convinced they have ED. If you tell a guy suffering from baldness that there's "a good chance you're gonna break your dick if you drink this pill" you've already biased your study. Blind study is the only way. I'm not suggesting there is no risk, at this point the numbers are just a joke. This study is another example of how to NOT to do it.
    - throwaway6111 10y ago
      They're also just doing analysis on a static data set. > PED was determined by manual review of medical narratives for all subjects with ED. Risk of an adverse effect was expressed as number needed to harm (NNH). So this doesn't rule out the possibility of the subjects' mental state affecting their ED.
    - oxide 10y ago
      >one bad experience and now they're convinced they have ED Those nofap guys...I don't understand the logic. It's totally normal for this kind of thing to happen occasionally. If drugs or alcohol are involved it can happen as well. It happens, young, middle-aged or old. You can't fix it by giving up masturbation for a month.
firebones 10y ago
I'm guessing this is a dig at someone of prominence having notable hair who is in US news who is on one of the drugs mentioned.
hartator 10y ago
Where is commonly found finasteride or dustaride?
- jjensen90 10y ago
  They are both drugs to treat enlarged prostate (benign prostatic hyperplasia)
- rosser 10y ago
  Among other things, in a drug that is used to treat BPH (benign prostatic hyperplasia — a non-cancerous enlargement of the prostate), and male pattern hair loss. It's also sometimes used as a hormone replacement in FtM transgender individuals. It's widely rumored that President Trump uses it for hair loss, which I suspect is part of why this article was shared, and is being upvoted; this side effect wasn't exactly unknown before this study...
  - deleted 10y ago
    [deleted]
- moh_maya 10y ago
  they are used for treating prostrate enlargement as well as hair loss in men, among other things.. https://en.wikipedia.org/wiki/Finasteride https://en.wikipedia.org/wiki/Finasteride https://en.wikipedia.org/wiki/Dutasteride https://en.wikipedia.org/wiki/Dutasteride But I don't think that this side-effect was unknown. ED / sexual dysfunction is a documented side effect for both the drugs in a significant percentage of the patient population.
  - zedred 10y ago
    I think this study is exploring "persistent" ED, which is less known. ED is a documented side effect, but this shows that some men continue to experience ED even after they stop taking the drug.
    - rosser 10y ago
XNOVRJ 10y ago
Can anyone knowledgeable guess at the mechanism of action?
- rosser 10y ago
  The Wikipedia article says it prevents conversion of testosterone into dihydrotestosterone by the enzyme 5α-reductase, and also affects the GABA system. Particularly relevant quote: "Reduction of GABA-A receptor activation by these neurosteroids has been implicated in depression, anxiety, and sexual dysfunction." More specific than that is way beyond my understanding of these things. https://en.wikipedia.org/wiki/Finasteride#Mechanism_of_action https://en.wikipedia.org/wiki/Finasteride#Mechanism_of_actio...
  - XNOVRJ 10y ago
    That's fine, but how would that account for PED?
    - rosser 10y ago
      Like I said, any more is beyond my level of understanding of these things. All I can say for sure is that the GABA system is incredibly important, and kinda delicate. Read up on delirium tremens, for example: long-term alcoholics, and benzodiazepine and barbiturate addicts need to be really careful in stopping their use of those drugs — they could die if they aren't. Those drugs also affect the GABA system. Maybe the long-term down-regulation of some aspect of GABA-A metabolism by finasteride's preventing the formation of an agonist for those receptors becomes permanent or semi-permanent after a while? I really don't know.
- scottlocklin 10y ago
  It blocks DHT, your body's strongest androgen.
KVFinn 10y ago
A little strange to see this at the very top of the site, doesn't look like anything particularly interesting?
- throwaway6111 10y ago
  I'm a fin user and frankly I'm surprised to see this here. It's already well known that persistent ED is a potential side. I'm guessing its here because its a new study and other HN readers are curious about the drug (or taking it).
- rosser 10y ago
  My theory: it's a back-handed jab at President Trump, as he's reported to be a user of Propecia for hair loss. Overtly political stories are usually flagged off the front page quickly, but this is "just" a journal article. (Note: I'm not a Trump supporter — quite the opposite. I just don't like round-about mocking: "Oh, he can't get it up. That must be why he's such a jerk!")
  - pseudalopex 10y ago
    My theory: an overwhelming majority of HN readers are men, many of whom have taken or considered taking finasteride.
throwaway6111 10y ago
> Among men 16–42 years old and exposed to finasteride ≤1.25 mg/day, 34 of 4,284 (0.8%) developed PED (persistence median 1,534 days, IQR 651–2,351 days); the multivariable model predicting PED had one variable: duration of 5α-RI exposure So less than 1% of finasteride users get PED. PED was already a known side effect. That's good it's being confirmed with data, but aren't the odds still very low that this would happen to fin users? As a fin user myself, I haven't experienced any of the sexual sides so I'm wondering if there's any new take-away from this. When I look at this as a fin user, I'm personally happy to see that the data says its so unlikely.

30 points by noshbrinken 10y ago

This study is fucked, to put it bluntly. They're lumping together Fin and Dut and people taking 5mg Fin. Most people taking Fin for MPB take 1mg Fin, for example. You can actually not draw any conclusions from this paper other than, don't use Dutesteride unless you're male to female transitioning and don't go above 1.25mg finasteride if you want to keep your hair and your dick. But it just confounds everything together, it's a terrible study.

throwaway6111 10y ago
0.8% of a 4000+ sample size had PED with the regular dosage for baldness treatment. That's absurdly low and pretty much confirms that though the risk is there, it's highly unlikely. Its even more ridiculous that 1.4% of the ENTIRE sample size (over 11,000 people) taking less than or equal to 1.25mg of fin, greater than 1.25mg of fin, and dutasteride reported persistent ED. As a fin user I actually find this data to be re-assuring.
- laichzeit0 10y ago
  The criterion of PED is also vague. It's basically asking people do they think their dicks are broken. There's enough guys going on Noporn/Nofap routines because they couldn't get it up one night with a girl because they're so used to watching porn and jerking off that real sex is too weird, and one bad experience and now they're convinced they have ED. If you tell a guy suffering from baldness that there's "a good chance you're gonna break your dick if you drink this pill" you've already biased your study. Blind study is the only way. I'm not suggesting there is no risk, at this point the numbers are just a joke. This study is another example of how to NOT to do it.
  - throwaway6111 10y ago
    They're also just doing analysis on a static data set. > PED was determined by manual review of medical narratives for all subjects with ED. Risk of an adverse effect was expressed as number needed to harm (NNH). So this doesn't rule out the possibility of the subjects' mental state affecting their ED.
  - oxide 10y ago
    >one bad experience and now they're convinced they have ED Those nofap guys...I don't understand the logic. It's totally normal for this kind of thing to happen occasionally. If drugs or alcohol are involved it can happen as well. It happens, young, middle-aged or old. You can't fix it by giving up masturbation for a month.

firebones 10y ago

I'm guessing this is a dig at someone of prominence having notable hair who is in US news who is on one of the drugs mentioned.

hartator 10y ago

Where is commonly found finasteride or dustaride?

jjensen90 10y ago
They are both drugs to treat enlarged prostate (benign prostatic hyperplasia)
rosser 10y ago
Among other things, in a drug that is used to treat BPH (benign prostatic hyperplasia — a non-cancerous enlargement of the prostate), and male pattern hair loss. It's also sometimes used as a hormone replacement in FtM transgender individuals. It's widely rumored that President Trump uses it for hair loss, which I suspect is part of why this article was shared, and is being upvoted; this side effect wasn't exactly unknown before this study...
- deleted 10y ago
  [deleted]
moh_maya 10y ago
they are used for treating prostrate enlargement as well as hair loss in men, among other things.. https://en.wikipedia.org/wiki/Finasteride https://en.wikipedia.org/wiki/Finasteride https://en.wikipedia.org/wiki/Dutasteride https://en.wikipedia.org/wiki/Dutasteride But I don't think that this side-effect was unknown. ED / sexual dysfunction is a documented side effect for both the drugs in a significant percentage of the patient population.
- zedred 10y ago
  I think this study is exploring "persistent" ED, which is less known. ED is a documented side effect, but this shows that some men continue to experience ED even after they stop taking the drug.
  - rosser 10y ago

XNOVRJ 10y ago

Can anyone knowledgeable guess at the mechanism of action?

rosser 10y ago
The Wikipedia article says it prevents conversion of testosterone into dihydrotestosterone by the enzyme 5α-reductase, and also affects the GABA system. Particularly relevant quote: "Reduction of GABA-A receptor activation by these neurosteroids has been implicated in depression, anxiety, and sexual dysfunction." More specific than that is way beyond my understanding of these things. https://en.wikipedia.org/wiki/Finasteride#Mechanism_of_action https://en.wikipedia.org/wiki/Finasteride#Mechanism_of_actio...
- XNOVRJ 10y ago
  That's fine, but how would that account for PED?
  - rosser 10y ago
    Like I said, any more is beyond my level of understanding of these things. All I can say for sure is that the GABA system is incredibly important, and kinda delicate. Read up on delirium tremens, for example: long-term alcoholics, and benzodiazepine and barbiturate addicts need to be really careful in stopping their use of those drugs — they could die if they aren't. Those drugs also affect the GABA system. Maybe the long-term down-regulation of some aspect of GABA-A metabolism by finasteride's preventing the formation of an agonist for those receptors becomes permanent or semi-permanent after a while? I really don't know.
scottlocklin 10y ago
It blocks DHT, your body's strongest androgen.

KVFinn 10y ago

A little strange to see this at the very top of the site, doesn't look like anything particularly interesting?

throwaway6111 10y ago
I'm a fin user and frankly I'm surprised to see this here. It's already well known that persistent ED is a potential side. I'm guessing its here because its a new study and other HN readers are curious about the drug (or taking it).
rosser 10y ago
My theory: it's a back-handed jab at President Trump, as he's reported to be a user of Propecia for hair loss. Overtly political stories are usually flagged off the front page quickly, but this is "just" a journal article. (Note: I'm not a Trump supporter — quite the opposite. I just don't like round-about mocking: "Oh, he can't get it up. That must be why he's such a jerk!")
- pseudalopex 10y ago
  My theory: an overwhelming majority of HN readers are men, many of whom have taken or considered taking finasteride.

throwaway6111 10y ago

> Among men 16–42 years old and exposed to finasteride ≤1.25 mg/day, 34 of 4,284 (0.8%) developed PED (persistence median 1,534 days, IQR 651–2,351 days); the multivariable model predicting PED had one variable: duration of 5α-RI exposure So less than 1% of finasteride users get PED. PED was already a known side effect. That's good it's being confirmed with data, but aren't the odds still very low that this would happen to fin users? As a fin user myself, I haven't experienced any of the sexual sides so I'm wondering if there's any new take-away from this. When I look at this as a fin user, I'm personally happy to see that the data says its so unlikely.