Indecision of taking finasteride is driving me crazy!

[jorgedudicoff]

Hey guys, I'm less than a week away from seeing a cosmetic dermatologist, an appointment I am likely to get a prescription for finasteride. My anxiety about taking finasteride is through the roof. I've been on this forum for a year and a half and have read all I could possibly read to make an informed decision. I keep telling myself how good my chances are, but I still struggle with the decision to take finasteride.

I am trying to give myself some serious confidence going into treatment because I know being psychologically unprepared could be really bad, but I can't help feeling nervous. As a worst-case scenario type of guy, I know I am naturally inept for situations like this.

I am trying to look at it like this. It's either be depressed, lose self-confidence, regret never trying, regret not starting earlier, OR make a decision that could save me all of that, and let me get my life back on track.

Of course, the fear of the drug ruining my life (persistent sides) vs just going bald, always finds a way back into my mind. Everyday I am repetitively going over the studies, the numbers, my odds, my vanity, and no matter how good they look, I still remain scared to death of this decision.

I guess, I'm looking for some positive support from people who have gone through this indecision as well. I would love to hear some positive outlooks that could help me find the motivation to be confident in taking Finasteride.

Thanks guys, as my sole outlet for the topic of hairloss, this forum has always been great.

 

[Yoshi3Mario]

https://www.youtube.com/watch?v=8cTkTEpEYfk

- - - Updated - - -

How to accept being bald: Watch as many pitbull youtube videos and jason statham movies as possible.

How to accept taking finasteride? Daniel tosh takes it... It doesn't matter what way you go, just do what makes you feel comfortable. You don't have to take the drug. You could just go bald like many men eventually do. Don't let your self-conscious tendencies inhibit you from being who you are.

 

[Captain Hook]

No one is forcing you to take it, but that being said, you only have yourself to blame if your hair loss gets worse.

Let's take a step back and look at things logically, if you look at the studies for the oral 5ARIs, finasteride and dutasteride, you'll see that a good percentage of the placebo group even experiences side effects. Such is the nature of a study where the researchers tell you what side effects to look out for, impotence and the like are largely influenced by psychogenic factors, this is why the placebo group experienced side effects too! Even if you do experience ED or similar side effects, they will resolve a few months after ceasing the drug.

This guy on bodybuilding forums compiled a post with studies to back it (http://forum.bodybuilding.com/showthread.php?t=158889153), one of the very important questions was answered as follows:

"Sperm mobility and morphology is regulated by testosterone levels, rats given 100mg/kg of finasteride showed no effect on fertility, so did humans with up to a single 400mg dose. Chances of finasteride causing impotence are close to zero. Chances of finasteride causing permanent impotence are statistically non-existent."

All those scare stories you see on the internet are either a product of an extreme nocebo effect or a result of someone who already had impotence in the past, finasteride certainly won't improve any existing sexual issues but it won't cause them on its own. The mind is a powerful entity, so try to relax and trust in science instead of drones parroting invalid advice. I actually read one of the Propecia suicide stories, the bloody idiot was on two other medications that could cause sexual side effects at a much greater propensity than finasteride alone (zolpidem and an SSRI).

Calling DHT a vestigial hormone would be a bit extreme but in fully grown men it really only enlarges the prostate, causes acne and miniaturises hair follicles, it isn't essential for healthy adult males.

What about gynaecomastia? Worrying about this side effect is slightly more warranted but even then it's statistically insignificant. Take a look at this chart for some proof:

http://i.gyazo.com/dbbc762b031e11387805edd0605aedf1.png

Average serum estradiol, which increases when excess free testosterone is aromatised, never rises above what is considered the normal reference range for men. Even the outliers (which were also present in the placebo group!) likely wouldn't produce any abnormal pathological changes. Look at this study, (http://www.ncbi.nlm.nih.gov/pubmed/7614406), it even shows normal, healthy, fertile men can have serum estradiol levels as high as 82 pg/mL (ng/L). Someone would have to have a predisposition for estrogenic side effects such as gynaecomastia to occur (read: abnormally high serum estradiol levels), hence the low incidence rate. This is why I had a comprehensive male hormone panel performed before I started any treatments, everything came back within their normal reference ranges and I plan to start dutasteride at the end of next week. I suggest you do the same to make sure you are considered a normal, healthy male from an endocrinological perspective.

Think of it this way, oral 5ARIs can exacerbate or manifest an underlying endocrinological issue but it's doubtful that they can cause such issues outright. It's like with psychedelics and their relation to mental illness, just because someone takes LSD once, has a psychotic episode and is later diagnosed with schizophrenia, doesn't mean the LSD caused it. It's well known that psychedelics only can cause mental illness to manifest itself earlier, but even if you hadn't taken said psychedelic drug, you still would experience the very same mental illness, only with a later onset. Basically only people with underlying issues that haven't surfaced yet will experience problems with certain drugs, be it finasteride, ibuprofen (look up Stevens-Johnson syndrome), aspirin (look up Reye's syndrome) or psilocybin. Correlation does not equal causation. (Or should I say "correlation does not equal castration"? )

I honestly regret not going on an oral 5ARI sooner, I admit I should've done more research and then I would've realised that the side effects were statistically insignificant. I feel like a damn fool, especially given the above LSD analogy, which is a great parallel. Granted I haven't waited as long as some people (1 year since Androgenetic Alopecia likely started, took about 9 months wasting time ruling out other causes, spent 3 months on only mildly effective treatments, here I am now at NW1.5-NW2 and ravenous for my first dose of dutasteride) but I'm not about to wait any longer and see my temples get worse! Don't be an anus, take prophylactic action as soon as you've confirmed you have Androgenetic Alopecia. Pursuing every avenue is vital to at least achieve maintenance, regrowth is a bonus if you're lucky. I see far too many sad boys on this forum who have woken up too late, you don't want to end up like them.

If the above reasons aren't enough, let's examine some of the potential health benefits of going on an oral 5ARI:

-Possible decreased risk of prostate cancer as well as slowed progression or even regression/remission if you have the cancer already (https://www.youtube.com/watch?v=0g0m8ATOLaM) (notice how he even says that Avodart, which is a trade name for dutasteride, has no significant side effects!)
-DHT stimulates sebum production, so you may even see decreased acne, attenuation of seborrhoeic dermatitis symptoms and better skin overall.
-Easier time peeing, 5ARIs shrink the prostate, reducing urethral occlusion and therefore increasing urinary flow rate.
-And of course the obvious fact, it's very likely that you'll end up keeping your hair

Here's a bit more concrete (and extreme) analogy involving Michael Jordan: "In their discussion about risk-reward, Reinsdorf offered Jordan an example of having 10 pills in front of him to help a headache, but one of the 10 pills would kill you. He said he didn't think it was worth the risk, however, Michael said "it depends how bad the headache is"

So, how bad is your Androgenetic Alopecia headache?

 

[Norwood One]

If you're that anxious about trying finasteride, I would say try S5 cream for topical usage. It is more of a hassle than just popping a pill but it similarly an anti androgen that can provide you some benefit.

 

[jorgedudicoff]

@Captain Hook I cannot thank you enough for that post. The amount of effort you put in to help a complete stranger like me is unreal. I can also say it is exactly what I need to hear. You sir are an absolute saint, I appreciate the care you put in. It will not go to waste, you have strongly strengthened my will to take finasteride again.

Do you think there are any tests I could do while taking finasteride to really test for sides, just to eliminate the psychological component from it? I read somewhere about putting stamps on your penis overnight and if they moved in the morning you had had an erection, or something like that. (I might make a new post just for this)

 

[Captain Hook]

If you're that anxious about trying finasteride, I would say try S5 cream for topical usage. It is more of a hassle than just popping a pill but it similarly an anti androgen that can provide you some benefit.

While this is generally good advice, take it from me who lost ground on S5 cream, only continue using it if you are 100% certain it is working for you. It certainly slowed my shedding down but my temples continued to slowly recede and hence it wasn't strong enough to halt my Androgenetic Alopecia. If that's the case for you then by all means discontinue treatment and get on an oral 5ARI.

@Captain Hook I cannot thank you enough for that post. The amount of effort you put in to help a complete stranger like me is unreal. I can also say it is exactly what I need to hear. You sir are an absolute saint, I appreciate the care you put in. It will not go to waste, you have strongly strengthened my will to take finasteride again.

Do you think there are any tests I could do while taking finasteride to really test for sides, just to eliminate the psychological component from it? I read somewhere about putting stamps on your penis overnight and if they moved in the morning you had had an erection, or something like that. (I might make a new post just for this)

Glad I could be of service! You're most welcome, don't hesitate to ask any further questions.

If you're really neurotic then you could always get a comprehensive male hormone panel performed after the first month of being on finasteride, then at the 3 month mark, then at the 6 month mark and then once again after 1 year has elapsed. At that point if you don't notice any problems it's very likely you'll be able to tolerate the medication long term.

As for the whole 'penis stamping' thing, you can do it if it makes you feel better but not doing it isn't going to have any effect on how the drug affects you, I personally wouldn't do it because I'm lazy and it seems like a waste of time, if you're going to get side effects you'll get them regardless if you stamp your genitals or not. It really would just be one more thing to worry about, which is the last thing you need, you don't want to induce a possible nocebo effect from freaking out if your penis didn't move one night, just because you don't get an erection one night doesn't mean you have a problem.

http://i.gyazo.com/5a9d772aae48efae376aeaad77e701cd.png

Take a look at this chart, during months 7-12 and 19-24, the placebo pill had a higher incidence of causing impotence compared to dutasteride. Further validating the idea that 5ARI "induced" impotence may very well be psychogenic for almost all users. The fact that gynaecomastia only occurred at a 0.8% increased risk over placebo at the maximum during one part of the study (month 13-18) says a lot too. Look at it conversely, you have a 99.2% of not experiencing it. To put this percent into perspective, you have about a 1.2% chance of dying in a car crash in your lifetime. It's all about determining an acceptable level of risk, which 5ARIs certainly have.

That being said, best of luck mate!

 

[NickUK01]

As always Hook, your knowledge blows me away! I actually had a break from finasteride due to some sides I was experiencing, although I am not convinced it is due to that, but have come off them for the moment before I would have seen any benefits from it so I can access my situation and start them again. I am on Sertraline daily, which is an SSRI, been on them for years, but make no mistake that it means it could be my head telling my body something and not the other way around! Like Hook said, I believe a lot of it is mental, or you have/had signs of ED or otherwise caused by something else possibly. I am trying to get myself in a good place mentally regarding not just my hair, but also in general, so that I see finasteride as nothing more than a tablet you take daily and think no more of it, as soon as you think "what if this happens though?", it could well be game over.

Like the other guys said, no one is forcing you to take them, I thought about it for months, tried it for a while, and WILL be going back on them soon, no regrets no and I hope it stays that way. The main thing is to be comfortable in the decision, whichever one it is.

 

[King_without_a_crown]

DON'T TAKE IT!

I stopped taking it 3 years ago and I'm still experiencing awful sides.

 

[Captain Hook]

DON'T TAKE IT!

I stopped taking it 3 years ago and I'm still experiencing awful sides.

A wild fear-mongerer appears!

Captain Hook used logic...

You're obviously one of the infinitesimally small minority of users who either had an underlying issue to begin with, or extreme anxiety contributing to a nocebo effect that has lasted long after cessation of the drug. 5AR is simply an enzyme, even if it is irreversibly inhibited, the body replenishes it at a certain rate and the inhibition stops when the drug is eliminated (which takes around 5-7 half-lives) and new 5AR is synthesised. You don't hear of people on, let's say ACE (angiotensin-converting enzyme) inhibitors for example, experiencing permanent side effects such as the infamous ACE inhibitor cough or persistent hypotension when they discontinue the drug.

Also, anyone interested in male contraception in the future should certainly be open to 5ARIs, as dutasteride in combination with testosterone enanthate proved to be a possibly useful combination contraceptive in this preliminary study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664381). As for side effects "The administration of 800 mg oral Telogen Effluvium daily combined with dutasteride for 28 days significantly suppresses gonadotropins without untoward side effects and might have utility as part of a male hormonal contraceptive regimen." not to mention that while serum estradiol increased, there was no incidence of gynaecomastia at all.

Keep in mind finasteride is weaker than dutasteride so if dutasteride has been shown to be this safe, finasteride is even more so!

...it's super effective!

Take note everyone, this idiot just logs on, posts 2 lines and then goes about his day. He cites no evidence, no details and he likely didn't get a comprehensive male hormone panel performed before he started treatment, so we have no idea if as to whether he had an underlying endocrinological abnormality to begin with or not.

We also don't know his body fat percentage! This sounds insensitive but clinical studies back it up. Aromatase enzymes are synthesised in adipose tissue, 75% of estradiol is aromatised from testosterone in fat cells, the remaining 25% in the testes and adrenal glands. People should really be doing everything in their power to maintain a healthy body fat percentage to ensure the lowest propensity for estrogenic side effects. (http://www.ncbi.nlm.nih.gov/pubmed/3504068 http://www.ncbi.nlm.nih.gov/pubmed/234975)

Nor do we know about his exercise levels! Regular exercise prevents the overproduction of estrogen and those who do exercise regularly tend to have lower estrogen levels compared to their sedentary counterparts (http://www.ncbi.nlm.nih.gov/pubmed/23652373).

If it's any consolation a lot of the people who you see claim "permanent side effects" from finasteride on YouTube and on TV and such tend to look like they could stand to shed a few kilograms.

 

[King_without_a_crown]

Propecia has already taken away my dignity and I don't need your smart-*** expertise to add another layer to this.

There are thousands of testimonies of finasteride users suffering from long term post-finasteride syndrome.

I wish I had listened to those "fear mongers" a few years ago because most (if not all) their experiences are very real. You can also add to this all those who suffer "in silence" (aka offline).

We're not only a tiny minority and we weren't all unmotivated fat slugs who were destined to suffer from erectile dysfunction in our 20-30's.

 

[Captain Hook]

Propecia has already taken away my dignity and I don't need your smart-*** expertise to add another layer to this.

There are thousands of testimonies of finasteride users suffering from long term post-finasteride syndrome.

I wish I had listened to those "fear mongers" a few years ago because most (if not all) their experiences are very real. You can also add to this all those who suffer "in silence" (aka offline).

We're not only a tiny minority and we weren't all unmotivated fat slugs who were destined to suffer from erectile dysfunction in our 20-30's.

Thousands of people with nocebo/underlying issues out of millions who take 5ARIs without any side effects at all. Let's just say hypothetically that there are 1000 "PFS sufferers" for every 1 million finasteride users, so if what you were talking about was even medically valid, the incidence would still only be 0.1%. If that is not a "tiny minority" then I'm sorry for your inability to grasp basic statistics.

I also love how you ignore everything logical and refer to clinical studies as 'smart-*** expertise'. You're not a physician, you're just some wanker on the internet, where are your qualifications and evidence to back your outlandish statements? How do you know their experiences are 'very real'? It seems to me that the idiots on PropeciaHelp are nothing but a group of sad boys looking to use finasteride as a scapegoat.


If you really had an argument, you'd mention that you did have a comprehensive male hormone panel performed before treatment, you would've mentioned your exercise level and you would've mentioned your body fat percentage. Since you did none of that I'm going to assume that my preconceptions about you were right. You're lashing out because you weren't prepared and faced a risk that you could've ameliorated.

For others reading this, make sure you do this before you start treatment with 5ARIs to minimise the risk of estrogenic side effects:

1. Ask your GP, dermatologist or endocrinologist to perform a comprehensive male hormone panel, if they see no issue then continue to step 2.

2. If you're not at a healthy body fat percentage, lose it! Get it as low as healthily possible, I'm personally at 8% as we speak. 6-17% is ideal and is considered the target range for a fit adult male. Sitting at +20% is unacceptable. Considering the fact that Androgenetic Alopecia is correlated with metabolic syndromes, I wouldn't be surprised if the majority of patients who did get side effects weren't at a healthy body fat percentage.

3. Cardio is your friend. Exercise regularly, you don't need to lift if that's not your thing, just do some form of exercise 3-5x per week. Swimming is something that's fun and excellent for both cardiovascular fitness and muscle tone. I personally lift 3x per week and do 20-30 minutes of cardio (elliptical, running, cycling or swimming) 2x per week.

 

[TransientHair]

There are thousands of testimonies of finasteride users suffering from long term post-finasteride syndrome.

Anecdotal evidence is not evidence. It can be used to form a hypothesis, but it is does not hold weight in an argument without any research backing it up.

 

[deniak]

LOL Hook, I remeber that in your story thread you said you wont touch finasteride because of "small but certain side effects". Based on your words Im pretty sure that you done your research. And now youre preaching about finasteride safety. May I ask what happens that you changed your mind? Is it emotional decision based on your further hairloss (I know, its sucks)? Whats more you calling guys "idiots" and "wankers", while even Merck officially stated that erectile problems are side effects of finasteride, and there is possibility of erecticle disfunction after discontinuation of treatment. Didnt you read that on propecia website? Thres no doubt that finasteride is proven to work, but like hellouser said, its stone age treatment. Its like trying to kill a mouse with axe, you can accidentally chop your leg. Its shame that to this day there is no proven, safe topical treatment...

 

[nocombovers2k15]

I'de say get on finasteride man. I'm 2.5 months in with no sides and it feels great to see the progress even after such a short time.

 

[hair_nag]

I waited more than a year to start finasteride because I was worried about sides, but then I realized that may hairline had gotten worse than the year before for sure and I couldn't simply stay on the fence, either I accepted losing hair and lived with it or I can see if this drug can make a difference.

I ve been on finasteride for 3.5 months now and I haven't noticed any real sides so far. I still jerk off a lot and my ejacs feed just as good as before. I also have more fine hair on the temples than before but I can't really call it regrowth until it actually turns into real hair, so I ll wait until 6 month mark to make any real assessment.

 

[GoldenMane]

Just take it for a couple of months, if you get sides then quit, if you don't then no problem. You will regret not trying much, much more than you would trying, getting sides, quitting and eventually going back to normal. The odds are very much in your favor, your chances of maintaining or regrowing hair are much, much higher than the chance that you'll get side effects, and the chance that you will get permanent, persistent sides are almost zero.

 

[Pequod]

Propecia has already taken away my dignity and I don't need your smart-*** expertise to add another layer to this.

There are thousands of testimonies of finasteride users suffering from long term post-finasteride syndrome.

I wish I had listened to those "fear mongers" a few years ago because most (if not all) their experiences are very real. You can also add to this all those who suffer "in silence" (aka offline).

We're not only a tiny minority and we weren't all unmotivated fat slugs who were destined to suffer from erectile dysfunction in our 20-30's.

Apparently you haven't heard, but all medical studies done today are flawless and the results are so exacting that they are chipped into stone tablets at the top of an important mountain. You can completely trust all things you read in the medical literature as well, there are thousands of these articles and studies online and they have been proven to be true because they are still online.

Had you seen a doctor you would have never had any issues with finasteride. All doctors are equally exacting and were born with a knowledge beyond the average person, you see all of us in here are uneducated in the medical sciences so we are just guessing after all, but they are the ones that know. Never listen to anyone other than a doctor, and had you seen one so blessed as I describe above you should have been warned about Propecia and/or finasteride to keep you from getting irreversible psychological side effects, side effects that actually don't exist because the studies prove that as we all know. Yes they could perform medical tests on you and had the numbers come in then they would have had no explanation for your side effects, in other words, you imagined it all and still do to this day.

Do you believe any of that, I hope not, lol. Oh, and I was just passing by, sorry for the false prophecy. Someday people will see the light, peace all.

 

[Captain Hook]

LOL Hook, I remeber that in your story thread you said you wont touch finasteride because of "small but certain side effects". Based on your words Im pretty sure that you done your research. And now youre preaching about finasteride safety. May I ask what happens that you changed your mind? Is it emotional decision based on your further hairloss (I know, its sucks)? Whats more you calling guys "idiots" and "wankers", while even Merck officially stated that erectile problems are side effects of finasteride, and there is possibility of erecticle disfunction after discontinuation of treatment. Didnt you read that on propecia website? Thres no doubt that finasteride is proven to work, but like hellouser said, its stone age treatment. Its like trying to kill a mouse with axe, you can accidentally chop your leg. Its shame that to this day there is no proven, safe topical treatment...

You're not wrong. It's a combination of emotional decision and furthering of knowledge. Laugh all you want, but you may end up in the same position in a few months or years. I never bothered doing in depth research on 5ARIs when I first started, I merely scratched the surface. Keep in mind Merck never stated 'permanent' side effects, the word they used was 'persistent'. I do agree with that last bit though and hence hope setipiprant will end up being marketed by Kythera in the not-so-distant future.

Apparently you haven't heard, but all medical studies done today are flawless and the results are so exacting that they are chipped into stone tablets at the top of an important mountain. You can completely trust all things you read in the medical literature as well, there are thousands of these articles and studies online and they have been proven to be true because they are still online.

Had you seen a doctor you would have never had any issues with finasteride. All doctors are equally exacting and were born with a knowledge beyond the average person, you see all of us in here are uneducated in the medical sciences so we are just guessing after all, but they are the ones that know. Never listen to anyone other than a doctor, and had you seen one so blessed as I describe above you should have been warned about Propecia and/or finasteride to keep you from getting irreversible psychological side effects, side effects that actually don't exist because the studies prove that as we all know. Yes they could perform medical tests on you and had the numbers come in then they would have had no explanation for your side effects, in other words, you imagined it all and still do to this day.

Do you believe any of that, I hope not, lol. Oh, and I was just passing by, sorry for the false prophecy. Someday people will see the light, peace all.

I do believe you're just here to sow discord. If clinical studies are flawed then what are anecdotal reports? You have some serious holes in your logic. I also never mentioned that side effects from 5ARIs don't exist, I simply said a lot of the time they're psychological and in the remaining amount of real occurrences they're due to abnormally high serum estradiol levels.

You just don't seem to like the fact that there's a reason to explain and hence a way to minimise the incidence side effects. You keep saying you're 'just passing by' or 'leaving this forum forever' in several of your posts, it's quite obvious you realise your insolence isn't welcome here. Do us all a favour and either quit acting like you're above modern medicine or stop trolling.

 

[shyyguy123]

Start off super slow if you're worried. Maybe .25 mg every 3rd day or something. Then after a couple weeks or however long until you're comfortable move it to every other day. And just keep slowly progressing in small increments. Helps a lot with the mental aspect of sides.

I started off with .25 mg EOD and stuck with it for 6 and 1/2 months then moved to .25 every day which I'm still currently on. Couldn't be happier. I appear to be maintaining my hair fairly well and have 0 sides. I was scared to death of all the potential sides too but it's been totally worth it.

EDIT: I had a significant decrease in sex drive and watery semen the initial 2-3 weeks but they disappeared and I've been side free since.

 

[Captain Hook]

Start off super slow if you're worried. Maybe .25 mg every 3rd day or something. Then after a couple weeks or however long until you're comfortable move it to every other day. And just keep slowly progressing in small increments. Helps a lot with the mental aspect of sides.

I started off with .25 mg EOD and stuck with it for 6 and 1/2 months then moved to .25 every day which I'm still currently on. Couldn't be happier. I appear to be maintaining my hair fairly well and have 0 sides. I was scared to death of all the potential sides too but it's been totally worth it.

EDIT: I had a significant decrease in sex drive and watery semen the initial 2-3 weeks but they disappeared and I've been side free since.

http://s1071.photobucket.com/user/sofasale1/media/blah_zps37bfd8cb.jpg.html

This is the DHT conversion inhibition curve for finasteride, as you can see 0.2 mg inhibits ~61% whereas 1 mg inhibits ~68%. Like you said, it may help with the mental aspect but physiologically this is going to have a negligible influence on the manifestation of side effects, if any at all.

Keep in mind finasteride is a suicide inhibitor of 5AR2 (this simply means it forms an irreversible complex with the enzyme, meaning the percentage of 5AR2 it inhibits will be unavailable for use to synthesise DHT), an enzyme with a longer turnover rate than finasteride's half-life (this is why we don't need to take it more than once a day despite its relatively short 6 hour half-life). So while taking it every other day may be a decent way to save money if that ends up being effective for you, it's also going to do very little in terms of mitigating side effects.