Originally Posted by imhotep
I have some advice. Go on Propecia. Do it as soon as possible. Don't listen to hearsay bullshit about side effects but instead investigate them from reliable medical sources. There is a legitimate treatment for hairless but stupidity is preventing people from utilizing it.
Side effects of finasteride include impotence (1.1% to 18.5%), abnormal ejaculation (7.2%), decreased ejaculatory volume (0.9% to 2.8%), abnormal sexual function (2.5%), gynecomastia (2.2%), erectile dysfunction (1.3%), ejaculation disorder (1.2%) and testicular pain. According to the product package insert, resolution occurred in men who discontinued therapy with finasteride due to these side effects and in most men who continued therapy. The PPI also states that patients have reported persisting erectile dysfunction despite discontinuing the drug. In December 2010, Merck added depression as a side effect of finasteride.
In November 1997, an FDA panel refused to recommend approval of the drug Propecia for male pattern baldness. Although it was not disputing its efficacy, the committee members expressed some concerns about the possibility of long-term side effects on sexual function and possibly even fertility, which arose because of some evidence of diminished ejaculate levels.
The FDA has added a warning to finasteride concerning an increased risk of high-grade prostate cancer. While the effect of finasteride on the risk of developing prostate cancer has not been established, evidence suggests it may temporarily reduce the growth and prevalence of benign prostate tumors, but could also mask the early detection of prostate cancer. The primary concern is patients who develop prostate cancer while taking finasteride for benign prostatic hyperplasia, which in turn could delay diagnosis and early treatment of the prostate cancer, thereby potentially increasing the risk of these patients developing high-grade prostate cancer.
The 2005 Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5 mg per day, as is commonly prescribed for BPH, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo. It appeared (incorrectly) that finasteride increased the specificity and selectivity of prostate cancer detection, thus creating an apparently increased rate of high Gleason grade tumor. A 2008 update of this study found that finasteride reduces the incidence of prostate cancer by 30%. In the original study, the smaller prostate caused by finasteride facilitated detection of cancer nests and aggressive-looking cells. Most of the men in the study who had both low and high-grade prostate cancer chose to be treated, and many had their prostates removed. A pathologist then carefully examined each of those 500 prostates and compared the kinds of cancers found at surgery to those initially diagnosed at biopsy. This study concluded that finasteride did not increase the risk of high-grade prostate cancer.
Sexual side effects
There are case reports of persistent diminished libido or erectile dysfunction, even after stopping the drug. In December 2008, the Swedish Medical Products agency concluded a safety investigation of finasteride and advised that finasteride may cause irreversible sexual dysfunction. The Agency's updated safety information lists difficulty in obtaining an erection that persists indefinitely, even after the discontinuation of finasteride, as a possible side effect of the drug. The UK's Medical and Healthcare Products Regulatory Agency (MHRA) cites reports of erectile dysfunction that persists once use of finasteride has stopped. Similar labeling changes have been made by the Italian government. For a period of time there was a discrepancy between
European and North American warning labels regarding the risks of developing persistent sexual side effects from taking Propecia but after two years in April 2011 Merck revised the United States' warning in consumer and medical leaflets to include erectile dysfunction that may persist after stopping finasteride. In April 2012, the FDA chose to approve Merck's proposed labeling from 2011 only after the warning label was further strengthened to include reports of persistent libido disorders, ejaculation disorders, orgasm disorders, and decreased libido.
Anxiety and depression
Finasteride has been found to robustly induce depressive and anxious behaviors in animals. Accordingly, its clinical use has been associated with depression and anxiety in both men and women in at least several reports in the medical literature. In one study, at a dose of 1 mg per day, finasteride induced moderate to severe depression in 19 of 23 or 83% of participants, notably including all of the female patients. In addition, marked anxiety occurred comorbidly with the depressive symptoms in some cases. Another study with a larger sample size of 128 men, though no women, also at a dose of 1 mg per day, found that finasteride increased both BDI and HADS depression scores significantly. It also increased HADS anxiety scores, though this was not found to be statistically significant. The authors concluded that finasteride should be prescribed cautiously to patients at a high risk of depression.
In late 2010, Merck revised the label of its Propecia formulation of finasteride in the United States and Canada to add depression to the list of possible side effects.
In August 2012, a study of 61 former users of finasteride with persistent sexual side effects found that 75% of them showed significantly higher rates of depressive symptoms relative to a control group. Of the treated men, 36% had severe symptoms, 28% had moderate symptoms, and 11% had mild symptoms. In addition, 44% of these men reported suicidal ideation. In the control group of 29 men, 10% showed depressive symptoms, with all of these cases being mild, and 3% reported thoughts of suicide. It was concluded that finasteride may cause symptoms of depression and suicidal ideation in some persons which can persist even after discontinuation of treatment.
Male breast cancer
In December 2009, the Medicines and Healthcare products Regulatory Agency in the UK announced new drug safety advice on finasteride and the potential risk of male breast cancer. The agency concluded that, although overall incidence of male breast cancer in clinical trials for finasteride 5 mg was not significantly increased, a higher risk of male breast cancer with finasteride use cannot be excluded. A warning on this risk will be included in the product information. Merck revised the United States' warning in consumer and medical leaflets to include the risk of male breast cancer.