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Pharmacology C‑class Mid‑importance

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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.

The new address is: Patient Information Leaflet in English (http://www.lakemedelsverket.se/SPC_PIL/Pdf/enhumpil/Propecia%20film-coated%20tablet%20ENG.doc)

Can someone please update the reference with the new link address? (This Wiki page is semi-protected so I cannot do it myself) —Preceding unsigned comment added by 90.230.5.41 (talk) 11:45, 13 May 2010 (UTC)

Finasteride linked with male breast cancer!

UK medicines regulator The Medicines and Healthcare products Regulatory Agency (MHRA) did an indepth analysis and found that Finasteride is linked to an increase in incidents of male breast cancer 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.

Could someone please add this to the article - I cant because its in a state of semi-protection. This news is important. —Preceding unsigned comment added by 86.138.236.249 (talk) 02:19, 4 December 2009 (UTC)

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!

Jessicabest9 (talk) 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 internet 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. --Nectarflowed 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. JFW | T@lk 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) —Preceding unsigned comment added by Berryham (talk • contribs) 22:15, 28 September 2008 (UTC)

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?--Nectarflowed 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. Sfahey 01:19, 22 July 2005 (UTC)

Thanks. The dosage information, though, isn't in the current reference. Do you have another reference? --Nectarflowed 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. —Preceding unsigned comment added by 78.150.153.10 (talk) 15:13, 2 December 2007 (UTC)

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. —Preceding unsigned comment added by 67.241.7.135 (talk) 01:40, 15 June 2008 (UTC)

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. Dave94703 (talk) 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 Pondle 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". JFW | T@lk 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? --James Bond 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 —Preceding unsigned comment added by Themightythor1212 (talk • contribs) 23:23, 11 March 2009 (UTC)

(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. -- JdwNYC 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 —The preceding unsigned comment was added by My phantom limb (talk • contribs) 14:02, 4 March 2007 (UTC).

This could be due to a confounding variable - hair loss.Pondle 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. —Preceding unsigned comment added by 149.225.92.116 (talk) 22:27, 29 December 2007 (UTC)

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'.Pondle (talk) 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. Paldiski 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.164.214.1.54 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.Pondle 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 NorthernLad79

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.Pondle 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. —Preceding unsigned comment added by 82.47.83.135 (talk) 12:49, 12 March 2008 (UTC)

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?

80.221.61.231 20:40, 27 October 2007 (UTC)

That's probably a reference to the Australian Medicines Handbook. I'll check the history and see if I can track it down. Fvasconcellos (t·c) 01:29, 28 October 2007 (UTC)

Got it. I couldn't find it because it was ported over from Baldness treatments in August 2006; that article, however, didn't have the reference either, because its content had been copied and pasted from Baldness in May 2005. Thank God for page histories :) Fvasconcellos (t·c) 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? 132.205.44.5 (talk) 05:16, 22 November 2007 (UTC)

OK, I've added the template. This article has been semi-protected to due persistent long-term vandalism. --Ed (Edgar181) 12:04, 22 November 2007 (UTC)

And not just vandalism: spam and junkpiling. JFW | T@lk 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? —Preceding unsigned comment added by 76.181.4.47 (talk) 00:35, 9 January 2008 (UTC)

You should seek professional medical advice.Pondle (talk) 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 Pondle (talk) 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 wikipedia entry is in error. —Preceding unsigned comment added by Flying Hamster (talk • contribs) 10:40, 3 April 2008 (UTC)

No this statement is made by the manufacturer. Finasteride is a specific 5AR inhibitor rather than a general anti-androgen.Pondle (talk) 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 —Preceding unsigned comment added by Spacydick (talk • contribs) 09:43, 23 August 2009 (UTC)

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. Pine (talk) 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". Pondle (talk) 11:44, 12 April 2008 (UTC)

Please read the following abstract: http://pubs.acs.org/doi/abs/10.1021/jm00161a028 —Preceding unsigned comment added by Yid (talk • contribs) 17:24, 7 April 2010 (UTC)

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. Dralanbauman (talk) 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?
--Jerome Potts (talk) 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 here, at the Virginia Commonwealth University School of Pharmacy website. Fvasconcellos (t·c) 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 JFW | T@lk 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?

GoodThought101 (talk) 16:18, 22 December 2008 (UTC)

The wording should be changed to highlight "PERMENANT ERECTICAL DYSFUNCTION" can be caused by Finasteride. —Preceding unsigned comment added by 12.129.211.97 (talk) 19:04, 22 February 2010 (UTC)

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.67.84.209.60 (talk) 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. Steelblade (talk) 15:53, 11 December 2010 (UTC)

wiil nottaking finasteride bring my semen quantity to normal? how long after?

miguel angel ngel —Preceding unsigned comment added by 98.244.204.1 (talk) 07:07, 8 February 2009 (UTC)

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. 71.17.52.50 (talk) 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. —Preceding unsigned comment added by 4.158.0.26 (talk) 07:40, 7 March 2009 (UTC)

Yeah right, "neuro-protecting cannabinoids" are (possibly the only) real meds and FDA is the conspiracy. --Wayfarer (talk) 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 —Preceding unsigned comment added by 132.187.51.130 (talk) 13:58, 5 September 2009 (UTC)

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. —Preceding unsigned comment added by Dratman (talk • contribs) 17:30, 14 October 2009 (UTC)

Irreversible Side Effects

{{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 —Preceding unsigned comment added by Chiller20 (talk • contribs) 22:34, 10 November 2009 (UTC)

YouTube isn't a reliable source.--Pondle (talk) 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. BejinhanTalk 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 —Preceding unsigned comment added by 208.82.14.213 (talk) 18:11, 24 May 2010 (UTC)

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.67.84.209.60 (talk) 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 WIKIPEDIA 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 —Preceding unsigned comment added by 76.108.160.140 (talk) 21:29, 25 January 2011 (UTC)

Finasteride vs prostate cancer

Editor182 (talk · contribs) has now twice reinserted the claim that finasteride decreases the risk of prostate cancer, 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 WP:LEAD. 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. JFW | T@lk 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 WP:Undue weight is given to either interpretation. I agree with JFW that this doesn't belong in the lead, however. --ἀνυπόδητος (talk) 18:55, 10 March 2010 (UTC)

Sadly Editor182 continues to add mention of this in the lead. It sounds like protection may be needed. JFW | T@lk 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. Editor182 (talk) 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.67.84.209.60 (talk) 20:55, 10 August 2010 (UTC)

Traish is post hoc qualitative study that basically says "there are anecdotal reports of persistent side-effects, and goes so far as to misrepresent its sources. For instance, at one point it cites a study in which half of the men that discontinued finasteride did not see the resolution of symptoms. If you follow up on the source, which I'm sure even many medical professionals don't, you'll see that 50% of men in the placebo group also did not see the resolution of side-effects after discontinuation. This should obviously indicate that the side-effects were not caused by the drug, but Traish uses it as evidence for *just the opposite*. I normally try not to criticize peer-reviewed research, but Traish is Trash.

We have to have to be able to recognize the difference between Traish (not a placebo-controlled study, and in fact the authors never administered the drug to one patient) and the massive (n=19,000), 7-year, double-blind, placebo-controlled PCPT. Some research is more powerful than other research, and some research is much much more powerful than other research.

This is article should have a small section discussing the debate surrounding finasteride and persistent side-effects, where research like Traish is properly and correctly described as an outlying interpretation of a literature review.

We've entered the unavoidable nexus of science and politics which is essential only for lay people. The main stream medical position on finasteride is that it's safe and well-tolerated in adult males. Trying to usurp this article and insinuate otherwise is disingenuous, no matter how sure you are that you have some insight that actual medical professionals lack. 174.252.72.197 (talk) 19:48, 12 June 2011 (UTC)

Poor quality image detracting from article

Closing.
The following discussion has been closed. Please do not modify it.
File:Propecia (finasteride).jpg 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. --Kristoferb (talk) 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. Editor182 (talk) 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. --Kristoferb (talk) 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.  – Tommy 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. Editor182 (talk) 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.) --Kristoferb (talk) 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. Editor182 (talk) 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?? --Kristoferb (talk) 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.  – Tommy 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. --Kristoferb (talk) 15:14, 27 June 2010 (UTC) Dude, it's a pink pill, what else do you wanna see?  – Tommy 17:10, 27 June 2010 (UTC) To be honest I don't think that this is really a major issue. There was a proposed guideline on image quality, I think that this photo meets the requirements of clearly portraying what it is supposed to.--Pondle (talk) 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: Focus (optics) --Kristoferb (talk) 17:24, 27 June 2010 (UTC) As per proposed guideline on image quality: 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 dispute resolution.--Pondle (talk) 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. --Kristoferb (talk) 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. --CliffC (talk) 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.  – Tommy 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. --Kristoferb (talk) 20:42, 27 June 2010 (UTC) Kristoferb, 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. Editor182 (talk) 07:22, 28 June 2010 (UTC) As CliffC (talk) 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.--Kristoferb (talk) 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.--Kristoferb (talk) 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. Editor182 (talk) 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. --Kristoferb (talk) 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. Editor182 (talk) 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". --Kristoferb (talk) 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. Editor182 (talk) 22:00, 29 June 2010 (UTC)

Outside party's image opinion

File:Propecia_(finasteride).jpg needs completely removed, it is a bad picture, blown highlights, out of focus. File:Propecia box and tablet.jpg is a fine image, can completely replace the first. I also uploaded some other images as alternatives, although I think File:Propecia box and tablet.jpg is a fine image. — raeky  08:40, 30 June 2010 (UTC)

Also suggest that if File:Generic Propecia.jpg 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. — raeky  08:42, 30 June 2010 (UTC)

• Editor182 has done a "new" layout including, again, File:Propecia_(finasteride).jpg. --Kristoferb (talk) 13:53, 30 June 2010 (UTC)
  • Yea I saw where he deleted this whole section too on the talk page... very VERY bad form. — raeky  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. --Kristoferb (talk) 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 Kristoferb. Votes are tallied by numbers, it's time to put an end to this debate. Editor182 (talk) 13:32, 1 July 2010 (UTC)

We don't vote on Misplaced Pages, we work by consensus. File:Propecia_(finasteride).jpg needs removed and is redundant behind the far superior image File:Propecia_box_and_tablet.jpg and File:Finpecia_from_India_is_Cheap_Propecia.jpg. Consensus is against you, and you've WELL gone beyond violating WP:3RR, so if you manage to not get banned it would be a miracle. — raeky  14:17, 1 July 2010 (UTC)

Since I've been contacted to contribute here consider my !vote moot. Regardeless, Editor182, we work on WP:CONSENSUS, and you have none. Frankly, you should have been blocked already per WP:3RR, WP:DISRUPTIVE, WP:CIVIL, and WP:AGF. N419BH 14:57, 1 July 2010 (UTC)

If going light on showing packing is something we want to do, then I suggest File:Generic Propecia.jpg for the generic image. --Kristoferb (talk) 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... — raeky  17:53, 1 July 2010 (UTC)

I can do that without problem. --Kristoferb (talk) 17:54, 1 July 2010 (UTC)

Be sure to upload your images to Commons, if you don't have an account yet, click this magic link: Special:MergeAccount. — raeky  18:02, 1 July 2010 (UTC)

Let me know if it is suitable: File:Generic finasteride tablets cipla.jpg --Kristoferb (talk) 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? — raeky  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.:File:Generic Propecia.jpg) I do.--Kristoferb (talk) 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 ;-) — raeky  18:31, 1 July 2010 (UTC)

I did, actually. I said 'I do'. --Kristoferb (talk) 18:33, 1 July 2010 (UTC)

Sorry I missed that. ;-) — raeky  18:35, 1 July 2010 (UTC)

So you don't want to marry me? That's highly disapointing. ;-) --Kristoferb (talk) 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. — raeky  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. --Kristoferb (talk) 18:46, 1 July 2010 (UTC)

I agree with the backgrounds. — raeky  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.--Pondle (talk) 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. --Kristoferb (talk) 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. --CliffC (talk) 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.:File:Generic Propecia.jpg--Kristoferb (talk) 19:32, 2 July 2010 (UTC)

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 Physicians' Desk Reference 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 {{infobox capsule|size=regular|label="50 mg"|shape=round|color=yellow}}, & then we do the politically correct thing & delete all of these presumably Fair use unfree images.

That is the quote I was referring too above from the ANI post... 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. — raeky  19:28, 2 July 2010 (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.: Panadol or Tylenol.) 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.--Kristoferb (talk) 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.--Pondle (talk) 19:40, 2 July 2010 (UTC)

(ec)I've already read that, and I agree. What I'd personally like to see is a series of high quality images like File:Temazepam_DOJ.jpg (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 File:Temazepam-bottle.jpg, 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. — raeky  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.--Kristoferb (talk) 19:46, 2 July 2010 (UTC)

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. — raeky  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). —Preceding unsigned comment added by Kristoferb (talk • contribs) 19:56, 2 July 2010 (UTC)

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. — raeky  19:59, 2 July 2010 (UTC)

No question, I don't think showing just a cardboard box is sufficient. --Kristoferb (talk) 20:03, 2 July 2010 (UTC)

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? —Preceding unsigned comment added by 124.188.96.167 (talk) 12:30, 20 July 2010 (UTC)

This is a literature review, like Traish, but the difference is that this one did not wildly misinterpret the evidence. 174.252.72.197 (talk) 19:52, 12 June 2011 (UTC)

Side Effects Listed Do Not Match The Reference

The reference is drugs.com.

The Side Effects Listed in the source are:

TABLE 2. Drug-Related Adverse Experiences for PROSCAR (finasteride 5 mg) BENIGN PROSTATIC HYPERPLASIA N = 1524 and 1516, finasteride vs placebo, respectively

.

YEAR 1 Impotence- 8.1 vs 3.7 Decreased Libido 6.4 vs 3.4

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%!67.84.209.60 (talk) 04:24, 5 August 2010 (UTC)

You can be bold and add the reference and data yourself... — raekyT 04:27, 5 August 2010 (UTC)

I can't edit this page, and I don't feel like making an account on the assumption that is the problem.67.84.209.60 (talk) 09:38, 5 August 2010 (UTC)

To edit this page you do have to have an account... — raekyT 22:00, 10 August 2010 (UTC)

Edit request from 128.36.205.2, 20 October 2010

{{edit semi-protected}} 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 128.36.205.2 (talk) 16:00, 20 October 2010 (UTC)

Done. Thanks. -Atmoz (talk) 21:22, 20 October 2010 (UTC)

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. 86.163.201.239 (talk) 01:43, 23 October 2010 (UTC)

Environmental persistence?

From the description, it appears that this could be considered an endocrine disruptor 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. 96.228.129.74 (talk) 07:38, 10 November 2010 (UTC)

Controversy and Lawsuit

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. press release Schpes (talk) 14:16, 29 January 2011 (UTC)

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. this one) 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 WP:RS. SDY (talk) 16:24, 29 January 2011 (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

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.

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.

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.

- Doors 22 — Preceding unsigned comment added by Doors22 (talk • contribs) 19:00, 2 February 2011 (UTC)

People feel they can trust Misplaced Pages because we absolutely insist on specific citations from reliable sources 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, verification is a non-negotiable requirement--every reader must be able to check for him/herself rather than trusting another editor's word. Even if it's the truth, it can't be here until it's got an available source. WP:MEDRS is a good page about the level of referencing needed. DMacks (talk) 19:17, 2 February 2011 (UTC)

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?

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?

If there are problems with these sources or a lack of evidence, please let me know and I will gather some more information. Thanks.

Doors22 (talk) 20:25, 2 February 2011 (UTC)

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. Doors22 (talk) 18:53, 7 February 2011 (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. JFW | T@lk 19:57, 7 February 2011 (UTC)

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. Doors22 (talk) 21:08, 7 February 2011 (UTC)

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. JFW | T@lk 21:24, 7 February 2011 (UTC)

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 consensus. It would not be good if the article was locked, but this will be the next step. JFW | T@lk 21:41, 7 February 2011 (UTC)

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 WP:CONSENSUS you will require me to initiate a formal challenge to your administrative status. Doors22 (talk) 22:09, 7 February 2011 (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 attacking me personally (as indeed you did in this edit summary).

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). JFW | T@lk 23:16, 7 February 2011 (UTC)

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.Doors22 (talk) 01:57, 8 February 2011 (UTC)

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 WP:EL 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 support and at this point there isn't much of a case for including it other than gossip and rumors. SDY (talk) 03:34, 8 February 2011 (UTC)

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. Doors22 (talk) 05:03, 8 February 2011 (UTC)

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 WP:NPOV might be a good idea. JFW | T@lk 07:07, 8 February 2011 (UTC)

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. Doors22 (talk) 19:28, 8 February 2011 (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 WP:BRD. I suggest you have a look at that before making further speculations about myself or about Misplaced Pages policy. JFW | T@lk 21:17, 8 February 2011 (UTC)

I am here on a request on WP:PHARM. Reading the article, I currently see the following concerns:

• "In December 2010, Merck acknowledged that depression is a side effect of Finasteride.": Needs a source; I only get the Merck site map when clicking on the link. The study or official publication (FDA, EMA, ...) that found depression to be a side effect would be the ideal source.
• "Thousands of former finasteride users have reported permanent sexual side effects...": Sources say "a subset of men, raising the possibility of a causal relationship..." and "Compared with placebo, men treated with finasteride experienced new drug-related sexual AEs with an increased incidence only during the first year of therapy.". I don't have access to the full texts, but the claim is at least WP:UNDUE. It also is misleading ans unencyclopaedic: "thousands" sounds a lot, but out of how many users altogether? And is the number sourced (not counting blogs and forums)? I'm not saying this has to be deleted, but it should be made clear that irreversible side effects are an unproven possibility.
• "In January 2011, a class action lawsuit was filed..." Always dangerous – a pending lawsuit sounds if someone broke a law without proving anything. (see also #Controversy and Lawsuit above).

Other points, such as formatting of the references and capitalisation, are of less importance and can be fixed when the content dispute is over. --ἀνυπόδητος (talk) 18:44, 9 February 2011 (UTC)

Jfdwolff went ahead and removed the sentence about the lawsuit. Your comment doesn't seem to me to state that the lawsuit should not be included, but rather mentions it is dangerous. Is there any way this can be reworded to have it included in the article? I initially tried to have this included as a controversy which is much more clear but he would not have it. Under the designation of a controversy, it seems much more clear that the issue has serious backing, but is not completely resolved. Doors22 (talk) 21:49, 9 February 2011 (UTC)

There are lots of reasons why we generally don't cover lawsuits. There are plenty of reasons why this may never get to court (e.g. the manufacturer may choose to settle). This is also the problem that any mention of class action is perceived as a covert attempt to solicit cases, something that certainly goes against the spirit of a general purpose encyclopedia. Finally, this particular lawsuit is only taking place in Canada, and is therefore mostly of local interest. JFW | T@lk 22:22, 9 February 2011 (UTC)

Also, per WP:NOTNEWS, that there is a lawsuit is probably not appropriate. That there was a lawsuit is more likely to be of interest, especially if the trial does actually bring out evidence of real effects. Given that people have a tendency to sue at the drop of a hat and for the most trivial things, the existence of a lawsuit is not a meaningful event. SDY (talk) 23:53, 9 February 2011 (UTC)

I agree. We can include this once there is a judgement. --ἀνυπόδητος (talk) 09:39, 10 February 2011 (UTC)

Neurosteroids

According to Doors22 (talk · contribs), finasteride blocks the production of neurosteroids allopregnanolone and THDOC, and THDOC perturbations cause epilepsy and depression. I asked for references to be added, but these don't directly support the claim that finasteride interferes with the synthesis of these substances. Anycase, I think this should be sourced to a secondary source rather than primary research papers. JFW | T@lk 22:20, 8 February 2011 (UTC)

Added sources that show finasteride and other 5-alpha reductase inhibitors influence the creation of neurosteroids. I believe other neurosteroids are affected but this is what I can verify for now.Doors22 (talk) 23:19, 8 February 2011 (UTC)

At least one of them is a mouse study that might not be generalisable to humans. Don't you agree secondary sources would be more persuasive? JFW | T@lk 23:36, 8 February 2011 (UTC)

The Traish article (literature review) is a secondary source, to my knowledge, and is where I learned of 5-alpha reductase's role in creating neurosteroids. The mouse study, is only 1/3 sources, and just verifies that 5-AR plays a role in generating neurosteroids as well. The result of the study is not relevant. I included 3 sources to be thorough but I can delete the mouse study if you wish. Just out of curiosity, are you currently taking finasteride? I initially sought treatment for the problems I had at the NHS in the UK, and the physician told me they really don't like prescribe it for MPB. — Preceding unsigned comment added by Doors22 (talk • contribs) 00:36, 9 February 2011 (UTC)

If the results are not relevant the study shouldn't be cited. It says nothing about neurosteroids in humans. I am under no obligation to disclose my medical history to you, but I do not have a conflict of interest. JFW | T@lk 06:56, 9 February 2011 (UTC)

Again, following the request on WP:PHARM: To judge from the sources' abstracts, there is no evidence of a relationship between finasteride and epilepsy/stress/anxiety in humans. This seems to border on WP:SYNTHESIS. For a better judgement, it would be nice if someone with access to the whole texts could give a comment. --ἀνυπόδητος (talk) 19:03, 9 February 2011 (UTC)

If you are able to gain access to the Traish article it is spelled out quite clearly. However, the connection is quite direct and can be verified from other wiki articles. 5-alpha reductase in an enzyme that is plays a significant role in the creation of neurosteroids. Finasteride reduces 5-AR, which will decrease the level of AP and THDOC. A decrease in AP or THDOC can lead to mood/stress/epileptic issues. I see this as a logical syllogism, rather than a synthesis problem. However, at least the Traish article describes the connection in its entirety. The official literature for Propecia entirely neglects to mention there are other mechanisms affected other than the conversion of T to DHT. Doors22 (talk) 06:44, 10 February 2011 (UTC)

I get the argument, but the human body doesn't always work like that.

Selective serotonin reuptake inhibitors, for example, work as antidepressives. It follows that tianeptine, a subtance with the opposite effect (a serotonin reuptake enhancer), causes depression. Trouble is, tianeptine is also an antidepressive. You simply can't tell what effects a substance has before they have been studied in humans; all else is guesswork. --ἀνυπόδητος (talk) 10:24, 10 February 2011 (UTC)

The wiki article says that recent research believes it may not actually affect serotonin pathways. Pretty unnerving, if you ask me, that these drugs are being prescribed without a good understanding of how it works, let alone why. Anyways, the connection is within the articles. What I want to add clearly add is that finasteride tweaks the level of neurosteroids. This mechanism was not listed before and rightfully demonstrates the mechanism for finasteride is much more complex than merely inhibiting DHT.Doors22 (talk) 18:24, 10 February 2011 (UTC)

I have no problem with including the information about neuropeptides provided it is made clear that the siginificance, if any, for clinical use is unknown. It might become a WP:WEIGHT problem, though, if too much experimental data are included in the article compared to clinical data. Keep in mind that "mechanism of action" means that it has something to do with its clinical action, which is not currently demonstrated in this case.

Regarding your concern with mechanisms that are not well understood: Aspirin had been used for about half a century until John Vane found out how it works. Paracetamol (acetaminophen) seems to change its mechanism every few years; at one point it was thought to act as a COX-3 inhibitor following a study in dogs, until it turned out that humans don't have COX-3. That's exactly why results of animal and in vitro study should be treated with extreme caution. --ἀνυπόδητος (talk) 12:12, 11 February 2011 (UTC)

Traish and the J Sex Med article

I have rationalised the amount of attention devoted to Traish et al. Clearly, once we have cited a reliable source, citing the news stories becomes much less useful (unless the news story offers a radically new perspective not actually discussed in the source, as Andrew Wakefield did back in the day).

I don't think anyone denies there is a problem, but that doesn't need that we need to run around screaming "look here, this is really bad, you know!" The reader can conclude that for themselves. JFW | T@lk 10:49, 13 March 2011 (UTC)

The recent news coverage does present a radically new perspective (to some). It is not apparent on Misplaced Pages, but many doctors and the pharmaceutical company still deny the connection between finasteride use and permanent side effects. Often, when patients present this condition to most doctors, it is rejected out of hand as being psychosomatic since 'finasteride couldn't possibly cause permanent side effects'. They will soon feel very embarrassed once the informational flood gates break.

Take for example the following blog by a 'world expert' in hairloss. I know blogs are not sufficiently reliable for Wiki, but it should give you an understanding as to the scale of the current problem. http://www.baldingblog.com/2011/03/02/erectile-dysfunction-appeared-suddenly-after-taking-propecia-for-7-months/ Doors22 (talk) 12:34, 14 March 2011 (UTC)

Please read WP:MEDRS. There is suitable source. No blogs needed. The "scale of the problem" has not been measured outside internet messanging boards. JFW | T@lk 12:37, 14 March 2011 (UTC)

Need for balance

We are devoting a lot of attention to the sexual side effects of finasteride, but I am concerned that we are not neutrally representing all opinions. For instance, PMID 18421068 seems to imply that 5alpha inhibition has minimal impact on erectile function. They are not plucking that opinion out of a hat. PMC 2840927 is similar. This does not do injustice to those affected by these side effects, but simply represents the range of opinion in the urology/andrology research community. JFW | T@lk 12:49, 14 March 2011 (UTC)

If you actually read the articles, rather than just the conclusion, which you clearly have not, you'll see they dont' really present evidence supporting their conclusion. The article by the Indian doctors is especially egregious in this logical flaw. They somehow present plenty of evidence as to why finasteride causes ED (even the permanent effects) and then conclude there is no link or it is minimal. I am not sure why they do this. The connection between ED and finasteride is well established in nearly every medical article I have read. The controversy lies in whether or not the effects are permanent. This only remains the case because there are not yet many studies and many doctors are currently unaware of those that exist.Doors22 (talk) 13:19, 14 March 2011 (UTC)

@Doors22.

(1) There are still WP:SYNTHESIS concerns on my part, and this has nothing to do with sourcing as WP:SYNTHESIS should make clear. ("If one reliable source says A, and another reliable source says B, do not join A and B together to imply a conclusion C that is not mentioned by either of the sources.")

(2) Traish summarises his article as "Prolonged adverse effects on sexual function such as erectile dysfunction and diminished libido are reported by a subset of men, raising the possibility of a causal relationship." (my highlighting). I don't have access to the full text, but unless is says something different from the abstract, I don't see how it can support your views.

Please refrain from reverting other people's edits until there is consensus. Do not edit war. Thank you. --ἀνυπόδητος (talk) 13:38, 14 March 2011 (UTC)

I'm not sure why they chose that weak language for the abstract. They are much more straight forward about the connection in the body of the article, in fact saying something to the effect of 'clearly side effects do not resolve in every situation'. Which claims are you specifically worried about with regards to synthesis problems? In the cases that I included more than one source, it was to show evidence that corroborates the claim in more than one source. I don't believe I synthesized two sources into a single claim but please correct me if I am mistaken.

I only reverted the edit because the reasons that Jfdwolff provided was entirely irrelevant. There were no referenced animal studies and his reversion of the 5-beta-reductase comment was clearly wrong from reading the referenced source. It seems like he has a personal vendetta against me for some reason. Such is life...?Doors22 (talk) 13:50, 14 March 2011 (UTC)

"Clearly, the sexual adverse events do not necessarily resolve completely in all patients, who discontinue use of finasteride, again supporting the premise that in some patients these sexual

side effects remain “persistent." Here is a direct quote from the published article. If I recall properly, I had put it in the article before but JFDWolff recently removed this statement. This was conclusion sentence from a a section titled "Adverse Effects of 5AR Inhibitor Therapy."Doors22 (talk) 03:19, 15 March 2011 (UTC)

We don't normally advocate direct quotes from articles (see WP:MEDMOS). If the article uses guarded language, then we should be just as cautious in our own description of their findings. JFW | T@lk 03:40, 15 March 2011 (UTC)

I agree with JFW that there is no need to actually quote the above in this page, but, if I understand correctly, this quote is the material in the full text that Doors22 proposes to indicate a stronger wording by the source in the main text than in the freely available abstract. If I understand that correctly, my reading is that there really isn't any contradiction between the abstract and the main text, and I see no reason to over-emphasize the findings beyond the cautious wording in the abstract. --Tryptofish (talk) 20:16, 15 March 2011 (UTC)

I don't normally follow this page, but I saw a request at Misplaced Pages talk:WikiProject Pharmacology. I've reviewed the talk here, and some of the most recent edits, and I'd like to make a couple of friendly suggestions:

1. Per WP:NPA, please comment only on the content, and not on what anyone thinks is another editor's motivations. Continuing inappropriate comments are likely to lead to being blocked from editing.
2. If there are thought to be cases where the abstract of the source, and the full text of the source, are different, one approach would be to copy and paste some of the unavailable full text (but not so lengthy a copy as to run into copyright issues) to this talk. That way, editors can evaluate whether the abstract was unrepresentative. However, per WP:SYNTH, it is extremely important that there be a clear indication in the source itself for anything said here. The opinions of editors about what the authors of the source might have been trying to say do not count.
3. For cases where the only existing studies have been done in animals, one approach would be to say explicitly that these observations occur in mice or whatever, in a manner to make it clear that the observations have not been extended to humans. It's generally not OK to report animal studies in this context without spelling that out.

I hope that helps. --Tryptofish (talk) 22:05, 14 March 2011 (UTC)

Yawn. Neurosteroids are still nowhere near as important as neurotransmmitters. JFW | T@lk 21:38, 23 March 2011 (UTC)

Don't be bitter because you were wrong. Plenty of sources show that neurosteroids are important in regulating many behavioral traits in humans. It doesn't even make sense to compare their importance to neurotransmitters as both obviously hold direct importance to issues like mood. Neurosteroids will become increasingly studied in the next decade and much more will be known about their significance. For your own interest, here is a quick sampling of articles I picked up from google. It appears as though you have an unreasonably high view of yourself if you deem something is unimportant based on the fact you have not learned about it.

http://www.europeanneuropsychopharmacology.com/article/S0924-977X(05)00142-2/abstract http://www.andrologyjournal.org/cgi/content/full/29/5/524 Doors22 (talk) 00:01, 26 March 2011 (UTC)

To both of you: please do not comment on one another. Just let it go. --Tryptofish (talk) 18:12, 26 March 2011 (UTC)

Animal Studies?!

JFDWolff - what are you talking about when you keep referencing animal studies and removing my edits? I'm going to reinsert the text tomorrow in the absence of a reasonable response. The following sources show that 5AR inhibitors also inhibit the synthesis of neurosteroids in HUMANS and that neurosteroids have certain functions in HUMANS. There were no mentions of animals studies in any of the following references.

1. Traish, Abdulmaged M.; Hassani, John; Guay, Andre T.; Zitzmann, Michael; Hansen, Michael L. (2011). "Adverse Side Effects of 5α-Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients". The Journal of Sexual Medicine. 8 (3): 872–884. doi:10.1111/j.1743-6109.2010.02157.x.

   In the brain, the products of 5a-Rs are transformed by another group of specific enzymes known as 3a-hydroxysteroid dehydrogenases (3a-HSD), which reduce 5a-DHT to 3a,

   5a-androstane 17b-diol (3a-diol) and 5a-DHP to 3a, 5a-tetrahydroprogesterone (allopregnanolone). Similarly, 5a-DHDOC is further

   reduced to 3a, 5a-tetrahydrodeoxycorticosterone (THDOC). These derivatives are thought to function as neurosteroids in the central nervous system (Figure 3), with important physiological functions including modulation of gamma-aminobutyric

   acid type A (GABAA) receptor, sigma receptor function, nicotinic acetylcholine receptor, voltage gated calcium channels, and synaptic and brain plasticity. These physiological functions may

   impact mood, rhythm, stress, sleep, memory, anxiety, and sexual function."

2. http://books.google.com/books?id=uABKkFdPjhkC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

   "neurosteroids may affect learning, act as anxiolytic, anti-aggressive, sedative/anesthetic, and anti-epileptic agents in both animals and HUMANS

3. http://www.ncbi.nlm.nih.gov/pubmed/12628349

   "recent studies indicate that stress induces THDOC to levels that can activate GABA(A) receptors. These results might have significant implications for human stress-sensitive conditions such as epilepsy, post-traumatic stress disorder and depression."

4. http://www.biomedcentral.com/1472-6904/6/7

   5alpha-reductase is a critical enzyme in the conversion of several steroids such as testosterone, progesterone, aldosterone and corticosterone in the brain. This enzyme converts testosterone to the most natural potent androgen DHT, and also it acts an important role in conversion of progesterone to dihhydroprogesterone (DHP). DHP is further converted to allopregnanolone (5alpha, 3alpha-tetrahydroprogesterone) by 3alpha-HSD . Allopregnanolone is a modulator of gamma amino butyric acid type A receptor (GABA-A), and increases chloride conductance. This neurosteroid has been found to exert anti-convulsant, anesthetic and anxiolytic effects . Moreover, change in the levels of allopregnanolone is found to be associated with depressive disorders. Doors22 (talk) 18:55, 15 March 2011 (UTC)

• I strongly urge both editors to work this out in talk, here. Reverting, by either editor, will not get anywhere. --Tryptofish (talk) 20:07, 15 March 2011 (UTC)

What do editors think of my suggestion, above, that including these studies can be done if the wording on the page clearly indicates that the data are from animals? --Tryptofish (talk) 20:34, 15 March 2011 (UTC) my mistake --Tryptofish (talk) 22:31, 15 March 2011 (UTC)

My point is that these statements are all evidence that have nothing to do with data from animal studies. He basically just deleted my edits and proposed a rationale that seemed to be entirely unrelated. If I wanted to include information about research on animals, I would have no problem mentioning the distinction. Thanks. Doors22 (talk) 22:22, 15 March 2011 (UTC)

OK, I misunderstood. Taking these sources in numerical order:

1. Already discussed, about humans but worded cautiously.
2. The quote is from page 6, appears to be as you quoted, but does not appear to refer specifically to finasteride.
3. Does not seem to be specifically about finasteride.
4. Quote: "Conclusion: This preliminary study suggests that finasteride might induce depressive symptoms; therefore this medication should be prescribed cautiously for patients with high risk of depression. It seems that further studies would be necessary to determine behavioral effects of this medication in higher doses and in more susceptible patients."

So, if we omit anything that violates WP:SYNTH, we are left with cautious, preliminary data for humans. Anything we say would need to reflect that. --Tryptofish (talk) 22:41, 15 March 2011 (UTC)

None of the quotes above give me the information that is actually needed to make the edits believable. It is a presumption that finasteride penetrates the CNS, you have not presented data that there are measurable differences in these substances in the human brain when exposed to pharmacological doses of finasteride. Everything you (Doors22) are writing is based on circumstantial evidence. It cannot be included. JFW | T@lk 00:35, 16 March 2011 (UTC)

You have completely changed the reason you are unhappy with this addition and I don't understand your current problem. There are dozens of sources that show 5-alpha reductase inhibitors (finasteride being one) will inhibit the production of neurosteroids. Why do you find this presumptuous? Are you going to continually introduce new arbitrary objections?

@Tryptofish - I had intended to show two points. The first being that 5 alpha reductase was involved in the genesis of neurosteroids and secondly that the neurosteroids had the effects stated above. The depression was not an issue as it was recently included in the PPI by the manufacturer. Doors22 (talk) 04:30, 16 March 2011 (UTC)

That being the case, I think we are left back with just reference 1, and no compelling reason to say more about it than what the page already says. If you are satisfied with respect to the issue of depression, that deals with reference 4. As for the rest, you really need a single source that shows that finasteride specifically, not 5-alpha reductase inhibitors in general, leads to the neurosteroid-related functional effects. Otherwise, you are engaging in WP:SYNTH if you make the connection yourself. Sorry, but there's no getting around that. --Tryptofish (talk) 19:35, 16 March 2011 (UTC)

Thanks Tryptofish. This should resolve the conflict. Two quotations from another section of the Traish article that directly state finasteride lowers the level of neurosteroids. In the other sections, it specifically mentions when referring to animal studies and this part does not. I was also satisfied with the existing part of the article that mentions depression, but I feel it is important to note that finasteride affects neurosteroid biosynthesis which was removed.

• Neurosteroids and neuroactive steroids play an important role in memory enhancement, sedative, hypnotic, anesthetic, anxiolytic, antistress, sleep modulating, anticonvulsant, and antidepressant properties .
• Biosynthesis of neurosteroids and neuroactive steroids requires 5a-R function. Indeed, it has been shown that finasteride diminishes neurosteroid biosynthesis suggest that finasteride may induce depressive symptoms.
• Finasteride is thought to cross the blood–brain barrier and inhibits 5a-Rs in the central nervous system. Doors22 (talk) 02:23, 17 March 2011 (UTC)

If, then, the three passages that you bulleted here are quotes from the Traish article, I cannot think of any reason not to have a sentence or two summarizing them (without going beyond what they say, of course), cited to that article. Do other editors have any objections to that? --Tryptofish (talk) 23:16, 17 March 2011 (UTC)

Thanks Tryptofish. Another article was published today that further details 'persistent' sexual dysfunction but I don't feel it is imperative to add any additional information at this point.

http://www.news-medical.net/news/20110318/New-study-Men-who-consume-hair-loss-drug-may-report-sexual-dysfunction.aspx Doors22 (talk) 15:56, 18 March 2011 (UTC)

I see that you went ahead and re-added it. It would have been better to wait a bit and give other editors an opportunity to reply. --Tryptofish (talk) 17:25, 18 March 2011 (UTC)

JFD always answers within 24 hours so he would have said something if he opposed. Nobody else mentioned they had any problems with the content.Doors22 (talk) 21:08, 18 March 2011 (UTC)

Please don't presume that I will always respond rapidly. I cannot currently access the Traish article, but your quotes seem to put to rest my suspicion that claims about neurosteroids were being extrapolated from experimental data in unrelated settings. JFW | T@lk 00:05, 20 March 2011 (UTC)

Agreed. (Including the part about giving other editors sufficient time to respond.) And I think that your further edits to the section are good. Perhaps this issue has now been resolved. --Tryptofish (talk) 23:39, 20 March 2011 (UTC)

JFDWolff's last edit does not seriously bother me, but it does have problems. First, the word psychosexual originates from Freudian psychoanalysis and means that the dysfunction is psychological in origin. The studies point to a physiological disruption, which is quite a significant distinction. Second, the Traish article directly stated that neurosteroids play "an important" role in the aforementioned functions which was removed by JFD. I don't necessarily mind its absence, but it was originally in the article and I don't see why it was removed. I would vote to remove that last sentences entirely but I am happy that Misplaced Pages now has more information about the drug's mechanism of action than the manufacturer would like to publicly admit. That is commendable.Doors22 (talk) 04:13, 22 March 2011 (UTC)

I changed "psychosexual" to "mental and sexual", which I think is truer to the source, and I agree with you about the Freudian connotations. I hope that helps. --Tryptofish (talk) 18:12, 22 March 2011 (UTC)

Removed "important" because it is a typical example of words to avoid. I think that if neurosteroids were that important, I would have learnt about them in medical school. Traish probably uses the word for the same reason: because it retroactively validates their hypothesis on the link between finasteride and specific problems. JFW | T@lk 19:59, 22 March 2011 (UTC)

I don't agree that important can be categorized by a word to avoid but I am fine with the current state of the article since the point is communicated. I am pleased with Tryptofish's revision. I don't know when you completed med school, but my father is a physician and has always advocated the idea that biology is rapidly evolving from year to year beyond what is taught in medical school. Neurosteroids are a new topic for investigation. Btw, graduate schools teach economists that free markets are stable and efficient. We have all been victims of the brilliant academic experience of Alan Greenspan and friends for the past 3 years. Doors22 (talk) 23:29, 22 March 2011 (UTC)

Not everyone agrees with your assessment of Greenspan et al, and in any case, since Greenspan isn't a biochemist, I don't think he belongs in the discussion of a medication. Just my 2p worth. --Alan the Roving Ambassador (talk) 23:41, 22 March 2011 (UTC)

Not everybody agrees with my assessment of Alan Greenspan, but Alan Greenspan himself did after the financial crisis. Mentioning him is a digression, but it provides a example of where academic experts have failed. I will return to more relevant comments from here out.Doors22 (talk) 01:00, 23 March 2011 (UTC)

Even more animal studies

After all the discussions above, I'm really somewhat surprised at Doors22's latest offering. This is PMID 12647000 (Asian Journal of Andrology 2003), a primary research study on 18 rats that looked at penile tissue. Its relevance for the average reader is uncertain; from the abstract I cannot judge whether the animals received doses of finasteride comparable with doses used in humans. If it is meant to show that finasteride stops men getting erections, this is a wild extrapolation. The source is not a WP:MEDRS in that it is not a secondary study. In the absence of any other source confirming its relevance in practical terms, I do not see how this could possibly be useful. JFW | T@lk 04:39, 29 March 2011 (UTC)

You are wrong in that this was the first time I actually included an animal study, despite your accusation. I acknowledge that primary sources are frowned upon in Misplaced Pages so I have collected a secondary source by my favorite biochemist. As agreed upon above, animal studies are fine to include so long as it is specified that animals were the subjects of the experiment. Thanks. Doors22 (talk) 06:38, 29 March 2011 (UTC)

There are two issues. You are using a URL reference to a journal article copied illegaly to a website; you could have overcome this by citing it properly. But there is another concern: why should the average reader care what finasteride does to rat penises? Traish concedes that this data is not available in man. From the abstract I cannot judge whether these rats received similar doses of finasteride as people taking it for hair loss or prostatism - one can therefore not extend its findings to humans. By citing it, you imply that you can (which is why you placed it in the "side effects" section).

This is meant to be an encyclopedia article, not a collection of things that you might find interesting because of your personal negative experiences with this drug. I urge you to keep the general reader in mind. I really do not have a conflict of interest, apart from wanting to ensure NPOV rather than the deafening grinding of axes. JFW | T@lk 10:12, 29 March 2011 (UTC)

What is it that makes this article not a proper secondary source? I can easily find a direct link to the journal article. I don't mind placing it elsewhere in the article, but it fits best in side effects currently and I am not sure what would be an appropriate section to create for that. Would you mind suggesting one that is compatible with the typical medical article? Perhaps something on additional studies? I will get access to the article and find out the comparable dose for humans that was used in the underlying Shen study. The average reader comes to the finasteride article to learn more about the safety profile for finasteride that goes above and beyond what is available in the product warning. Of course, studies on rat penises would not guarantee a connection to the effects on human penises but the truth is that it would be considered inhumane in our society to treat human patients with a drug and then castrate them to look at cross sections of their penis under a microscope. The purpose of the study was to get a rough idea of how androgen deprivation would affect human penile tissue using a study that is as close as possible. I was very explicit in mentioning the lack of available human studies to attempt to maintain a NPOV, even though the study very much speaks for itself. Doors22 (talk) 13:23, 29 March 2011 (UTC)

It is not a secondary source – it's a primary source. "Policy: Unless restricted by another policy, primary sources that have been reliably published may be used in Misplaced Pages, but only with care, because it is easy to misuse them. Any interpretation of primary source material requires a reliable secondary source for that interpretation. A primary source may only be used on Misplaced Pages to make straightforward, descriptive statements that any educated person, with access to the source but without specialist knowledge, will be able to verify are supported by the source." A reliable secondary source, such as a review article in a peer-reviewed medical journal, is needed to back up the interpretation of the effects of this drug on six rats, that you are trying to add to the article. Graham Colm (talk) 13:55, 29 March 2011 (UTC)

One would not expect to read about a tiny animal study in an encyclopedia, so one would not want to add it over here. You are lending too much WP:WEIGHT to a study that cannot be extrapolated to humans. Traish (PMID 17329016) is "allowed" to do that because that is a scientific review. However, nowhere does Traish actually say that finasteride causes erectile dysfunction in humans because of direct action on penile tissue. Your conclusion is therefore original research. Again, I wish you would have a think about what the normal reader would expect to be reading in an article like this. Compare this article (in its pretty woeful state) with a good article on a drug, such as metformin or warfarin. Neither of these articles shy away from the adverse events associated with their use (warfarin is a dangerous drug, and metformin is not universally well tolerated in addition to rare episodes of lactic acidosis), but they do not make claims that cannot be substantiated with sources that individually meet WP:MEDRS. JFW | T@lk 18:32, 29 March 2011 (UTC)

I agree with JFW and Graham Colm about the sourcing. Asian J. Androl. is only an isolated account, not rising to the level of passing WP:UNDUE, and "your brain on porn dot com" falls decidedly short of being a secondary source for our purposes. --Tryptofish (talk) 19:04, 29 March 2011 (UTC)

For the record, the URL used directs to an illegal copy of PMID 17329016. As it happens, this would qualify as a secondary source, but I think the rat penis example is cherrypicked and blown out of proportion. JFW | T@lk 19:14, 29 March 2011 (UTC)

OK. Hypothetically, how many more similar sources would be required to be able to put this type of thing on Misplaced Pages? Of course, it would be highly unethical to perform this study on humans so it is not done but what would enable it to surpass the level of =WP:UNDUE Doors22 (talk) 00:33, 30 March 2011 (UTC)

You don't need more sources, you need stronger sources. The fact that no human data exist matters not - if the studies have not been done you cannot presume their outcome.

Could you give me some reassurance that you have understood the several points I have made about your plans with this article? JFW | T@lk 00:36, 30 March 2011 (UTC)

Doors22: You would need some recent, peer-reviewed, review articles (articles in scientific journals, reviewing the scientific literature), saying that numerous studies from numerous investigators have now established this observation to be correct, and that it has important implications for human use of the drug. Not you inferring that the implications are important. --Tryptofish (talk) 20:33, 30 March 2011 (UTC)

tidied a little

Just tidied the syntax a bit but got reversed. I promise my changes re an improvement. Recommend reading thme before reversing. Chickenboner (talk) 16:10, 26 May 2011 (UTC)

5 Alpha Reductase Inhibitors actually increase the risk of aggressive prostate cancer

http://www.reuters.com/article/2011/06/09/us-fda-prostate-idUSTRE7585KZ20110609

The FDA has finally come forward and stated that 5-ARIs (including finasteride) increase the risk of aggressive forms of prostate cancer based on a randomized study of 5 million patients. Due to this recent conclusion, section 1.3 needs to be revised immediately. I would feel better if somebody more experienced than myself were to rewrite the section. If somebody were to do this, I would be greatly appreciative otherwise I'll give it in a go in a day or two. Doors22 (talk) 23:27, 9 June 2011 (UTC)

Yes I think I already updated it.Doc James (talk · contribs · email) 01:42, 11 June 2011 (UTC)

Doors22, I notice that you are adamant that this article should be as inclusive as possible so that the average consumer can make an informed decision about this medication. Many would argue that this is the primary purpose of Misplaced Pages, but I actually agree with you on this one. As such, I was hoping you could help me get the wording right for an addition to the article in the side-effects section, under the new blurb about the FDA warning. I was thinking of something like: "In contrast, the National Institute of Health, another US governmental agency, continues to recommend finasteirde for prostate cancer prophylaxis."

Thanks in advance and I look forward to reading your contribution. http://www.cancer.gov/cancertopics/factsheet/prevention/pcpt

174.252.94.51 (talk) 23:05, 12 June 2011 (UTC)

Thanks DocJames for updating the article. To the anonymous contributor, the article you reference states "Men taking finasteride may not have an increased risk of high-grade prostate cancer. Adjusting for the known effects that finasteride has on prostate cancer detection, investigators estimated that high-grade tumors (Gleason scores 7–10) were no more likely in the men taking finasteride than in the men taking placebo. However, because very few prostate cancers were detected at Gleason scores of 8 to 10, it is difficult to draw conclusions about this group."

From this text, I think it would be appropriate to say something like - In contrast to the FDA's stance, the National Cancer Institute believes that finasteride may increase the ability to detect cancer which accounts for the higher prevalance of high-grade cancer. The article didn't specifically mention the NIH, but if you can cite it feel free to add it in the article and somebody will change it if they object. Doors22 (talk) 16:14, 18 June 2011 (UTC)

Reversion of PFS Conference

Since JDWOLFF is being a Misplaced Pages Nazi I have moved discussion to the talk page. In my opinion, the information I have included is very germane and significant. It demonstrates not only that medical practitioners are taking Post-Finasteride Syndrome seriously but also informs to those who may be suffering from negative persistent side effects from Propecia and Proscar that there are current ongoing studies. While it may not be apparent on this Misplaced Pages article because JDWOLFF is very aggressive to remove comments he doesn't like, there is an ongoing controversy relating to the side effects of taking Propecia. Many men have disregarded the claims since a handful of doctors remain ignorant to the potential risks of the drug and have been misinforming their patients only to lead additional patients to suffer what seems to be permanent side effects. Please state your case as to why the information about the conference should not be included or else I would put it back up.

Additionally, I do not believe that JDWOLFF's edits were in 'good faith' was was suggested in the edit page. His excessively hostile tone in commenting on his edits shows he is bringing more emotion than rational thought to the discussion. — Preceding unsigned comment added by Doors22 (talk • contribs) 19:55, 25 September 2011 (UTC)

Godwin's law violated in the first sentence. Your personal attacks invalidate your arguments. I will respond when you've calmed down and apologised. JFW | T@lk 21:13, 25 September 2011 (UTC)

In all honesty, the comparison is neither hyperbolic, nor a personal attack. You have demonstrated an abuse of Misplaced Pages power by repetitively deleting appropriate comments while supplying rude comments that fail to provide any justification for your actions. Secondarily, the comment referred to your relevant behavior and not some personal characteristic that has no pertinence to the discussion at hand. Lastly, even in the case that there was a personal attack (hypothetically), the subsequent arguments would not be invalidated and should be considered separately on their own merit. Please stop playing games and respond to the direct inquiry. If you continue to behave in this manner, I will take proper action to have your administrative status reviewed. This is not a game for me as this drug has been and continues to destroy lives in the name of saving hair. Doors22 (talk) 23:59, 25 September 2011 (UTC)

I agree with JWF's removal of the poorly sourced information. We need an appropriately high quality secondary source to include such information here. Further disruption such as the above, despite the protestation otherwise, are certainly a violation of WP:AGF and WP:NPA and need to stop. Yobol (talk) 00:18, 26 September 2011 (UTC)

Yobol, if you decide to opine please take a few minutes to thoroughly understand that upon which you are commenting. Your response was a non-sequitur as the specific matter at hand has nothing to do w/ "poorly sourced information". Rather, I would like to note that a conference was held in Europe to explore the mechanism behind the irreversible side effects of taking Propecia. The source in and of itself is not in question. JFD and DocJames have not yet provided a satisfactory reason for why this information cannot be on Misplaced Pages. It is very relevant for prospective finasteride consumers, medical researchers, and those who have suffered damages from taking Propecia. I would appreciate it if those who dissent would give a relevant answer as to why this cannot be on the webpage or else I am entirely within my rights to place it back on the article. Thank you. Doors22 (talk) 02:26, 27 September 2011 (UTC)

You must use a review article. This has been stated a couple of times. Doc James (talk · contribs · email) 12:39, 27 September 2011 (UTC)

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