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Old 02-25-2009, 10:36 AM   #1
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Cool Hurray for finasteride (Proscar) - the medical community finally does the right thing

There is monumental news for the prevention of prostate cancer: major medical associations recommend the use of finasteride (also sold under brand name Proscar) for prevention! In other words, drum rolls, fanfares with trumpets here,

the medical community has agreed that finasteride helps safely prevent a substantial portion of prostate cancer!!!

On Tuesday the American Association of Clinical Oncologists and the American Urological Association issued a joint guideline, stating that the drug "can reduce the risk of developing prostate cancer by 25%."

While it is not news that finasteride safely prevents at least 25% of prostate cancer, this twin endorsement will give cover to doctors, enabling them to open up prevention discussions with patients and not worry about jackals in the legal profession (not all lawyers, but the self-centered greedy ones that are altering the way medicine is practiced for the worse) .

The new statements are based on the fruits of a number of followup studies of the landmark "Prostate Cancer Prevention Trial," whose final results were published in 2003. That study was huge - 18,882 healthy men who took finasteride or placebo for seven years. It found that prostate cancer was reduced by about 25%. Unfortunately, there was also a very slight increase in high grade (Gleason) disease in the finasteride group compared to the placebo group; even though this was believed probably a harmless artificial finding by the researchers, out of proper caution they included it in their conclusion, and it spooked the media and medical community. Finally, after thorough followup analysis, that higher incidence of high grade disease has been explained. In essence, it is due to an increased efficiency in detecting high grade disease in the group getting finasteride. (Actually it was well explained several years ago, but it has taken several two-by-fours upside the head to drive the point home! That's cost us a fair amount of prevention, but better later than never.)

In fact, recent analysis suggests the prevention impact is actually about 30% rather than 25%, but that has not been firmed enough to have been incorporated in yesterday's Joint Guideline. Also, that recent analysis suggests tentatively that finasteride actually slightly decreases higher grade disease.

Finasteride also increases the efficiency of PSA trend analysis (after it resets the PSA at about 50% lower in healthy men and the trend is restarted), and it increases the effectiveness of the DRE exam. (Essentially, this happens because the drug reduces the PSA associated with Benign Prostatic Hyperplasia (BPH, in other words, benign enlargement); basically, in electronics terms, the finasteride reduces "noise", giving a better signal-to-noise relationship.) Dr. Howard Parnes, chief of the prostate and urologic cancer research unit at the National Cancer Institute, said about the new guidelines that "In addition to significantly decreasing the prevalence of prostate cancer, finasteride has been shown to improve the diagnostic accuracy of screening."

It helps another way in dealing with possible prostate cancer based on DRE and PSA results: it can be used as what has been called a "finasteride challenge." Dr. Eric Klein has described this previously. Basically, a patient is given finasteride for six months, and if his PSA does not fall by about 50%, then there is an increased risk of prostate cancer, and he is monitored more aggressively or advised to get a biopsy.

Dr. Otis Brawley, the head of the American Cancer Society, has been known to be tentative about the value of prostate cancer screening because he is so concerned about over treating the disease. Still, he had this to say about the new guidelines for finasteride: ""We still don't know if screening and aggressive treatment is a good thing," but with PSA tests, finasteride is another way to prevent the disease, noted the American Cancer Society's leading medical officer, Dr. Otis Brawley." (I'm hoping the results of the D'Amico teams' studies on PSA greater than 2.0 in the year prior to diagnosis will finally move Dr. Brawley off the fence and in favor of general screening. He is African-American, and I have an impression that he does push screening for African-American men, who are at great risk of getting and dying from prostate cancer.)

Of course the drug is often prescribed for BPH, so patients taking it not only are helping prevent prostate cancer but are also helping to prevent or to reduce urinary problems caused by BPH. One of the articles I read this morning noted a third benefit: reducing the need for prostate cancer treatment, and you can add biopsies to that too. (In other words, men (and their families of course)benefit not only by preventing the disease but by preventing the burden of treatment itself.) The article noted there would be fewer false positives and fewer false negatives. I think all of us who have received a biopsy report that is positive for prostate cancer realize the strong abhorrence of the disease that overcomes us at that time, and that abhorrence drives many of us to treatment even if the risk of significant disease is extremely low. Finasteride will help many future patients avoid having to face that abhorrence.

While prevention is a little late for most of us on this board, it is not too late for our children, younger workers, neighbors, church, synagogue, temple, mosque, club mates, and co-workers. You get the idea. We are in an ideal position to spread the word. If you want to learn more about finasteride prevention from the horse's mouth, so to speak, go to [url]www.pubmed.gov[/url] and search for " Prostate Cancer Prevention Trial ".

There is also a cost-benefit aspect, and the reports I read this morning are using a cost per pill that is much higher than my insurer was paying last year. The Washington Post quoted a doctor who said generic finasteride cost about $3 a day, or around $1,080 per year. Last year my Blue Cross insurer was paying $1.19 per pill, which would lead to a cost of $434 per year, far less! The Post article also quoted Dr. Kramer as saying "about 71 men would have to take finasteride for seven years to prevent one case of prostate cancer." That doesn't sound right to me; I'm wondering if he meant to say "one death", which sounds to me more in the ballpark. (I'm thinking 1 in 6 or (16.7%) will get diagnosable prostate cancer in our lifetime, and finasteride prevents about 25% per the older figure Dr. Kramer was using, so 16.7% X 25% prevention is about a 4% benefit, or 1 in 25 men preventing the disease. Can anyone help here? Maybe he's factoring in the seven years out of all the years after age 50, or something like that.) Also, while taking finasteride for seven years resulted in a 30% lower incidence (more recent analysis) at the end of the seven years, I suspect its likely the need for the drug would be ongoing. That's not known yet.

One other pessimistic factor no doubt influenced patients and doctors in holding back on finasteride for prevention: side effect information that was delivered and received without providing perspective. Finasteride is known to reduce erectile function and libido (interest in sex) in a small percentage of men. However, that information is often delivered, from what I've seen and heard, just as "there's a possibility of ED and decrease of libido", or even worse, "ED and decrease of libido are known side effects". The very low odds are not given , nor is the key fact that the effects, if experienced at all, are reversible if the medication is stopped! Here's what some knowledgeable doctors are saying. Dr. Eric Klein, the leading prostate cancer expert from the famed Cleveland Clinic: "The main side effect, which occurs in about 3 percent of patients, is diminished libido. Erectile dysfunction also has been reported, but in the vast majority of men who experience this, the side effect goes away after a few weeks." (Dr. Klein also said this: "The announcements of the benefits of Finasteride are "long overdue,"; when reviewing the drug's effects, he added "it's not a tough sell.") The Washington Post quoted Dr. "Howard M. Sandler, a radiation oncologist at Cedars-Sinai Medical Center and a spokesman for the American Society for Clinical Oncology," saying "that he would himself consider taking the medication on a trial basis: 'If I tried the medication for a month or two and I got side effects, then for me, personally, the benefit would not be worth the risk,' he said. (Dr. Mark Scholz, MD, an expert medical oncologist specializing in prostate cancer, has been pointing this out for years, as have some other experts in hormonal therapy for prostate cancer.) "But if I was not suffering any side effects, I might consider taking the pil.... I might sleep a little easier at night."

Here's a heads-up for a coming attraction: Avodart, the well-advertised drug in the same class as finasteride, seems to have about double the anti-cancer impact based on preliminary results of trials. We should get some final reports as early as this year! (On the other hand, it has not been around any where near as long, and it is not generic. Therefore, it costs a lot more.)

I also need to vent some frustration that borders on anger with media treatment of finasteride and prostate cancer, but I'll do that in a follow-up post in this thread. This news is glorious, and we should savor the moment!

Jim

Last edited by IADT3since2000; 02-25-2009 at 01:12 PM. Reason: Clarified point about avoiding burden of treatment as well as disease. Grammar. Spelling.

 
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Old 02-25-2009, 02:29 PM   #2
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Quote:
Originally Posted by IADT3since2000 View Post
There is monumental news for the prevention of prostate cancer: major medical associations recommend the use of finasteride (also sold under brand name Proscar) for prevention! ... Jim
Okay, this is the opportunity for venting I allowed myself at the end of the last post, where I did not want to detract from the wonderful news of the AUA/ASCO endorsement. If you are interested in this subject, please read the first post before this one. This second post may not be of interest to many of us, but it does indicate some sad defects in our medical world. Bottom line: it sometimes takes years for great news to penetrate into medical practice. It did in this case.

I read this wonderful news on page A14 of this morning's Washington Post. The reporter did a decent job, and the paper allocated thirty column inches to the story, including three column inches for the headline, "More Men Are Urged to Take Drug Against Prostate Cancer."

But practically burying the story on page A14 is disgraceful! There is a war on against cancer, with prostate cancer one of the key enemies, and obviously the editor is not keenly aware of that! I'll bet that fewer than half of readers saw that article on page A14. Maybe readers noticed the half inch tall, two inch wide bold print note near the left bottom of the front page: "Groups urge wider use of drug against prostate cancer", but I doubt it; I missed it. When I was working, I rarely had time to get to page A14 when reading the paper while eating breakfast. Usually I got to the front page, a glance at sports, a glance at business, and perhaps a story or two on the first few pages. In fact I would have missed the story this morning if my wife hadn't pointed it out.

I'm afraid I'm showing a cynical side here, but I can't help thinking this story would have been a front page item with a large headline if a drug with similar impact on breast cancer were involved. Oh that's right, guess what? There was such a story, with a large headline: "A Drink a Day Raises Women's Risk of Cancer, Study Indicates." Okay, that's newsworthy, even if it is just one more study in a series with the same finding (and it was a big study). And don't get me wrong: I'm delighted that breast cancer gets a lot of attention and funding.

But other front page stuff included "Market for Romance Goes from Bullish to Sheepish - Are Guys With Less to Spend Less of a Catch?", and "Recession Could End This Year, Fed Chief Says." Well, you could argue that both are also newsworthy, and the romance piece is upbeat, but page 1 instead of the finasteride story? I was also discouraged by some of the other choices for stories and ads on early pages of the edition that preceded the finasteride story.

Also, the media, including the Post, with their penchant for negative, gloomy news, focused on a potentially negative aspect of the key finasteride study when it was published back in 2003 (The Prostate Cancer Prevention Trial). That concern has now been resolved, and fortunately has fairly recently received a decent amount of coverage in the media from what I've seen, though it would have been far better if the media had managed to put the matter in proper perspective back in 2003 or had watched and reported developments in a timely way. However, the damage was done. How many of us and our relatives facing an increasing prostate cancer risk have been unaware of the finasteride prevention news? How many of us heard the news but decided to ignore it because it just wasn't getting much attention? How many cases of prostate cancer will develop as a result?

Some leading docs initially made the wrong call too, including Dr. Peter Scardino at Memorial Sloan Kettering, but he had the guts and talent to keep an eye on developments and reverse his stand at least a couple of years ago. My hat is off to those who were able to see the true merits of the situation and work their way through the confusion very early. Those leaders include Dr. Ian Thompson, a leader of the trial, the other authors of trial reports especially Scott Lippman and Scott Lucia, the renowned pathologist Dr. David Bostwick, the late Dr. Donald Gleason, Dr. Eric Klein of the Cleveland Clinic, Dr. Robert Leibowitz, Dr. Charles "Snuffy" Myers, Dr. Stephen Strum, Dr. Mark Scholz, Dr. Lam, Dr. Stephen Tucker and others.

I believe that thoroughly deserved embarassment has held the media and many doctors back from reversing their negative stands on using finasteride to help prevent prostate cancer. I had a personal encounter of that kind in 2007 during a break from a prostate cancer research proposal panel session (not related to finasteride). I was serving as a survivor representative (technically a "consumer reviewer", so called because we are consumers of the benefits of research). I was discussing finasteride for prevention with a fellow panel member, a lady doctor who was well aware of the Prostate Cancer Prevention Trial results that had been published four years earlier. However, when I brought up several studies that virtually resolved the concern that finasteride might stimulate more aggressive disease, she practically froze up and did not want to hear of it. She was very concerned about the high grade issue, and I had a strong feeling that she had been advising patients not to use the drug for prevention and did not want to face the embarassment of having to change her advice. We survivor representatives get a lot of respect during these panel reviews, but I had a feeling at that time that she was giving me the "me-expert doctor, you-ignorant patient" treatment.

By about 4 PM I had alerted both ABC and NBC news of the story by email. It's likely their nightly news staffs were already aware of it, but I'm concerned that it will lose out for a timeslot considering the news about the President's State of the Union address last night and some health news about alcohol and breast cancer. Both of those are important, but I'm convinced the prostate cancer story about the AUA and ASCO endorsement of finasteride for prevention is more impotant than one more study that confirms the alcohol-breast cancer link. It will be interesting to see if there is coverage. I normally do not watch CBS, but I'll try to alert them too. Unfortunately, neither the ABC nor NBC websites had any sign of the story as of about an hour ago.

I'm not singling out the Post for criticism. Actually, their reporters to a good and sometimes terrific job of covering cancer, prostate cancer, and other health topics. But there is a lot of room for improvement, and the media could do a much better job in improving the nation's health. Now that I've been able to vent, I can at least appreciate that the Post did cover the story.

I'm interested in whether local papers of our board participants covered this story today. I'm also interested in what the networks and cable news will say tonight. Here's hoping.

Jim

 
Old 02-25-2009, 02:29 PM   #3
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Great news, Jim! Thanks for keeping us informed.

 
Old 03-19-2009, 10:16 PM   #4
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Proscar does have some side effects. The worst is lowered libido. In my case it has lowered to near nil. The other is reduced semen during ejaculation. Also in my case the amount of ejaculate is near nil along with the strength and duration of the orgasm. If I were convinced that I am a candidate for PC, I might be happier with the medicine. I do have BPH which has improved very little over the year i have been on Proscar. Meanwhile, my love life is gone.

 
Old 03-20-2009, 08:27 PM   #5
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

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Originally Posted by Burtonbov View Post
Proscar does have some side effects. The worst is lowered libido. In my case it has lowered to near nil. The other is reduced semen during ejaculation. Also in my case the amount of ejaculate is near nil along with the strength and duration of the orgasm. If I were convinced that I am a candidate for PC, I might be happier with the medicine. I do have BPH which has improved very little over the year i have been on Proscar. Meanwhile, my love life is gone.
I'm sorry you drew the short straw on Proscar.

For the vast majority of us, Proscar will not lower libido much if at all. In fact, a common effect is to boost testosterone, since less testosterone is converted into DHT. But research has identified a small proportion of men that do suffer the side effects you are describing.

You probably already know that the adverse effects reverse if you stop the medication, but that wouldn't do much for the BPH and would not help prevent cancer.

Have you talked with your doctor about switching to Avodart? It's in the same class as finasteride, but for a lot of men works better. I haven't heard whether switching from one to the other (or vice versa) sometimes eliminates those unwanted side effects while keeping the benefits.

Take care,

Jim

 
Old 04-03-2009, 03:13 PM   #6
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

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Originally Posted by IADT3since2000 View Post
I'm sorry you drew the short straw on Proscar.

For the vast majority of us, Proscar will not lower libido much if at all. In fact, a common effect is to boost testosterone, since less testosterone is converted into DHT. But research has identified a small proportion of men that do suffer the side effects you are describing.

...Have you talked with your doctor about switching to Avodart? It's in the same class as finasteride, but for a lot of men works better. I haven't heard whether switching from one to the other (or vice versa) sometimes eliminates those unwanted side effects while keeping the benefits.
... Jim
I was fortunate to attend a presentation by Dr. Charles "Snuffy" Myers at a nearby US TOO prostate cancer support and education group, and he addressed questions on finasteride, which he uses in his practice. (Dr. Myers is an eminent medical oncologist specializing in prostate cancer - and a patient of a challenging case himself - who is known for his expertice and ability to communicate with PC survivors.

Apparently, for that small minority of us who experience unfavorable side effects with finasteride, switching from finasteride to Avodart would be unlikely to help with side effects, and might magnify them.

Also, asked about the effect of these drugs on reproductive capacity, he recommended that men donate to a sperm bank ahead of time because of the typical decrease in ejaculate volume.

Jim

 
Old 06-03-2009, 03:03 PM   #7
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Here's more evidence that the medical community is getting on board in using finasteride to help prevent prostate cancer. This relates to the first post in this thread, excerpted here:

Quote:
Originally Posted by IADT3since2000 View Post
There is monumental news for the prevention of prostate cancer: major medical associations recommend the use of finasteride (also sold under brand name Proscar) for prevention! In other words, drum rolls, fanfares with trumpets here,

the medical community has agreed that finasteride helps safely prevent a substantial portion of prostate cancer!!!

On Tuesday the American Association of Clinical Oncologists and the American Urological Association issued a joint guideline, stating that the drug "can reduce the risk of developing prostate cancer by 25%."...
Jim
The new evidence comes from a talk by the highly respected researcher/physician Dr. Eric Klein of the Cleveland Clinic. He made a key presentation at the annual conference of the American Society for Clinical Oncology (ASCO), which is currently in progress, in the session on prostate cancer screening and prevention. A report of his key points included this for finasteride:

- A 20 percent reduction in risk of high-grade PIN
- Fewer symptoms of urinary problems
- Reduced risk of urinary retention
- Avoidance of the burden of cure for low-risk cancers
- Improved diagnostic accuracy of PSA.

This is really significant because ASCO is one of the three major societies for doctors who treat prostate cancer (the others being the AUA for urologists, and ASTRO for radiation doctors).

Jim

 
Old 07-26-2009, 03:00 PM   #8
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

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Old 01-10-2010, 09:12 AM   #9
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

i have been on finesteride for the past 6 months as part of an active surveilance program. i was first dx last year, may 2009, with a psa 4.4, t1c,and gleason 6. i have followed my psa for a number of years and last year it hit 4.4. now 6 months later it is 2.4 with t1c and a biopsy again to be taken in june. what has been the experience with finisteride when someone is dx with pca . my initial biopsy was 2 cores out of 12 with 5% and10% . i am 67.5 years of age . thank you

 
Old 07-15-2010, 01:55 PM   #10
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Hi lorre,

I think I must have overlooked your post way back in January (below), but I just saw it as there has been another fresh post on this board. I hope you are still reading or have subscribed to this thread.

Finasteride has been a mainstay of my own intermittent triple hormonal blockade therapy for a challenging case for about ten years now, but you are using it in a different way - to help with active surveillance.

Obviously, I cannot give you personal experience with that use - wish I could . However, I can say that some of the leading experts in active surveillance believe that finasteride or Avodart will help with active surveillance, increasing the odds of long-term success. I'm almost positive that one of them is Dr. Laurence Klotz, the expert in Toronto, has recommended these drugs for active surveillance.

Take care,

Jim

Quote:
Originally Posted by lorre View Post
i have been on finesteride for the past 6 months as part of an active surveilance program. i was first dx last year, may 2009, with a psa 4.4, t1c,and gleason 6. i have followed my psa for a number of years and last year it hit 4.4. now 6 months later it is 2.4 with t1c and a biopsy again to be taken in june. what has been the experience with finisteride when someone is dx with pca . my initial biopsy was 2 cores out of 12 with 5% and10% . i am 67.5 years of age . thank you

 
Old 04-04-2011, 06:37 PM   #11
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

I am one who drew a short straw. One side effect of Proscar that I didn't see mentioned is reduced energy for exercise. Until I read this post, I was certain that my testosterone was lowered by the Proscar as my strength and endurance decreased after I started to take it. I suspended taking the medication until my libido returned and my strength and endurance seemed to return also. Although I am over 70, I try to exercise regularly in a fitness center where my exercise results are recorded. I'll check with my urologist to see if I can switch to Avodart. Maybe I'll draw a longer straw. I am currently taking only three finasteride pills a week with minor side effects. Should be seven a week but taking more makes the side effects unacceptable to me.

 
Old 04-04-2011, 08:47 PM   #12
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Hi Hank-

I had the same kind of libido problem with it. My workouts weren't affected. The manufacturers claim that only 20% experience loss of libido with it, but it seems like everyone I know who takes it for BPH or baldness (Propecia -- the 1 mg dose) has said the same thing. You can do a lab test for DHT to see if the amount of finasteride you're taking is enough.

Finasteride shouldn't affect your testosterone levels. If that is dropping (and that would affect your workouts to a far greater degree, as well as your libido), you might consider testosterone replacement therapy. There is no evidence that testosterone replacement causes, causes progression of, or stimulates the growth of early stage prostate cancer. It seems to only stimulate advanced disease, which is an entirely different animal. In fact, very low testosterone (hypogonadism) is associated with the development of aggressive PC.

Testosterone (T) is manufactured in the testes. There is a very sensitive feedback mechanism that keeps it at a steady level. Sadly, that level decreases with age. Excess testosterone is metabolized via two routes. One way is by conversion to DiHydro Testosterone (DHT), a more potent androgen responsible for libido, baldness and body hair, and stimulating the androgen receptor on prostate cancer cells (among other things). The other way T is metabolized is by conversion to estradiol (an estrogen), which is why some bodybuilders develop gynecomastia (enlarged breasts). Proscar (finasteride) blocks the enzyme (5-a-reductase) that converts T into DHT. Avodart (dutasteride) blocks two versions of that enzyme, and so is even more potent. If you disliked Proscar, you'll hate Avodart.

- Allen

 
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Old 06-04-2011, 03:20 PM   #13
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Wink Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

It has been over five weeks since my PVP procedure and three weeks of regular exercise. No problems! No Proscar! I don't think or worry over my previous Prostate problems. Whether it is the absence of Proscar or the procedure, I can't be sure. Maybe addressing what I perceived to be the causes improved my mental outlook as well as physical improvement. I don't believe I need to monitor my testostorone level unless I regress.

 
Old 06-06-2011, 06:57 AM   #14
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Re: Hurray for finasteride (Proscar) - the medical community finally does the right t

Hi Allen and Hank,

I'm sorry you both drew the short straws with finasteride. As mentioned earlier, up to about 20% of men "appear" to have certain adverse effects; I use the word "appear" because a hefty portion of patients on placebo also have those effects. For instance, the included detailed medical information handout that comes with my prescriptions cites data from the PLESS study showing that after one year of use impotence in the finasteride group was 8.1%, but it was 3.7% in the placebo group; moreover, at years 2, 3 and 4 the results for both groups were even at 5.1%. (From a glass way-more-than-half-full viewpoint, 94.9% of men on the drug were potent!) Other adverse reactions where the finasteride group had 21% or more adverse reactions than the placebo group over the four years of the study were: decreased libido (first year 6.4% vs. 3.4%; later 2.6%); decreased volume of ejaculate (first year 3.7% vs. 0.8%; later 1.5% vs. 0.5%); ejaculation disorder (first year 0.8% vs. 0.1%; later 0.2% vs. 0.1%); breast enlargement (first year 0.5% vs. 0.1%; later 1.8% vs. 1.1%); breast tenderness (first year 0.4% vs. 0.1%; later 0.7% vs. 0.3%); and rash (first year 0.5% vs. 0.2%; later 0.5% vs. 0.1%). The results indicate that most of the adverse events affect very few patients; they also indicate that several of the gaps close or nearly close as time passes.

It's noteworthy that the study omits the adverse effect of growth of hair in male pattern baldness areas for many of us (including me! ). That is actually an adverse effect as we have to spend more time fending off advances from amorous females. Seriously, it's nice to have more hair in those previously bald areas.

I have not heard previously of a negative impact on workouts, strength or fitness. That does not mean that your experience was not real, but it does raise the possibility that something else was the cause. Finasteride use is banned for olympic competitors because it is considered a performance enhancing substance; I'm thinking that's because it increases testosterone by decreasing conversion to DHT.

I have now been on Proscar or the generic form (finasteride) for 11 1/2 years continuously. I have been fortunate to be in the very large portion of men who have no or minimal adverse impact from the drug.

Take care,

Jim

 
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