Is Erectile dysfunction a \'nocebo\' effect of 5 AR inhibitors?

Medications for hair loss
1

Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon?

J Sex Med. 2007 Nov;4(6):1708-12

INTRODUCTION:
Sexual adverse experiences such as erectile dysfunction (ED), loss of libido, and ejaculation disorders have been consistent side effects of finasteride in a maximum percentage of 15% after 1 year of therapy. Such data could be seen as far from reality, if compared to a higher percentage that may be found in any common clinical practice.

AIM: This study aims to explain the dichotomy between literature’s data and clinical practice data.

METHODS:
One hundred twenty patients with a clinical diagnosis of benign prostatic hyperplasia (BPH), sexually active and with an International Index of Erectile Function-erectile function (IIEF-EF) domain >/=25 were randomized to receive finasteride 5 mg concealed as an “X compound of proven efficacy for the treatment of BPH” for 1 year with (group 2) or without (group 1) counseling on the drug sexual side effect. The phrase used to inform group 2 patients was “. . . it may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon”.

MAIN OUTCOME MEASURES: The estimation of side effect was conducted at 6 and 12 months using the male sexual function-4 (MSF-4 item) questionnaire and a self-administered questionnaire.

RESULTS: One hundred seven patients completed the study. Group 2 patients (N = 55) reported a significant higher proportion of one or more sexual side effects as compared to group 1 (N = 52) (43.6% vs. 15.3%) (P = 0.03). The incidence of ED, decreased libido, and ejaculation disorders were 9.6, 7.7, and 5.7% for group 1, and 30.9, 23.6, and 16.3% for group 2, respectively (P = 0.02, P = 0.04, and P = 0.06).

CONCLUSION: In the current study, blinded administration of finasteride was associated with a significantly higher proportion of sexual dysfunction in patients informed on sexual side effects (group 2) as compared to those in which the same information was omitted (group 1) (P = 0.03).

A scenario similar to group 2 of the current study is likely to occur in clinical practice, where the patient is counseled by the physician and has access to the drug information sheet.

The burden of this nocebo effect (an adverse side effect that is not a direct result of the specific pharmacological action of the drug) has to be taken into account when managing finasteride sexual side effects.

2

That’s a fascinating study, and the results don’t surprise me in the least!:wink:

.

3

» Finasteride 5 mg and sexual side effects: how many of these are related
» to a nocebo phenomenon?
»
» J Sex Med. 2007 Nov;4(6):1708-12
»
» INTRODUCTION:
» Sexual adverse experiences such as erectile dysfunction (ED), loss of
» libido, and ejaculation disorders have been consistent side effects of
» finasteride in a maximum percentage of 15% after 1 year of therapy. Such
» data could be seen as far from reality, if compared to a higher percentage
» that may be found in any common clinical practice.
»
» AIM: This study aims to explain the dichotomy between literature’s data
» and clinical practice data.
»
» METHODS:
» One hundred twenty patients with a clinical diagnosis of benign prostatic
» hyperplasia (BPH), sexually active and with an International Index of
» Erectile Function-erectile function (IIEF-EF) domain >/=25 were randomized
» to receive finasteride 5 mg concealed as an “X compound of proven efficacy
» for the treatment of BPH” for 1 year with (group 2) or without (group 1)
» counseling on the drug sexual side effect. The phrase used to inform group
» 2 patients was “. . . it may cause erectile dysfunction, decreased libido,
» problems of ejaculation but these are uncommon”.
»
» MAIN OUTCOME MEASURES: The estimation of side effect was conducted at 6
» and 12 months using the male sexual function-4 (MSF-4 item) questionnaire
» and a self-administered questionnaire.
»
» RESULTS: One hundred seven patients completed the study. Group 2 patients
» (N = 55) reported a significant higher proportion of one or more sexual
» side effects as compared to group 1 (N = 52) (43.6% vs. 15.3%) (P = 0.03).
» The incidence of ED, decreased libido, and ejaculation disorders were 9.6,
» 7.7, and 5.7% for group 1, and 30.9, 23.6, and 16.3% for group 2,
» respectively (P = 0.02, P = 0.04, and P = 0.06).
»
» CONCLUSION: In the current study, blinded administration of finasteride
» was associated with a significantly higher proportion of sexual dysfunction
» in patients informed on sexual side effects (group 2) as compared to those
» in which the same information was omitted (group 1) (P = 0.03).
»
» A scenario similar to group 2 of the current study is likely to occur in
» clinical practice, where the patient is counseled by the physician and has
» access to the drug information sheet.
»
» The burden of this nocebo effect (an adverse side effect that is not a
» direct result of the specific pharmacological action of the drug) has to be
» taken into account when managing finasteride sexual side effects.

I think the social/psychological nature of ED leads to correlations that are nothing more than “scapegoats” for a prexisting - but undisclosed - condition. Men are unwilling to honestly report ED, and this must be taken into consideration when causation is assigned. Its too bad; finasteride is overwhelming successful as a preventative measure and can add years to the longevity of one’s hair.

4

Once again, NO, NO, NO. Finasteride and dutasteride impair the sexual function in many more cases than declared. You could at least admit that Mercks’ data are wrong. They have always claimed 1-2% of sexual sides. We see here that the bracket would rather be 6 -10%. I personally had no noticeable problem with 1mg of fin, telling any curious guy that he could take the drug safely and switched to 2.5 mg with no concern, no worry, even no idea that the drug could decrease my potency. Until the day when it broke out brutally. I am the perfect example of a NON PLACEBO case. Rather an anti placebo. And unlike what they say, the condition has not the least improved over time. All this is BS.

5

the studies you post always use propecia and you act like this means all 5 ar inhibitors, when natural ones like Saw Palmetto and pygeum and nettles, in most people actually increase libido, i would like to see a poll on the board about this

do not lump natural 5 ar inhibitors in to your group when all the studies seem to be about Propecia, which reduces Serum DHT levels, while Saw Palmetto does not

6

You mean Saw palmetto does not reduce DHT levels?

7

found this on google books, a study done where Saw Palmetto did not decrease blood serum levels of DHT
whereas Fin reduces it by as much as 80 percent in some sources i found
sorry i could not cut and paste this from google books it wont allow

If you search around you will find many other studies saying the same thing, this is certainly not the first one I found saying this, i just found it in google in a few seconds

8

In that case you cannot call it 5 AR inhibitor …

9

» In that case you cannot call it 5 AR inhibitor …

apparently the scientific community disagrees with your statement as you can find 100s of studies referring to Saw Palmetto as a 5 AR inhibitor

A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia.
J Altern Complement Med. 2002 Apr;8(2):143-52. Clinical Research and Development Network, Aurora, CO, USA.
Androgenetic alopecia (AGA) is characterized by the structural miniaturization of androgen-sensitive hair follicles in susceptible individuals and is anatomically defined within a given pattern of the scalp. Biochemically, one contributing factor of this disorder is the conversion of testosterone (T) to dihydrotestosterone (DHT) via the enzyme 5-alpha reductase (5AR). This metabolism is also key to the onset and progression of benign prostatic hyperplasia (BPH). Furthermore, AGA has also been shown to be responsive to drugs and agents used to treat BPH. Of note, certain botanical compounds have previously demonstrated efficacy against BPH. Here, we report the first example of a placebo-controlled, double-blind study undertaken in order to examine the benefit of these botanical substances in the treatment of AGA. The goal of this study was to test botanically derived 5AR inhibitors, specifically the liposterolic extract of Serenoa repens (LSESr) and beta-sitosterol, in the treatment of AGA. Subjects: Included in this study were males between the ages of 23 and 64 years of age, in good health, with mild to moderate AGA. RESULTS: The results of this pilot study showed a highly positive response to treatment. The blinded investigative staff assessment report showed that 60% of (6/10) study subjects dosed with the active study formulation were rated as improved at the final visit. This study establishes the effectiveness of naturally occurring 5AR inhibitors against AGA for the first time, and justifies the expansion to larger trials.

regardless it has the same effect as the propecia without all the negative side effects because it does not lower serum DHT levels

what more could u ask for

10

If the DHT serum level is untouched, then there’s no inhibition of the 5ar… Then SP would rather bind locally to the ARs…

11

» If the DHT serum level is untouched, then there’s no inhibition of the
» 5ar… Then SP would rather bind locally to the ARs…

i have seen studies also which said the SP reduced serum levels mildly

again take it up with the scientists, the referring to it as a 5 ar inhibitor

12

» » If the DHT serum level is untouched, then there’s no inhibition of the
» » 5ar… Then SP would rather bind locally to the ARs…
»
» i have seen studies also which said the SP reduced serum levels mildly
»
» again take it up with the scientists, the referring to it as a 5 ar
» inhibitor

maybe saw palmetto binds with receptor sites in such a way as to allow testosterone to be uptaken but dht not to be uptaken…or maybe saw palmetto binds with serum dht so its still there, but cant bind…

it IS helpful for prostate hyperplasia and in cellular experiments the fatty acids therein certainly inhibit dht. Topically Saw Palmetto was found to decrease sebum in the Italian experiment with it…thats a good sign.

13

» » » If the DHT serum level is untouched, then there’s no inhibition of the
» » » 5ar… Then SP would rather bind locally to the ARs…
» »
» » i have seen studies also which said the SP reduced serum levels mildly
» »
» » again take it up with the scientists, the referring to it as a 5 ar
» » inhibitor
»
»
»
»
» maybe saw palmetto binds with receptor sites in such a way as to allow
» testosterone to be uptaken but dht not to be uptaken…or
» maybe saw palmetto binds with serum dht so its still there, but cant
» bind…
»
» it IS helpful for prostate hyperplasia and in cellular experiments the
» fatty acids therein certainly inhibit dht. Topically Saw Palmetto was found
» to decrease sebum in the Italian experiment with it…thats
» a good sign.

also saw palmetto has been found to inhibit both type 1 and type 2 5AR while propecia was only found to inhibit , one type

forgot which one

14

hmm this is an old thread, well im going to have my say and bring it back to life, the stats for the prevalence of sexual side effects from such 5ar inhibitors is totally indicative of the percentage of the population who have gilberts syndrome of the ugt deficiency type, which is 10-15% of the population. people with gilberts have higher dht levels than other people in the population because the enzyme deficiency they have is responsible for conjugating dht and making it hydrophilic bio-inactive and excreatable through the kidneys and liver, they have on average a 70% reduction in this effect on dht so its the people with high bilirubin levels that are going to notice the drop in sex drive from 5ar inhibitor the most,

and any study like this one that wants to make a point could easily exclude the people with gs from there study to make the point the wish to convey, if you went and picked at random 100 people off the street chances are you will only find one with gs in that 100, but its the people with gs or high unconjugated bilirubin that are most likely to have hair loss and thus take a prescription 5ar drug for hair loss, personally i think every single medical population study that is ever done should declare what percentage of people were of gs type because they are so damm biologically metabolically different to the general population!!! and if they dont then the people who conduct such surveys should be held to account and not taken seriously.

15

“is Erectile dysfunction a ‘nocebo’ effect of 5 AR inhibitors? (Drugs & Medications)”

Generally ? No, it isn’t.