I need your advice?

[StressedToTheBald]

Thank You Dr. Cole. I for one very much appreciate Your attention to details and having the opportunity to exchange thoughts here on the forum. If my situation changes at some point in the future, I'd be more than glad to sign up for live consultation at least.

[Winston]

Dr. Cole, with all due respect, I think I can speak for many BTT users when I say that stressedtobebald has the right to voice his opinions and concerns, but he does not have the right to destroy every thread with his rhetoric. I also disagree with your assessment of Propecia as well as your assertion of “where there’s smoke there's fire” when it come to ambulance chasing attorneys. These people are predators who simply smell blood in the water. I think it’s best to educate the less informed as opposed to pandering to them.

[Tracy C]

Dr. Cole, with all due respect, I think I can speak for many BTT users when I say that stressedtobebald has the right to voice his opinions and concerns, but he does not have the right to destroy every thread with his rhetoric.

Voicing concern is one thing - but fear mongering is something completely different. What StressedToTheBald has been doing is fear mongering. It is what it is.

[Winston]

We’re not dealing with independent thinkers here. Fear mongering is like a cancer, that if not cut out early, only spreads.

[John P. Cole, MD]

You guys must be progressives. What happened to freedom of speech?

I have prescribed propecia and avodart for years. I asked all of my patients to read the data reported by Merck prior to receiving prescription. Those who choose to fill the prescription have always done so following full disclosure.

More recently, some people have reported that dht blockers can cause depression, irreversible impotence, and sterility. I don't think any of these reports have sound scientific studies to support their conclusions.

I think the risk for high grade prostate tumors is very small and question whether finasteride might be beneficial in regard to prostate cancer.

Someone may hijack every thread with concerns about medications. I'm sure that this can be annoying if you see it every day. I don't read every thread and have not spent much time perusing so i really don't know who is doing what. i think that suggests that others are doing the same thing from time to time so the only way you might get your opinion in front of that particular person is to replay your thoughts over and over.

Now, let me say this in all frankness. The only person who can properly address the topic of medication side effects does not live on earth. These concerns do exist with a growing faction here on earth, however. The fact that many of us including myself do not necessarily agree with the newer side effects does not matter. It's an individual decision. I am told that in the UK that depression was added to the product labeling by Merck. Maybe it can cause depression. i've never had a patient complain of depression, but maybe it can cause depression.

Today i had a patient ask for a prescription of finasteride. i suggested that he break generic proscar in quarters until the Merck patent expires. he was all for this. then i went through the list of issues put out by Merck and the newer stuff that is circulating, which i don't think is scientifically sound. The patient elected to not take the prescription. Others despite full disclosure do elect to take the prescription.

I had another patient who was on propecia for 8 years. suddenly his hair started to fall out heavily again. Finasteride does not always work, it does not always work forever, and it very rarely produces significant hair regrowth. I do recommend it to anyone whose hair loss really bothers them but at the end of the day hair loss is a normal condition. If you do not like the side effect profile, you should have the right to make a choice one way or another. It's not as if you are going to die if you don't take it.

someone may incite fear, but taking away someone's right to free speech is even worse in my opinion. People should have the opportunity to make their own decisions without fear of censorship.

Ok, i hear your arguments on both sides. I've played a bit of the devil's advocate here. Let's talk about something more interesting if you like. Thanks for you opinions.

[StressedToTheBald]

I agree with Dr. Cole - if risks are clearly explained, then no one indeed has a right to deny one's choice, whatever that choice might be. What I would like however is that all doctors out there follow the same procedure as Dr. Cole. I'm afraid that way too many doctors downplay the full disclosure simply because they're not in touch with the latest news and risk updates, either that or they have personal stance on how the drug is generally safe. Patient needs to hear the whole story, to be given all the facts, even the worst case scenario and based on that the patient will make a decission on his own, like in the example given by Dr. Cole.

Same way, if propecia promoters have a right to speak freely and state their side here, the rest of us who are against propecia should be allowed to tell our side of the story as well, without beeing marked or insulted every single time.

[John P. Cole, MD]

I just reviewed a study of finasteride on Japanese patients. The response was really pretty good in the 3000 patient study population. Some quit for strange reasons though. Memory disturbance and hepatic (liver) dysfunction. I've not seen either complaint linked to finasteride in the past. Strange? What was striking was that only 12.5% had no response, while the rest of the study population had slight, moderate, or great increase (total number evaluated was over 2500). That's about the best response i've read to date.

I also recall a patient who responded to 1/2 propecia a day. he took only 1/2 pill a day because he was concerned about side effects. He had no side effects, but had outstanding hair growth.

I'm going to try to add something else on Monday.

[StressedToTheBald]

I just reviewed a study of finasteride on Japanese patients. The response was really pretty good in the 3000 patient study population. Some quit for strange reasons though. Memory disturbance and hepatic (liver) dysfunction. I've not seen either complaint linked to finasteride in the past. Strange? What was striking was that only 12.5% had no response, while the rest of the study population had slight, moderate, or great increase (total number evaluated was over 2500). That's about the best response i've read to date.

I also recall a patient who responded to 1/2 propecia a day. he took only 1/2 pill a day because he was concerned about side effects. He had no side effects, but had outstanding hair growth.

I'm going to try to add something else on Monday.

Dr. Cole, I'm interested in any way to learn how certain dosage of saw palmetto/beta sitosterol compares to certain dosage of finasteride. I've even found a section in one study claiming saw palmetto 320mg to be more potent than 5mg finasteride in BPH treatment. Do You have any insights whatsoever in how these compare. I wish someone would do a study showcasing both effectivness and dosages of natural vs. chemical DHT inhbitors.

[John P. Cole, MD]

You are searching for something that no one has any financial interest in. Suppose you want to do the study. How do you keep people in the study? You have to give them product and you have to pay someone to do the follow up, data crunching, and evaluations. Even people on welfare and unemployment get paid to do what they do every day. How can you expect a researcher to work for free?

Some altruistic individual might some day pay for the study you want, but they are more likely to pay for a cancer study if that makes sense to you.

I once saw a study that showed that saw palmetto was just as effective as proscar in benign prostatic hypertrophy.

One concern i have that someone else echoed was that if you are decreasing DHT through natural means, you might also be doing similar damage to you system. Remember that hemlock, lead, arsenic, and fire are all natural. Be careful what you look for because you might not like what you find. I like the concept of natural, but you really don't know, do you? And.....as i pointed out who is going to spend the money to insure that what you are doing is safe?

Sorry to be so morbid. I prefer to be upbeat.

[StressedToTheBald]

Well I know all that, theres no big money to be made on saw palmetto or other natural compounds, nor they are FDA regulated. By default big pharma corporations only test chemical drugs they sell at heavy price and whatever studies we're blessed to have about natural ingredients are ways smaller, less funded and much more rare. Its just, I guess I wish someone would do something even if its a small study, it would mean a lot.. Its surprising that none of the supplemental companies seem to show interest, although its them who would actually benefit the most if these natural compounds would become more mainstream alternative against propecia.

I saw that study too, saw beeing said to be as effective as proscar for BPH.

As for the safety of what I am doing, I am not really worried, I have both faith and reports from several studies to support my faith in several ways. I am decreasing DHT, but I strongly believe propecia does it with completely different mechanisms, affecting either something else or doing it too much.. Dr. Irwig says that what makes propecia dangerous is because it affects brain chemistry and unlike other drugs.. it might not stop even if the treatment ends.

Anyway, these are some findings which back the safety of my natural DHT inhibitors vs. propecia..

"Since AGA shares similar hormonal pathways with BPH, it was previously recognized that the pharmaceutical agents useful against BPH may offer some potential benefit in the treatment of AGA. The modification of Proscar (finasteride 5mg initially indicated for BPH), to Propecia (finasteride 1mg new indication AGA) serves as a paradigm for this rationale (Kaufmann 1999). Like finasteride, several botanically derived substances have also demonstrated the ability to inhibit key hormonal processes associated with BPH. Importantly, these botanicals have not been linked with the spectrum of negative side effects, adverse reactions, or teratogenicity, associated with the pharmaceutically derived alternatives (Klepser and Klepser, 1999).

Recently, several clinical trials have been reported demonstrating the efficacy of botanical compounds in the treatment of a number of androgen dependent conditions, and, specifically, BPH. For example, among 1,098 BPH patients tested in one recent study, the general safety profile of the lipsterolic extract of Serenoa repens (LSESr 320 mg/day), or saw palmetto berry extract, compared favorably with that of finasteride, and sexual side effects were less common with the extract than with the drug. In particular the use of this extract has not been associated with erectile dysfunction, ejaculatory disturbance, or altered libido (Wilt et al. 2000a). Remarkably, in another biochemical study, it was found that LSESr was a 3-fold more effective inhibitor than finasteride (5 mg/day) at concentrations adjusted to the recommended doses for BPH treatment. It should be noted that finasteride as indicated for AGA is dosed significantly lower (1 mg/day), suggesting, a 15-fold more potent level of inhibition at the recommended daily dose of LSESr (320 mg/day) (Delos et al. 1994)."

[Follicle Death Row]

I'm sure the finasteride and DHT issue will rage for a long time yet. However if you really detach yourself emotionally from this (and it's not easy) and try to objectively look at the big picture for some people it certainly makes sense not to take finasteride. I don't want to upset anyone but I think if you take hair loss out of the equation for one second and have a look at everything that DHT does you may find that it's not a trade off you want to make. For others you may want to go for it.

[StressedToTheBald]

I'm sure the finasteride and DHT issue will rage for a long time yet. However if you really detach yourself emotionally from this (and it's not easy) and try to objectively look at the big picture for some people it certainly makes sense not to take finasteride. I don't want to upset anyone but I think if you take hair loss out of the equation for one second and have a look at everything that DHT does you may find that it's not a trade off you want to make. For others you may want to go for it.

For me, finasteride is simply not worth the risk. If it was safe, I'd be the first to sign up and dearly embrace it, but with the latest findings linking it to permanent ED and even cancer and depression.. trading the potential of hair regrowth for potential of all this, its not a fair trade to begin with.

I have to put my faith and go with other anti-DHT alternatives which are natural and I hope for the same or better results than with finasteride.

What puzzles me in general.. the role of DHT in adult males. While it has crucial role in embrionic development, I am much more sceptic about its benefits in adult males.. DHT is linked both to baldness and prostate cancer ! Yesterday, in another thread, I was given a few links where a completely different perspective on given to DHT... but reading through these following articles - I still I can't say I'm convinced of DHT beeing a good thing and king of hormones as portrayed... What do You think ?

"Testosterone is great but Dihydrotestosterone is the king of all male androgens"

http://www.mikemahler.com/online-library/articles/hormone-optimization/dihydrotestosterone-king-of-male-androgens.html

or

"The Facts and Myths about DHT"

http://www.bodybuilding.com/fun/reform8.htm

[PayDay]

You should listen to the Bald Truth. Spencer Kobren has stated countless times on his show that when it comes to herbal dietary supplements, don't be fooled because they are natural. He calls these herbs part of nature's pharmacy and specifically says that they can cause side effects that can be even worse then Propecia. Something I always agreed with is that he says that because these herbs have no regulation, we'll never know the true potential dangers of taking them for the long term.
I feel much more comfortable taking a drug that is manufactured to have the exact same dose in every pill and that has been studied for years then some herbs that have been grown God knows how, picked by day workers and never studied for long term safety. Like Dr. Coles says, there is plenty of poison on being made in nature. Don't be fooled into think that what you are taking is safe because someone who is selling it tells you so. I would never take that crap.

[StressedToTheBald]

Well I personally don't suffer from any side effects with natural DHT inhibitors. Plus, if You've read one of my previous posts - studies report that these natural inhibitors compare favourably against propecia. Side effects are not reported as significant nor permanent.

As for regulation - it would be great if it worked in reality as it does in theory. As I stated in another thread, FDA has recently upgraded risk labels and now when 2 studies are out and manufacturer has pulled down their own website and will face charges in court.. FDA will either have to upgrade risk labels again and to the highest level or ban the drug. Either way, it feels like big time failure of regulation to me ! I mean, whats the point of having safety regulation when risks are beeing upgraded several times and drug has been on the market for so long and done enough damage in the process. Had the process of regulation been ideal, all these risks should have been seen and anticipated from the very starts !