Talk:Finasteride/Archive 2

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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That is a blog, not peer reviewed research, unlike the 5 year Proscar FDA Study (n~=3000), or the FCPT (n~=19,000).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)

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)

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 Wikipedia 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/wiki/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 Wikipedia, even if the condition is rare. Many people trust Wikipedia 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 Wikipedia 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 [WP:MEDRS]. 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 Wikipedia 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. Wikipedia 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 Wikipedia 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 Wikipedia'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 Wikipedia'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 Wikipedia 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 Wikipedia 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..." [my highlighting] 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 Wikipedia, 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 Wikipedia 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 [9,21]. 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 [22-24]. Moreover, change in the levels of allopregnanolone is found to be associated with depressive disorders. [25,26] 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 [11,79–83].
• 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 Wikipedia 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 Wikipedia 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 Wikipedia, 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 Wikipedia 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 Wikipedia? 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 Wikipedia, 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 Wikipedia 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 Wikipedia 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 Wikipedia 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 Wikipedia. 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)

Individual conferences are rarely notable for discussion on Wikipedia, even if they discuss something interesting. A secondary source is required to support any claim of importance. For instance, if the members of the conference agree on a classification, and this classification is then adopted as a professional standard, the conference assumes importance (see examples of this in pulmonary hypertension and hereditary hemorrhagic telangiectasia).

I am very concerned that Doors22, being as close as you can get to a single-purpose editor, is allowing his strongly held views to interfere with basic civility. I don't think that if you were disagreeing with someone in public, you would risk comparing them with a Nazi. Despite the anonymity of online sites such as Wikipedia, this kind of basic standard of conduct should be kept here also. Any further aggressive outbursts are likely to lead to long-term blocking. JFW | T@lk 19:24, 27 September 2011 (UTC)

If somebody tried to intimidate me with some kind of power and silence my opinions, I would certainly find them to share similarities to the Nazis or at the very least a fascist. Your analogy tries to seriously downplay your hostility and aggression. Contrary to your claim, I am not a 'single-purpose-editor' but even if I were I still have every right to edit Wikipedia. 96.224.160.64 (talk) 04:17, 28 September 2011 (UTC)

You really must stop making comparisons. I am not arresting you without charge or shooting you. This is the internet. Get real.

It is blatantly obvious that you are a single-purpose editor, because apart from the few edits you made to achieve "autoconfirmed" status everything you have ever done on this encyclopedia is add negative information about finasteride.

Now please advise whether there is a secondary source that confirms the importance of the conference on post-finasteride syndrome. In the absence of such as source, I think the discussion is finished. JFW | T@lk 13:05, 28 September 2011 (UTC)

NPOV Concerns Supported

To disclose: I am someone that was recently prescribed Proscar by my doctor, and I came to find information regarding possible side-effects.

This article reads like a horror story. There is a massive amount of weight dedicated to sexual side effects, despite government research to the contrary. It's dangerous to present the information in this manner. "Many people report persistent diminished libido or erectile dysfunction, even after stopping the drug." is the first sentence under Sexual Side-Effects. The effect of such heavy words on the emotions of vulnerable patients should not be underestimated. It's given me pause, and I don't even agree with it.

98.220.237.60 (talk) 00:27, 15 October 2011 (UTC)

Yes, welcome to the encyclopedia that everyone can edit. Unfortunately, many drug articles look like this. A quick look at this discussion page will reveal that there are editors with very strong agendas, often driven by personal experience. As a non-expert I am not in a great position to improve articles of this kind, and we sorely lack contributors who are prepared to do the research that is required to make an article like this truly encyclopedic and balanced.

Please encourage your doctor to become a Wikipedian! You can quote this article: doi:10.2196/jmir.1589 JFW | T@lk 20:00, 17 October 2011 (UTC)

The side effects listed in this article are the same information found in the product package information insert. Persistent sexual dysfunction is now listed by Merck as a side effect of using Propecia. Despite the discussion issues listed above this article is now of a high quality and NPOV. JacksonKnight (talk) 19:37, 23 October 2011 (UTC)

To the anonymous poster, you should feel free to adjust the tone of the article if you feel it is biased and I would encourage you to do so. But facts are facts and these issues can be found on the Merck labeling information and in published articles. JFDWolff has a very strong bias and has been keen on removing some of the factual statements in the past where he should focus on adjusting the tone, but I would welcome you to alter the presentation of the facts in such a way that you don't feel compelled to initially take a stance either way.Doors22 (talk) 21:18, 6 November 2011 (UTC)

My main concern against re-writing the article was that I did not want to remove any factual information. The current revision of the article seems reasonable to me. It does not focus solely on sexual side-effects, but does list them in whole. 98.220.237.60 (talk) 05:11, 16 November 2011 (UTC)

Cool, I am glad you are satisfied with the current iteration. I feel it is very important for the public to be aware of potential side effects, especially when physicians are willing to write freeflowing prescriptions without any consideration for the possible ramifications of doing so. It is important that the article maintains a neutral tone, of course, to prevent readers from entirely denying the facts. To JFDWolff, I do not think you are biased for the simple fact your are disagreeable. However, I do find your latest comment to be unnecessary and puerile and would appreciate it if you stay focused on the topic going forward. Doors22 (talk) 23:55, 20 November 2011 (UTC)

You disagree with me = I have a bias. That's what it is, isn't it? JFW | T@lk 23:14, 6 November 2011 (UTC)

Propecia Website Shut Down

The Propecia website has been shut down as of October 2011 whereas the rest of the product specific pages on Merck's website remain fully operational. They have removed all marketing materials and all that remain are links to a Propecia rebate program and a notice encouraging patients to report adverse side effects to the FDA. This is a very interesting development and there has been plenty of notice on the internet surrounding this action. What is required for me to put this on the Wiki article? I am happy to discuss wording if there are problems with how it was worded.

Doors22 (talk) 04:19, 25 January 2012 (UTC)

See WP:Reliable sources, especially this section. OhNoitsJamie ^Talk 04:53, 25 January 2012 (UTC)

From my perspective my edit is 100% compatible with what is the Wiki policy for "Reliable Sources". WP:No Original Research states: "A primary source may only be used on Wikipedia to make straightforward, descriptive statements of facts that any educated person, with access to the source but without specialist knowledge, will be able to verify are supported by the source." My comments were entirely descriptive statements of fact that even a young school child would be able to verify as being true. There was no presence of analysis or interpretation in my statement. I merely said the website was shut down and a new message replaced its text regarding side effects. Do you have any additional feedback? Doors22 (talk) 05:09, 25 January 2012 (UTC)

Yes, the website says what it says, but to include this in an encyclopedia you need a secondary source that provides context, supports the relevance (at the moment the relevance is not established beyond what are essentially conspiracy theories), and so on. JFW | T@lk 11:00, 25 January 2012 (UTC)

The WP:No Original Research page clearly shows that a secondary source is not necessary since it is merely a descriptive statement that does not require expert interpretation. The matter of relevance is an entirely separate issue, however. It is not a 'conspiracy theory' but clearly a reaction to the increasing awareness of the dangers of Propecia. They shut down both of their finasteride websites within months of updating the warning labels to include information that finasteride can cause irreversible side effects. However, stating that the website was shut down and replaced with a link to FDA medwatch does not contain any editorial opinion and is simply fact. I now turn to other Wikipedia members for additional opinions since JFDWolff has been unreasonably disagreeable in my experiences with him in the past and a single opinion is not sufficient to remove edits. Is it reasonable to add a sentence describing the fact that the Propecia websites have been removed from the internet and replaced with a warning to follow up with the FDA if issues arrive? Doors22 (talk) 02:48, 26 January 2012 (UTC)

I do not understand the importance of adding this to an article about Finasteride? The content from the Propecia website is readily available from numerous other sources, and the circumstances surrounding the removal of the official Merck Propecia website are entirely speculative. You say: "clearly a reaction to the increasing awareness of the dangers of Propecia" but this appears to be simply your interpretation of the event. I agree with Jfdwolff, and that these types of submissions should be saved for other mediums such as public forums and social pages, as it would seem out of place and of no use to the average reader of this article. Perhaps in the future if further information is available that supports your speculations, it would make sense to be included in this article. DangerGrouse (talk) 06:13, 26 January 2012 (UTC)

The average user of this Wiki article is going to be a man facing hairloss that is considering taking Propecia and doing further research. It is not going to be an individual that is curious about how the drug is chemically synthesized or its scientific mechanism of action for non-practical purposes. This information is important for the average reader, for this reason, and would be information one would like to know so that they further research why the website was shut down elsewhere. Doors22 (talk) 12:44, 26 January 2012 (UTC)

This page is not aimed at a particular population. It is meant to provide comprehensive and reliable information about the chemical, which includes chemical synthesis all the way to important references in popular culture. Alluding to supposed motives for the website shutting down is WP:NOR if the manufacturer gives no reason. Time to drop it? JFW | T@lk 14:44, 26 January 2012 (UTC)

Once again you are completely distorting the discussion. The average user (not a targeted population) would be interested to know that the website shut down. I am not making any allusions to why it was closed, but I am merely stating the facts which allow readers to do further informal research on their own. Your opinion is not the only one that matters and I will wait to consider other feedback so that a reasonable consensus is reached. Please stop trying to use Wikipedia as you bully pulpit. Doors22 (talk) 02:24, 27 January 2012 (UTC)

I don't think I am distorting the discussion. Websites shut down all the time without anyone caring a hoot. By mentioning it, you suggest that the company has something to hide. I am not trying to use Wikipedia as a bully pulpit, and neither will I accuse you of being a single-purpose account who is only here to add negative information about some drug you had problems with. Feel free to engage the usual dispute resolution process, but other editors have already reacted (see Ohnoitsjamie's comments above). JFW | T@lk 07:05, 27 January 2012 (UTC)

Ohnoitsjamie has simply offered a reference to the Reliable Sources page, which showed that it was entirely acceptable to use the website as a source. Your passive aggressive comments are unhelpful as you have poisoned the well by portraying me as a 'single purpose account' while saying you are not offering such an accusation. I have made edits on other pages, but either way single purpose users are in no way acting against the regulations of Wikipedia. As I said, I will continue to wait for others to offer their opinions otherwise I will initiate the dispute resolution process when I feel it is appropriate. Your abusive behavior will not be overlooked. Doors22 (talk) 22:42, 28 January 2012 (UTC)

Okay. Can I suggest you discuss the issues rather than your interpretations of my behaviour? JFW | T@lk 09:21, 29 January 2012 (UTC)

Should side effects be changed?

I was recently prescribed Propecia, and found my way to this article a while back to learn a little more about the drug. I notice the side effects listed here were drastically different than what was listed on my product insert. For instance, this article lists impotence occurring in up to 18.5% of patients, but my package insert indicates all sexual related side effects occur in less than 2% of men. Additionally, I came across a study (http://www.ncbi.nlm.nih.gov/pubmed/21980923) that concludes the total of all adverse reactions occurred in 0.7% of men, in a sample of 3177 individuals. I agree with another editor that this article reads a bit like a horror story. I just wanted to shed some light onto this as I am not an expert on this subject by any stretch, but it's a little puzzling.

One more point that I would like to make: are impotence and erectile dysfunction not one and the same? Why is impotence listed separately as a different side effect? Please correct me if I’m wrong, but this seems strange to me. In fact, ‘impotence’ links to the page on erectile dysfunction. It may make more sense to simply remove ‘impotence’ and the corresponding incidence percentages from the list. DangerGrouse (talk) 02:37, 7 February 2012 (UTC)

The list of side effects should be based on high-quality secondary sources. See WP:MEDRS. I agree that the discrepancy is worrying. JFW | T@lk 22:47, 8 February 2012 (UTC)

The list of side-effects for the most part is based on high-quality secondary sources. The insert label is a primary source, and problematic as it is the result of a study conducted by a company that planned to sell the drug along, making it prone to serious conflicts of interest. Please feel free to change what you feel is appropriate and hopefully the Wikipedia community will respond respectfully.Doors22 (talk) 02:10, 10 February 2012 (UTC)

Emotional disturbances section

Hi. I added a fairly in-depth section on emotional disturbances caused by finasteride (link). However, upon doing so, Jfdwolff reverted my additions, citing that they were in conflict with WP:MEDRS due to the fact that the section was "based purely on primary research" (paraphrasing). However, this was not accurate; a secondary source review was included (which he had apparently missed). As a result, I restored the section and added the reference for the review to a few more spots in the section to make its presence more obvious. However, once again, Jfdwolff reverted the changes and deleted everything in the section except for the very first sentence, stating that he "removed everything based on primary sources" because "use of primary sources are in conflict with WP:MEDRS" (again, paraphrasing). However, once again, this is untrue. The secondary source review more or less summarizes just about everything that was written in the section (which leads me to think that Jfdwolff did not bother to actually check the review before deleting the content). I included the primary sources mostly simply for additional context as well as improved accessibility. I figured doing so would be a lot more helpful than including the same reference template for the secondary source over and over again (which I could actually do at this point and would for the most part solve this matter, but I do not want to do that as it would detract from the quality of the article). Furthermore, WP:MEDRS does not state that primary sources cannot be used; so long as a given section is not purely based on primary sources (i.e., that a secondary source is also present), and so long as any reference to a primary source closely follows the interpretation of the data given by the authors or by secondary sources, primary sources may be included. See this excerpt from WP:MEDRS:

Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse. For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources, as defined above (see: Wikipedia:No original research).

Based on this, the section is compliant with WP:MEDRS. The secondary source covers the majority of the content in the section and the primary sources supplement it with additional information. In addition, the data from the primary sources is reproduced in a manner that is exact to what the authors themselves state. The only part in which I think could be in violation with WP:MEDRS is the final sentence: [...] due to the involvement of not only DHT [dihydrotestosterone] but the NAs [neuroactive steroids] as well, the fact that these effects occur in females too can also potentially be readily explained." At no point did any of the studies or the review state this (that I remember seeing at least), but I figured it was a fairly obvious and indeed perfectly valid conclusion so I decided to include it anyway. Nonetheless, I will remove it if necessary.

Finally, the section is very detailed and informative, and it is not opinionated (except for the final sentence arguably). It provides a great deal of useful information on the topic at hand, all of which is fully in accordance with the data contained in the papers cited (again, except for that last sentence). I actually added the section because I was sick of having to explain to people I met online why they were getting depressed while taking finasteride. To remove all of the content of the section except for the first sentence would substantially detract from its usefulness as well as from the accessibility to the relevant data in question and would prevent many people to whom it may be relevant to and potentially very beneficial to know of from learning about. After all, these appear to be pretty common side effects (e.g., that one study found a mind-boggling incidence rate of 83%), but as of present information on them is relatively obscure to the general population. I guess what I'm trying to say is that not only is there no justifiable reason that the content be removed since the section is compliant with WP:MEDRS but that one would be very hard-pressed to successfully argue that removing it would actually do more good than it would harm.

In any case, with all of that being said, namely due to the fact that the section is in fact compliant with WP:MEDRS (as far as I can see), I am going to once again restore the section now.

To Jfdwolff: if you still for whatever reason have an issue with the section even after reading all of this, please discuss your concerns here instead of simply reverting my changes again. I have presented my case, and if you are still at odds with me you will need to address what I have said here so that we can come to some sort of consensus on the matter. If necessary, I will do my best to work with you so that you too are satisfied with the content and presentation of the section. el3ctr0nika (Talk | Contribs) 04:44, 11 May 2012 (UTC)

P.S.: I apologize if I come across as a little hard around the edges; I'm just a little irritated, hopefully for reasons that you can understand (e.g., quite a bit of time and effort was put into all of this). el3ctr0nika (Talk | Contribs) 04:44, 11 May 2012 (UTC)

Whichever way you take it, your addition was based overwhelmingly on directly cited primary sources. Momentarily leaving apart the exact phrasing of MEDRS, I would personally be astonished if a general purpose encyclopedia based its content in primary sources, particularly small in vitro or mouse studies. It is entirely sufficient to say that people taking finasteride may experience mood disorders and that there is a statistical association (based on a secondary source), and that certain mechanisms are thought to underlie this association (based on a secondary source). I would strongly recommend you adopt this approach, which generally leads to better content that doesn't suffer from disagreements with regards to the relative weight lent to particular research findings. JFW | T@lk 18:33, 11 May 2012 (UTC)

Sorry for the delay.

Whichever way you take it, your addition was based overwhelmingly on directly cited primary sources. Momentarily leaving apart the exact phrasing of MEDRS, I would personally be astonished if a general purpose encyclopedia based its content in primary sources, particularly small in vitro or mouse studies.

Again, the primary sources were mostly supplementary of the secondary source review. If you read the review yourself (link to PDF) you'll see that it covers just about everything written in the entire section. The only thing that I can see that it didn't cover was the case report mentioned in the first paragraph. (And obviously that Merck added depression to the list of possible side effects on the Propecia label but that isn't really relevant here.) Also, I didn't cite any in vitro studies at all. Some in vivo animal studies were cited, yes, but again, they were simply supplementary of information that had already been contained in the review.

It is entirely sufficient to say that people taking finasteride may experience mood disorders and that there is a statistical association (based on a secondary source), and that certain mechanisms are thought to underlie this association (based on a secondary source).

I disagree. Well, I mean, it may be adequately sufficient to do that, but it's obviously going to be more informative and beneficial to the reader if the article goes into further detail on the subject.

I would strongly recommend you adopt this approach, which generally leads to better content that doesn't suffer from disagreements with regards to the relative weight lent to particular research findings.

Fair enough. In any case, perhaps the mechanism part of the section could be adapted and moved to mechanism of action section. It would reduce the apparent weight of the section and I think would be more appropriate in the mechanism of action section anyway. After all, inhibition of neurosteroid biosynthesis is implicated not just in the affective side effects of finasteride but in its sexual side effects as well.

el3ctr0nika (Talk | Contribs) 06:15, 13 May 2012 (UTC)

Much of this data is very recent, and one must be careful with WP:RECENTISM and WP:CRYSTAL in any such content. JFW | T@lk 20:46, 13 May 2012 (UTC)

Well, to be fair, finasteride is a fairly new drug. And there were indications that it could cause depression before it had even been marketed. In any case though, noted. el3ctr0nika (Talk | Contribs) 04:20, 15 May 2012 (UTC)

Could I persuade you to trim down your section to material that can be cited directly to the secondary sources? JFW | T@lk 20:52, 16 May 2012 (UTC)

Well, like I've been saying, with the exception of the case report (and the very last two lines of course), virtually everything can be cited directly from that main secondary source. I would be happy to remove that case report though if you'd like me to. After all, such a reference isn't exactly evidence of a particularly good quality, I agree. In fact, I'll just go ahead and remove it now. el3ctr0nika (Talk | Contribs) 21:00, 16 May 2012 (UTC)

Edit: Ended up changing a lot more than just that. Better? el3ctr0nika (Talk | Contribs) 21:59, 16 May 2012 (UTC)

recent news item that I hope will be of use

http://gma.yahoo.com/men-propecias-sexual-side-effects-may-long-lasting-215732153--abc-news-wellness.html

"For Some Men, Propecia's Sexual Side Effects May Be Long-lasting By CARRIE GANN, ABC News Medical Unit | Good Morning America – Wed, Jul 11, 2012 5:57 PM EDT" to replace footnote 26 , which is a dead link: Allen, Jane E (3 May 2012). "Pursuit of Better Hairline Costs Some Men Their Sex Lives" (HTML). ABC News: pp. 1-3. GangofOne (talk) 08:46, 13 July 2012 (UTC)

Please add section on reported TE side effects

A google search turns up a lot of discussion on telogen effluvium occuring as a side effect during the use of finasteride. The side effects are consistent with TE, diffuse and not localized (therefore likely not androgen dependant), with onset usually within 2 months of beginning the drug and resolution after 4 months and spontaneous relapse/occurance at any time - consistent with the Telogen Effluvium seen in other drugs. The effect is worrisome to many as it 1)potentially makes existing hair loss more severe cosmetically and 2)could be persitent in it's duration if the drug is continued as some reports say they continue to experience diffuse hair loss months into use.(this last point should be left out perhaps) cosmetically Merck has not observed this effect in any of it's literature but there are so many reports on online forums that many consider it standard or expect it to occur. Feel free to take any scentences that I have used here or add your own at your will, I just hope this gets added as it is information that is critical and missing as an "internet discussion phenomenon". The forums are biased and having an unbiased source of info here describing the phenomenon would be good. PS:the drug's inhibition of 5-alpha-reductase does not only affect the 5-alpha-reduction of androgenic compounds but also of various nervous-system-interacting hormones and these effects are thought to be behind the side effects of depression etc ie., it is not only androgens that get 5-alpha-reduced...— Preceding unsigned comment added by 173.34.53.98 (talk) 03:33, 17 July 2012 (UTC)

shedding reported in many languages, here is one in japanese http://xn--cckyb9em8g.net/tishiki/syoki.php The website says the phenomenon of shedding after a time of beginning finasteride is generally called プロペシアの初期脱毛 literally "propecia's comencement period shed" — Preceding unsigned comment added by 173.34.53.98 (talk) 00:39, 7 August 2012 (UTC)

Post-finasteride syndrome foundation

Doors22 (talk · contribs) added a separate paragraph to discuss the existence of this organisation. The only reference is from the organisation's own website. Without any prejudice on the organisation's activities, I think we should only discuss it if we can supply a source that demonstrates the foundation's notability. JFW | T@lk 21:19, 1 September 2012 (UTC)

Jfdwolff (talk · contribs) removed added paragraph for a second time. After the first time, he cited the need for a source that demonstrates the foundation's notability. His request was satisfied with a leading Australian newspaper. However, he removed the edit for a second time with the additional source. Do not remove the source again or I will report your abusive editing activities. Feel free to discuss if you feel it needs to be discussed, but your single request was clearly satisfied which does not allow you the right to remove edits at whim.Doors22 (talk) 02:01, 27 September 2012 (UTC)

An adverse effects section is not constructed with citations to political groups and newspapers. We need WP:MEDRS. Maybe one sentence to the group is deserved in a society and culture section. That's the only way I see them getting mentioned here. Biosthmors (talk) 02:09, 27 September 2012 (UTC)

You make a fair point. It is perhaps better suited to a society and culture section. I have placed the condensed text in a new section. However the group is not a 'political group' as you say, it is a foundation that is dedicated to financing research for an orphan disease caused by finasteride. Doors22 (talk) 03:29, 27 September 2012 (UTC)

Personally, I don't see how the section is anything more than giving undue weight to a non-notable organization. -- Ed (Edgar181) 13:32, 27 September 2012 (UTC)

I think your revert of this material was appropriate. The content was still biased[1] by stating, in Wikipedia's voice, that this syndrome was real without using any reliable medical sources. Even starting a society and culture section stating in one sentence that this group was established, without any other information on the societal (such as economic) influence of this drug is also risking undue weight. Biosthmors (talk) 16:47, 27 September 2012 (UTC)

If you are concerned with lack of medical sources that can easily be accommodated... there are 4 or 5 articles that have been published that confirm PFS exists. Some of them have already been cited elsewhere in the articleDoors22 (talk) 00:58, 29 September 2012 (UTC)

This is now at the Post-Finasteride Syndrome, and any diskussion about the existence of PFS is ridiculous. There are simply to many papers about this topic.

"Our research definitely concludes that PFS is real. For a subset of these men, the damage persists—maybe forever—even after they go off the drug. We don’t fully understand why, but it is as if something shuts off biologically, and stays that way."

by M. Traish, PhD, Professor of Biochemistry at Boston University School of Medicine

"We are becoming more and more aware of persistent sexual health problems occurring as a result of the use of 5-alpha reductase inhibitors, finasteride, and dutasteride, in a subset of patients. What is even more alarming is that in addition to persistent sexual issues, there are persistent central cognitive issues and concerns of persistent depression."

by Irwin Goldstein, MD, Editor-in-Chief of the Journal of Sexual Medicine

Valid ref. can be found in the article and even the term is used. It´s funny how people want to diskuss written and valid papers away. Even the 5AR3 is nothing new, why is this not in this article? --Brainbug666 (talk) 04:03, 4 October 2012 (UTC)

Take a look through Wikipedia:MEDRS. You have quoted what two doctors believe, but understand there exists a firm distinction between belief and recognized medical facts that are accepted by the consensus. If you could please provide direct links to the articles you obtained the quotes from then they can be addressed and discussed directly. DangerGrouse (talk) 04:53, 4 October 2012 (UTC)

Funny, sorry but can you count? You say, I quoted what two doctors believe. Please, try to count again. What you write is not true. Just take the first article, I count 7 who worked on it. There are many more even in the PFS article I count more than two MD. Please, stay on the truth. Or do what youself want, show a source. I should provide a direct links to the articals? Are you kidding? Please, read the Wikipedia:MEDRS. Do you ask people also, that they should send you the book, when they did a quote by it? Anyway, if you like to talk about it, here is the discusion. Please add also to this article about finasterid, that it also inhibits the 5ARIII. Or do also only two MD believe that 5ARIII exits?

--Brainbug666 (talk) 17:09, 4 October 2012 (UTC)

I would appreciate if you could please take on a more respectful tone. You posted two quotes by two doctors with no links to the sources themselves. I have no idea what sources you are referring to, or where you obtained these quotes from. I do not need a direct link to the full text of the article, but a link to the abstract or the PMID is necessary if you wish to discuss these sources. We are not discussing 5ARIII, so I will not comment on this.DangerGrouse (talk) 01:39, 5 October 2012 (UTC)