The paper mentions that finasteride passes through the blood-brain barrier and affects the conversion of progesterone to allopregnanolone, where low levels of allopregnanolone are associated with depression. Together with the correlational evidence for depression and suicidality, this presents a reasonable picture for concern.
Since there is a known central activity, it also raises the question -- in fact the article explicitly mentions it -- of whether a brain-sparing analogue of finasteride might not show the same side effects.
The apparent connection to "masculinity" or "feminization" may be a red herring. Excessive concern about "sex" effects in biological systems kind of reminds me of the alchemical theory of the four elements. It's not a great way to analyze the complicated effects of medicines.
It's one of the most commonly used DTC prescription drugs and is used for a purely cosmetic purpose, so debates about it are common online and full of low-quality motivated reasoning.
Self-perception can have a profound effect on one's physical and mental wellbeing, so even drugs which are for cosmetic purposes can be important for health.
True, and, I'd posit that there are often better and safer alternatives that would be similarly or more beneficial with less potential for harmful side effects.
I have several anecdotes from my own life. When I was ~18 the doctor proposed to give me jaw surgery to fix my overbite by extending my lower jaw. I asked him what the reasons for this were and he said it was mainly cosmetic. I thought this was not a good enough reason for surgery - which while often safe does also often have harmful side effects - I now know way too many people who had surgery complications that often took a long time for them to become aware of. I think I feel better about myself now for having made that choice than I imagine I would if I had a better jaw line.
It's true that some people are going to have a story where they see the cosmetic medical intervention as having been beneficial for their mental wellbeing. I'd still suggest that in many such cases there might have been other ways to get a better outcome. It's for each of us to decide.
Still, burden of proof of the safety of a drug should be on the company profiting from it.
I think to just brush over surgery fixing a malloclusion as "cosmetic" as if it's kind of a trite thing just doesnt seem right. There's definitely risks since there's a lot of nerves that can get botched in jaw surgeries causing different problems.
I can tell you tho I would never consider it just so superficial. A lot of unconscious behavior happens based on facial symmetry that is hard wired into us. Malloclusions can effect breathing especially at night (some problems that will only surface later in life when options to fix limited by your age), the way other parts of your face look such as the nose, oral health, long term root problems, uneven wear etc etc
I had a doctor that just shrugged his shoulders and said the same thing to me. I wish id had a doctor that pressed me a little to really think about the long term picture when I had the chance.
If theres already problems like pain etc then obviously the justification is more than cosmetic.
I dont know if you are still young enough I would reconsider. I think in general overbites are still more bearable than under.
I don't want to claim that it's always just cosmetic or that no one should ever get it, but my point is sometimes there are alternatives that don't carry the risks.
Another related anecdote from my own life, I had sleep apnea from when I was a teenager. Another doctor also proposed surgery to fix my nose for that, but somehow I'd become skeptical of doctors wanting to do surgery (probably I'd heard too many stories of something going wrong.) Anyway, a year ago I fixed my sleep apnea using a nose dilator and mouth tape at night for a month. I still have overbite but mostly breathe through my nose now.
Again, not saying that surgery or intervention is always bad, but this was an even more extreme case where they wanted to do surgery to fix something that could be fixed in a much more natural and much easier and extremely cheap way, but the natural way was never mentioned by a doctor, I only heard about it from a friend 15+ years later. And it just worked, and for the past year I've not had sleep apnea - I sleep better, don't snore anymore, and can breathe enough through my nose now while exercising etc. i.e. the nose must have been able to reshape itself with the help of the dilator and necessity (because the mouth was taped). I still have overbite but I'm not sure it's really a problem especially compared with the risks of surgery.
This is the hormone that makes you bald (if you got bad cards in the genetic lottery) and also makes your prostate the size of an apple. Also causes acne as a bonus, again a bit dependent on genetics. Amazing.
Exactly what finasteride does is not well understood. It effects the endocrine system, but not in consistent ways, and with some possibly serious side effects. It is being aggressively marketed as a way to stop hair loss, but may do various other things instead.
Yeah - it's a selective testosterone blocker, kind of, and tries to target the part that causes male pattern baldness without lowering overall T Levels.
I assume it still blocks enough hormones to cause mood shifts or other effects?
> Yeah - it's a selective testosterone blocker, kind of, and tries to target the part that causes male pattern baldness without lowering overall T Levels.
> I assume it still blocks enough hormones to cause mood shifts or other effects?
Endocrinology is a lot more complicated than you're giving it credit for. DHT blockers don't necessarily lower testosterone levels; they can actually increase it (although even then, the mechanism isn't as direct as you might think).
It's neither established nor a given that any side effects of finasteride have anything to do with effects on testosterone or hormone levels at all. A lot of people make that assumption, and there's reason to suspect there's truth to that hypothesis, but it's completely possible it's an unknown side effect of the drug, and there hasn't been enough study into the mechanism to understand it (in part because the side effects are relatively rare and weakly established).
It’s not a testosterone blocker at all. It blocks 5-alpha reductase, an enzyme that converts testosterone to DHT. It can actually increase serum testosterone by more than 10%.
As for DHT, that hormone doesn’t appear to have much significance for adult males. It’s critically important in puberty, though!
Blocking the conversion of testosterone to DHT (the effect of this medication) causes an indirect and minor increase in both testosterone and œstrogen levels, although DHT is more potent than testosterone for the receptors in many tissues.
