THE NOCEBO EFFECT
The role of nocebo effect in the causation of ED due to finasteride has been investigated (1). Nocebo effect refers to an adverse effect that results from the psychological awareness of the possibility of the side effects, but is not a direct result of the specific pharmacological action of the drug. In this study, the group informed about the sexual adverse effects of finasteride reported increased incidence of ED, when compared to the group without information (1). The side effects were completely reversible in 5 days when the medicine was discontinued, confirming that nocebo effect has an influence in causation of side effects and suggesting the role of psychological factors.
Two studies in 1998 and 1999 showed that the incidence of these side effects with finasteride therapy was generally comparable to that observed with the treatment with placebo (2,3),and there was no evidence of dose dependency or increased incidence with longer therapy out to 12 months.
In addition, the side effects ceased in patients even when they continued to receive finasteride (and told they weren't).
A long term study showed that drug-related sexual side effects such as decreased libido, ED, and ejaculatory disorders occurred in <2% of men (4).These side-effects disappeared not only in all men who stopped the drug because of the side effects but also in most of those who continued therapy. The incidence of each side effect mentioned decreased to ≤0.3% by the fifth year of treatment with finasteride. The incidence of side effects were comparable to that of placebo both at one year and at 5 years.
The mind is indeed a powerful instrument and the creator of all processes. No causal relationships have been established in your cited studies (through my perusal) between finasteride and loss in brain function. I have zero sexual dysfunction, nor any compromise in focus, concentration, thinking. Danger attested to none as well. What about you, Ubercat; any Asian girls complaining about your lack of brain function or that they aren't being piped correctly?
But hey, if one starts Finasteride, and feels a side effect, then get off. Any manipulation of hormones, including DHT, IMO could throw something off. Any side effects, if any, would be related to the reducing of DHT by 80%+, not so much the finasteride. Nothing wrong with a bald head. But if one wants to keep their hair, they must engage before the hair loss, as a bald head will remain bald outside of FUE/FUT hair surgery.
REFERENCES
1. Mondaini N, Gontero P, Giubilei G, Lombardi G, Cai T, Gavazzi A, et al. Finasteride 5mg and sexual side effects: How many of these are related to a nocebo phenomenon? J Sex Med. 2007;4:1708–12. [
PubMed]
2. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W. Finasteride in the treatment of men with androgenetic alopecia. J Am Acad Dermatol. 1999;41:555–63. [
PubMed]
3. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermaol. 1999;40:930–7. [
PubMed]
4. Kaufman KD. Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. Eur J Dermatol. 2002;12:38–49. [
PubMed]