domenica 14 ottobre 2012

Finasteride ed il profilarsi della disfunzione erettile a livello epidemico che minaccia milioni di uomini nel mondo: La Sindrome post-finasteride.

HAIR RESEARCH AND SCIENCE EST. Vaduz, Liechtenstein



FINASTERIDE AND THE LOOMING ERECTILE DYSFUNCTION EPIDEMIC ABOUT TO THREATEN MILLIONS OF MEN AROUND THE WORLD:

POST FINASTERIDE SYNDROME 




The dangers of finasteride have recently been exposed in two separate studies by top medical universities warning about the serious sexual side effects, often permanent in nature, produced by this Active Pharmaceutical Ingredient (API). They reported on three other significant potential side effects as well: Use of finasteride places users at an increased risk of acquiring one of the most aggressive and deadly forms of prostate cancer, may contribute to the pathophysiology of episodes of depression that have been observed following cessation of treatment and may be the cause of male breast cancer that has been reported in users.



A HIGH NUMBER OF PHYSICIANS DO NOT SEEM TO BE AWARE OF THE RISKS


As expressed by Kenneth Kochmann, M.D., general practitioner,“Over the years, I have prescribed Propecia to my patients and still do – I absolutely had no idea of its serious side effects and I do try to keep up with all the latest medical news,” a great percentage of physicians are apparently not aware of finasteride’s side effects. The results of the studies mentioned came to light by mid-2011 and, as expected, all manufacturers of finasteride commercial brands have tried very hard to keep a lid on the information. Most physicians and medical specialists are just now beginning to learn about the threat to men’s health and sexuality from this drug protocol. “Many of my friends take Propecia and I had no idea it had these side effects ... and I stay on top of the latest medical  news,” says Dr. Bashir A. zakria, Assistant Professor, Division of Sports Medicine at Baltimore’s Johns Hopkins Medical Institutes.


If these recent studies are accurate then there are millions of males with current or potential sexual problems 
looming over their lives without knowing the cause. In many cases, these men might have taken the drug years ago and discontinued use and thus the connection between finasteride and these side effects is less obvious. In fact, evidence is building that Propecia-induced erectile dysfunction and loss of libido can be permanent.  Most physicians, like the patients themselves, do not make the frightening connection between previous use of Propecia and sexual dysfunction.
Most men think of sex many times a day (at least 19 times a day among college students, based on a study published in The Journal of Sex Research and commented on by Ohio State University) and it is very common to find men who harbor a fear of sexual inadequacy. Sadly, in the case of finasteride users this common fear can transform into a dreadful reality.
Based on the above information, we can assume there may be millions of men with current or future sexual
problems walking around today with no idea why they are experiencing difficulties. If the association between taking finasteride and sexual dysfunction is not correctly made, unnecessary and erroneous visits to psychiatrists and sex counselors may increase, leading to incorrect diagnoses and treatments, potentially including psychotropic medications, and very possibly, worsening of the problem.  Second, many may also have a drug induced cancerous time bomb inside their bodies that can develop into the most aggressive and deadly form of prostate cancer. These at-risk men do not have a clue that they need an early check-up and close monitoring of potential prostate cancer development. Finally, how many physicians and their male patients around the world, who are still in the dark, continue to prescribe and begin taking Propecia or Proscar each day without being aware of the risks and debilitating, often permanent, side effects?


It is safe to say that the vast majority of men would never knowingly accept the threat of potentially significant sexual side effects such as erectile dysfunction or the risk of aggressive prostrate cancer for a fuller head of hair. The increase in self-esteem brought about by having a full, healthy head of hair is surely negated by an inability to engage in satisfying sexual activity.


HAS THERE BEEN A NEWS BLACKOUT ABOUT THE FINASTERIDE INDUCED ED EPIDEMIC?


The lack of news coverage is certainly frustrating, but the blackout has not been complete. This important topic is slowly beginning to be covered in sources such as CBS Money watch, Men’s Health and The Journal of Sexual Medicine. John Peige, a writer for The Examiner.com, has distilled much of this information into a series of timely articles on that website, which is a dynamic entertainment, news and lifestyle network serving more than 20 million readers monthly across the US and around the world. Even more detailed information can now be found in the popular Men’s Health magazine, where a few of the many cases have been depicted very clearly.


WHY ARE THE PROBLEMS ONLY NOW STARTING TO SURFACE?


First of all, few physicians have been familiar with the problem and the reports have just begun to seep out into the news media where consumers may notice them. Earlier diagnoses of the problem/solution have been lacking, to a great extent, due to the inherent nature of the medical profession: Most doctors who prescribe Propecia are general practitioners and dermatologists working with male patients concerned about hair loss, whereas the sexual side effects and prostate related problems are usually identified and treated by urologists and endocrinologists. These constitute very different medical disciplines, which seldom interact.
Second, the 2% risk of sexual side effects noted on the required packaging warning is a number similar to that found with Rogaine use.  If problems developed, patients were simply advised to use another drug protocol since the side effects of most drugs go away when patients stop taking the drugs. Thankfully, Propecia has recently changed its packaging language to also point out the permanent nature of sexual risks. Unfortunately, however, this is an almost meaningless statement given the declared 2% rate of sexual problems could actually be merely a tiny fraction of the actual rate.





http://www.biologixhair.com/default/assets/File/BiologixHairInc-Finasteride.pdf


La minaccia della sindrome sembra ora farsi largo anche tra gli esperti nel campo della medicina estetica. Questa pubblicazione dell'HAIR RESEARCH AND SCIENCE EST. mette in risalto ciò che da tempo abbiamo sottolineato, ovvero che i dottori di base ed i dermatologi - non avendo le necessarie competenze specifiche - potrebbero sottovalutare i sintomi lamentati dai loro pazienti.  Inoltre, i meno accorti, potrebbero semplicisticamente formulare erronee diagnosi indirizzando gli ignari pazienti verso cure psichiatriche. Tali cure, come sottolinea la pubblicazione, non potrebbero che intensificare i danni precedentemente causati dalla sindrome. Tuttavia la consapevolezza verso il sindrome e la sua diffusione sembra aumentare, siamo tuttora in attesa di nuovi studi che potrebbero meglio definire la portata del problema


venerdì 31 agosto 2012

NASCE LA POST-FINASTERIDE SYNDROME FOUNDATION




POST- FINASTERIDE SYNDROME FOUNDATION

http://www.pfsfoundation.org/


Nata da pochi giorni, questa fondazione, capeggiata dal Dott. Santmann, promette di offrire nuove speranze a tutti coloro che hanno sviluppato la sindrome post-finasteride.
Il Dott Santmann ha deciso di cimentarsi in questa difficile sfida spinto da motivazioni strettamente personali. Egli è infatti il padre di Randy Santmann, un ragazzo che purtroppo preferì suicidarsi piuttosto che vivere una vita segnata da questo terribile male.
Numerosi sono i casi di suicidi non ancora giunti all'attenzione dei media. Questo era già stato messo in luce dal Dott. Crysler, uno dei primi dottori che denunciò l'esistenza della sindrome.

La creazione di questa fondazione non potrà che avvantaggiare le ricerche già in corso raccogliendo fondi e promuovendo una maggiore attenzione del problema in campo medico e scientifico.



NUOVI STUDI DEI DOTTORI TRAISH E IRWIG



"5α-REDUCTASES IN HUMAN PHYSIOLOGY: AN UNFOLDING STORY"


LUGLIO 2012

While the clinical use of 5α-reductases inhibitors was well established, the scope and the magnitude of the adverse side effects of such drugs especially on the central nervous systems is still unrecognized, due to lack of knowledge of the various physiological function of this family of enzymes, especially in the central nervous system.

There is an urgent need to better understand the function of   5α -reductases and the role of neuro-active steroids in human physiology in order to minimize the potential adverse side effects of inhibitors targeting 5α-reductases to treat BPH and AGA.

new information suggests that these drugs may impair sexual function including sexual desire, erectile and orgasmic function [Table 3](for review cf. 83, 84). Recent studies in animal models suggested that these agents alter penile tissue histo-architecture and nitric oxide synthase function in penile tissue and thus can contribute to erectile dysfunction 

It is particularly important to note that in a subset of patients, the effects of these drugs are long lasting and may be irreversible (84). An association between use of these inhibitors and depression is also noted (88), suggesting potential adverse effect on the brain.

A number of case reports have suggested that  5α-reductase inhibitors therapy is associated with angioedema ( 91); cataract and intraoperative floppy-iris syndrome (92), pseudoporphyria, (93),T cell–mediated acute localized exanthematous pustulosis (94) and gyncomastia and male breast cancer

The recent introduced warnings on the drug labeling also suggests that increased awareness of the potential irreversible side effects of these agents

http://aace.metapress.com/content/t02936j2760g6483/?referencesMode=Show


"DEPRESSIVE SYMPTOMS AND SUICIDAL THOUGHTS AMONG FORMER USERS OF FINASTERIDE WITH PERSISTENT SEXUAL SIDE EFFECTS"

AGOSTO 2012


Pharmacovigilance is the science relating to identifying, monitoring, and effectively reducing adverse drug reactions. When a drug comes to market, it is often studied in only a thousand patients or less, as in the case of finasteride. 1,2 Less common adverse effects of a medication may be uncovered only in the postmarketing phase after many thousands of patients have been exposed to the medication.

In April 2012, the US Food and Drug Administration announced changes to the professional labels for Propecia (finasteride 1 mg) to expand the list of persistent sexual adverse events reported.8 ... In December 2010, the product labeling for Propecia in the United States was updated to include the side effect of depression.

In a group of 61 otherwise healthy former users of finasteride who developed persistent sexual side effects, depressive symptoms were present and categorized as mild in 11% of users, moderate in 28% of users, and severe in 36% of users. Suicidal thoughts were present in 39% of former finasteride users, and an additional 5% chose the statement “I would like to kill myself.”

The corresponding rates of depressive symptoms and suicidal thoughts were significantly lower in a control group of young men with male pattern hair loss who had not used finasteride and who did not have any current or past psychiatric conditions or use of psychiatric medications.
A plausible biological mechanism to explain the association between finasteride and depression lies with neuroactive steroids, neuromodulators that are synthesized in the central nervous system itself and that are also transported to the brain from the gonads and adrenal glands.

It turns out that finasteride crosses the blood-brain barrier and blocks the enzyme 5α-reductase, which reduces the concentrations of multiple neuroactive steroids derived not only from testosterone, but also from progesterone and deoxycorticosterone.... reduced concentrations of neuroactive steroids are associated with depression in several human studies.

Although the effects of finasteride in the human brain are poorly understood, clinicians, as well as potential finasteride users, should be aware of the serious potential risks of this medication, especially as it is being used cosmetically to alter a normal age-related process. This is the first study to document suicidal thoughts in (former) users of finasteride.


http://article.psychiatrist.com/dao_1-login.asp?ID=10007988&RSID=16409503147040


Come possiamo vedere in questi stralci, la ricerca in questi ultimi mesi si sta impegnando a fondo nel cercare di definire tutti le implicazioni patologiche dell'uso di inibitori della  5α-reduttasi.
Purtroppo per ora l'eziologia della sindrome rimane ancora un mistero.
Tuttavia, nuovi studi che sono all'orizzonte promettono di fornire al più presto importanti informazioni.

venerdì 13 luglio 2012

Finasteride: nuovo studio sulla persistenza degli effetti collaterali



The Journal of Sexual Medicine 



Persistent Sexual Side Effects of Finasteride: Could 

They Be Permanent?

July 12, 2012. Michael S. Irwig MD

ABSTRACT


Introduction.  Finasteride has been associated with sexual side effects that may persist despite discontinuation of the medication. In a clinical series, 20% of subjects with male pattern hair loss reported persistent sexual dysfunction for ≥6 years, suggesting the possibility that the dysfunction may be permanent. These subjects also reported a wide range of symptoms including changes in cognition, ejaculate quality, and genital sensation. Other medications have been associated with irreversible neurological effects, such as phenothiazines with tardive dyskinesias.
Aim.  To prospectively study whether the persistent sexual side effects associated with finasteride resolve or endure over time.
Methods.  Subjects (N = 54) with persistent sexual side effects associated with finasteride were reassessed after 9–16 months (mean 14 months). All subjects were otherwise healthy young men without any baseline sexual dysfunction, medical conditions, psychiatric conditions, or use of oral prescription medications prior to taking finasteride for male pattern hair loss.
Main Outcome Measure.  Scores from the Arizona Sexual Experience Scale (ASEX).
Results.  The participation rate was 81%. At reassessment persistent sexual side effects continued to be present in 96% of subjects. According to the ASEX scores, 89% of subjects met the definition of sexual dysfunction. Neither the length of finasteride use nor the duration of the sexual side effects correlated to changes in scores of sexual dysfunction.
Conclusion.  In most men who developed persistent sexual side effects (≥3 months) despite the discontinuation of finasteride, the sexual dysfunction continued for many months or years. Although several rat studies have shown detrimental changes to erectile function caused by 5 alpha reductase inhibitors, the persistent nature of these changes is an area of active research. Prescribers of finasteride and men contemplating its use should be made aware of the potential adverse medication effects.

Gli effetti collaterali della finasteride potrebbero essere permanenti?
Questo si chiede il prof. Irwig in questo suo nuovo studio sugli effetti nocivi della finasteride.
Le sue conclusioni: nella maggior parte degli uomini che hanno sviluppato  effetti collaterali persistenti sulla sfera sessuale (≥ 3 mesi nonostante l'interruzione della finasteride) questi effetti continuano a persistere per molti mesi o anni.
Anche se numerosi studi effettuati su ratti hanno già mostrato alterazioni negative alla funzione erettile causata dall'inibizione della 5 alfa reduttasi, la natura persistente di questi cambiamenti è tutt'ora un'area di ricerca attiva.
Questo studio ha fornito lo spunto per un rinnovato interesse da parte dei media
Propecia Problems: Baldness Drug Linked with Long-Lasting Sexual Side Effects
For Some Men, Propecia's Sexual Side Effects May Be Long-lasting















E' interessante notare che molti quotidiani hanno ritenuto opportuno utilizzare l'immagine di Waine Rooney per dare maggior risalto alla notizia. E' infatti risaputo che Rooney è un utilizzatore entusiasta della molecola.

Baldness drug Wayne Rooney took 'could cause permanent impotence and shrink genitals in some men' 


Hair loss drug used by Rooney 'could cause impotence'















Si vedano inoltre per completezza i vari servizi televisivi dedicati alla notizia.






NBC TODAY - Report links hairloss drug with sexual 


dysfunction








NBC TONIGHT - Propecia hidden risk?








ABC NEWS - Propecia linked to sexual side effects





Dr. Drew Pinsky - Possible sexual side effects for male 


baldness drug



sabato 5 maggio 2012

Il gruppo dei ricercatori italiani pubblica i primi risultati sulla PFS


European Urology Supplements
Volume 11, Issue 1, February 2012


Clinical analysis in young patient with persistent sexual
dysfunctions after finasteride assumption to prevent male pattern
hair loss

Trombetta C.1, Mazzon G.1, Liguori G.1, Ollandini G.1, Cauci S.2,
Toffoli G.3, Erika E.4

1Università Degli Studi Di Trieste, Dept. of Clinical Urology, Trieste,
Italy, 2Università Degli Studi Di Udine, Dept. of Biomedical Sciences
and Technologies, Udine, Italy, 3CRO, Dept. of Pharmacogenetics
Research, Aviano, Italy, 4CRO, Dept. of Pharmacology, Aviano, Italy

INTRODUCTION & OBJECTIVES: Finasteride is commonly used to
treat male pattern hair loss (MPHL). The effectiveness of the drug has
been demonstrated in a number of studies. Finasteride has been
associated with reversible adverse sexual side effects in multiple
randomized, controlled trials. The mentioned side effects are described
as reversible. However in literature a lot of case of persistent sexual
adverse symptoms are signaled. The persistence of symptoms after
discontinuation is named Post-Finasteride Syndrome (PFS). We
sought to characterize the types and duration of persistent sexual side
effects in otherwise healthy men who took finasteride for MPHL.

MATERIAL & METHODS: We enrolled in a retrospective study 78
patients affected by PFS who reported the new onset of sexual side
effects associated with the temporal use of finasteride, in which the
symptoms persisted for at least 3 months despite the discontinuation of
finasteride. Of all patients were collected hormonal blood analysis,
moreover to all the patients were dispensed ASEX and AMS
questionnaires before and after finasteride use. The blood analysis
need to have been performed not longer than 9 months before entering
the study and after 3 months of abstinence from any exogenous
hormonal/antidepressive/antipsychotic treatments or anabolic
androgenic steroids. Moreover, all patients with other diseases were
excluded.

RESULTS: Patients were aged 24-56. ASEX evaluated before and
after finasteride assumption had a mean decreasing of 13,84 (P<0.05).
No statistically significant differences were observed in relation to the
duration of therapy or to the age of assumption. 60% of patients
reported that their symptoms worsened after discontinuation of the
drug.

CONCLUSIONS: The finasteride used in young males should
determine a potential risk for sexual health, physicians treating MPHL
should evaluate the potential risk of persistent sexual side effects
associated with finasteride.
http://discover-decouvrir.cisti-icist.nrc-cnrc.gc.ca/eng/article/?id=19812233

Come possiamo vedere la ricerca italiana inizia a fornire prove sempre più valide e contorni sempre più definiti sull'entità  del fenomeno PFS. Attendiamo ulteriori notizie nel prossimo futuro.