Talk:Finasteride

Trump's use of Finasteride

Trump's doctor says he uses this drug, which should be enough for a mention. NY Times is the source. 104.163.150.250 (talk) 04:55, 3 February 2017 (UTC)

trivia. Jytdog (talk) 05:35, 3 February 2017 (UTC)

The Washington Post article [Potential side effects of the drug Trump reportedly takes for hair loss] by a urologist, Daniel Marchalik, cites many WP:MEDMOS articles, some of which are more recent than the articles cited in this entry, and which give a higher risk for impotence than we state in the article, based on 2010 papers. For example, it links to a 2012 FDA label change to say that sexual disorders may continue after discontinuation. I think a real urologist is in a better position to evaluate conflicting studies than most Wikipedia editors. He also says that there are psychological effects, including suicidality. --Nbauman (talk) 18:28, 5 February 2017 (UTC)

The following paragraph by the urologist is the kind of dreck that incompetent POV pushers rush to add to WP and that get quickly reverted:"At the same time, a recent study demonstrated changes in the levels of certain steroids in cerebrospinal fluid of men taking finasteride for hair loss. These steroids have been shown to influence brain function, and their presence may help explain the profound psychological changes such as depression and suicidality that have been associated with finasteride use." I believe you meant "MEDRS sources" and the paper cited in that passage (PMID 23890183) is not all that "recent" (2013) and is primary (a case report), not MEDRS (a literature review or statement by a major medical/scientific body). Most of the WaPo article is about the possibility of sexual dysfunction which this article covers already. Jytdog (talk) 18:46, 5 February 2017 (UTC)

Your reference to "incompetent POV pushers" is a violation of WP:NPA. Until you retract it I have nothing to say to you.

For the other editors working on this entry, I will point out that the most recent reference to sexual dysfunction in the entry is a 2010 review, and The Washington Post article cites a later meta-analysis J Sex Med. 2016 Sep;13(9):1297-310. doi: 10.1016/j.jsxm.2016.07.006. Epub 2016 Jul 27. --Nbauman (talk) 01:37, 7 February 2017 (UTC)

? i said nothing about you - i don't believe that you were proposing to add ":"At the same time, a recent study demonstrated changes in the levels of certain steroids in cerebrospinal fluid of men taking finasteride for hair loss. These steroids have been shown to influence brain function, and their presence may help explain the profound psychological changes such as depression and suicidality that have been associated with finasteride use." to this article. I did challenge your assertion that what this urologist said is relevant to WP content and gave that as an example of what the urologist thinks is important to discuss. Jytdog (talk) 02:16, 7 February 2017 (UTC)

I think that was pretty clearly a personal attack. Jytdog has a repeated history of expressing himself with a disrespectful tone and it has gotten him into trouble on many occasions. In any case, I don't feel strongly about this topic since I focus mostly on keeping the science up to date and objective as possible but it may be worth including in the "Society and Culture" section. Jytdog argues it is "trivia", but it is certainly more notable that the most politically influential person in the world is taking the drug compared to several retired athletes. Doors22 (talk) 03:02, 7 February 2017 (UTC)

Edit request

Doc James and SlimVirgin, will one of you please add the following text to the society and culture section in a section above the sentence that mentions the FDA? "In February 2017, Donald Trump's personal physician of over three decades announced he has been publicly taking finasteride to promote hair growth. Dr. Bornstein credited the drug for helping him maintain all his hair. Compared to the mention of former athletes taking finasteride, it is notable the world's most powerful politician and celebrity known for his hair is taking the drug. Two sentences should be reasonable. The story was reported in publications such as the NYTimes, the Washington Post, CNN, Men's Journal, and the Huffington Post. Thanks. Doors22 (talk) 15:59, 22 February 2017 (UTC)

Fairly decent source. Sort of trivia but notable trivia I guess. Slim your thoughts? Doc James (talk · contribs · email) 16:41, 22 February 2017 (UTC)

Doc James, I'm here only as an admin, so I'd prefer not to comment on content. SarahSV ^(talk) 17:31, 22 February 2017 (UTC)

SlimVirgin, I'm not sure if you remember but due to constant conflicts on this page, Jytdog offered to "walk away from this page" if I agreed to submit edit requests on the talk page. You offered to assist with the edits which I why I pinged you. Even though I have kept my end, he has clearly violated our agreement and was unpleasant and rude towards NBauman.Doors22 (talk) 02:45, 23 February 2017 (UTC)

Per MEDMOS we don't add this kind of trivia to artiicles about medicine and drugs. I would be fine with removing mentions of athletes. Jytdog (talk) 21:44, 22 February 2017 (UTC)

Doors22, I offered to respond to your edit requests by making edits for you, as an admin, if there is consensus for them or no objections. I'm still happy to do that. By the way, please don't keep mentioning other editors. SarahSV ^(talk) 03:00, 23 February 2017 (UTC)

SlimVirgin, thanks for your response. Right now it appears as though there is consensus. The anonymous IP, NBauman, DocJames and myself all appear to support adding the information. Is there anything else required? Doors22 (talk) 03:04, 23 February 2017 (UTC)

There seems to be consensus. What's needed now is to decide what text you want to be added, and where you would like it to be placed. You suggested:

"In February 2017, Donald Trump's personal physician of over three decades announced he has been publicly taking finasteride to promote hair growth. Dr. Bornstein credited the drug for helping him maintain all his hair."

Three problems. (1) He announced that Trump had been taking it, not the doctor. (2) It's not clear what "publicly taking" means; I assume that "taking" would do? And (3) the second sentence arguably violates MEDRS. The doctor isn't in a position to say what effect the drug has had (and Trump hasn't maintained all his hair, so the sentence doesn't work for that reason too). SarahSV ^(talk) 19:06, 23 February 2017 (UTC)

SlimVirgin, thanks for the feedback. If you prefer, we can take out the second sentence since I was just quoting what the doctor said. I agree with your suggested clarifications for the first sentence. How about this: "In February 2017, American President Donald Trump's personal physician of over three decades revealed Trump has been taking finasteride to promote hair growth." — Preceding unsigned comment added by Doors22 (talk • contribs)

Let me know when you've decided where you'd like it placed. Doc James and Nbauman are welcome to make the edit too. SarahSV ^(talk) 01:03, 24 February 2017 (UTC)

IMO all we should say is "In February 2017, Donald Trump's personal physician Harold Bornstein stated he has been taking finasteride to promote hair growth."

Ref is not sufficient to say it "works". Doc James (talk · contribs · email) 10:32, 24 February 2017 (UTC)

I suggested that article for 2 reasons: (1) Even though it isn't a WP:MEDRS, it cites some good WP:MEDRS, which are more recent (and possibly better) than the ones in the current WP entry. (2) I don't like using celebrity patients just to decorate an article. However, I am willing to use a celebrity patient as a teachable moment to illustrate an important point (and to keep the reader's interest). In this case, one serious issue is whether finasteride at this dose causes sexual dysfunction, and whether that sexual dysfunction may even continue permanently after discontinuation. Another serious issue is whether finasteride causes psychological effects. "What if the man in charge of the nuclear codes is taking mood-affecting drugs?" That sounds like a case that walked out of a medical ethics class.

As to the question of whether it "works" -- celebrity doctors make a lot of dubious claims. We do say in the article that it has 30% effectiveness. It would be nice to have a quote from a reliable doctor speaking directly to Bornstein's claims (presumably that a claim like that isn't justified). It is also impossible for us to know from news reports whether the result is due to the finasteride or the hair resorations. http://gawker.com/is-donald-trump-s-hair-a-60-000-weave-a-gawker-invest-1777581357

This isn't important enough for me to argue over. But when there is extensive coverage of a subject in non-WP:MEDRS sources that are otherwise WP:RS, like the NYT and Washington Post, that raises the question of whether under WP:WEIGHT it belongs in Wikipedia. I think there is a way to do it under WP policies and guidelines, provided we can place it in the context of WP:MEDRS information. "Notable trivia" is a good way to put it. --Nbauman (talk) 16:52, 24 February 2017 (UTC)

I agree with Doc James' suggestion. I would combine it with SlimVirgin's suggestion and change the phrase to "Harold Bornstein stated Trump" to remove pronoun ambiguity. I didn't totally understand Nbauman's argument but my sense is he was on board with the change. Will somebody please add the sentence Doc James' sentence to society and culture after the sentence about the FDA advisory? Thanks. Doors22 (talk) 04:45, 25 February 2017 (UTC)

Added Doc James (talk · contribs · email) 10:10, 25 February 2017 (UTC)

Doc James, thanks for adding that. Also, in case it helps, there's a 2016 systematic review not included as a source. SarahSV ^(talk) 01:25, 27 February 2017 (UTC)

New Study

A new study was published today that shows 1.4% of men who took 5-alpha-reductase inhibitors developed persistent erectile dysfunction which lasted more than 90 days after discontinuing the drug. A notably high frequency, considering the drug is widely prescribed for cosmetic purposes with incomplete efficacy. This study is a retrospective, so it doesn't seem to me like it is primary research and may be worth including in the article, but I am not sure at this point. If not now, this will likely be referenced in other sources in the near future at which point we can include the new quantitative data in the article. Hair transplant surgeons to date have inaccurately deniedi the existence of this syndrome or have written it off as being so rare as occur in one per tens of thousands of patients. This is the first study to quantify the actual risk and in that regard it is quite groundbreaking. https://peerj.com/articles/3020.pdf Doors22 (talk) 04:57, 10 March 2017 (UTC)

Primary source. We need to wait for a high quality secondary source. Doc James (talk · contribs · email) 18:19, 10 March 2017 (UTC)

Sexual function

The first sentence of this section states, "Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear.[18]

This sentence does not correctly cite the meta-analysis by Belknap et al, which actually concludes that "Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of (male pattern baldness)." When I made this correction, it was reverted and I got a warning. — Preceding unsigned comment added by Sbelknap (talk • contribs) 20:35, 11 March 2017 (UTC)

Yes that section is about "sexual function" so "Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of male pattern baldness." is out of place.

Your paper says "a medical literature review of the use of finasteride for AGA concludes that finasteride is safe for AGA and notes that “permanent sexual adverse events have yet to be established in higher quality studies, such as randomized controlled trials.”"

It then goes on to say "Most provided no description of the duration or severity of signs or symptoms of sexual dysfunction and failed to distinguish between mild, reversible sexual dysfunction and severe, permanent sexual dysfunction."

Doc James (talk · contribs · email) 23:37, 11 March 2017 (UTC)

Doc James quotes from the introduction to Belknap et al, not from the results or conclusion. The major finding of Belknap et al is that published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA. — Preceding unsigned comment added by Sbelknap (talk • contribs) 01:08, 12 March 2017 (UTC)

We paraphrase sources fairly rather than "quote from" bits of them (aka cherrypicking). ISTR this wording has been discussed at length before. Alexbrn (talk) 06:37, 12 March 2017 (UTC)

I agree with the point that Sbelknap is making. By merely referencing a piece of the intro, the effect is to "cherry pick" rather than paraphrase the reference. It is also worth mentioning that the reference of which we speak is a high quality meta-analysis published in JAMA Dermatology and worthy of its due weight. Doors22 (talk) 17:02, 12 March 2017 (UTC)

Adverse Effects

The first sentence of the adverse effects section cites a 2010 meta-analysis and states that, "A 2010 Cochrane review concluded that side effects from finasteride are rare when used for BPH.[4]"

As a later 2015 meta-analysis by Belknap reviewed all adverse effects (not just sexual adverse effects) in clinical trial reports of finasteride and found that this conclusion of the 2010 meta-analysis is unwarranted, the wikipedia article should not cite the 2010 Cochrane review and it should be considered deprecated on issues related to finasteride adverse effects.

The findings of the 2010 meta-analysis related to efficacy are still considered generally reliable. — Preceding unsigned comment added by Sbelknap (talk • contribs) 20:27, 12 March 2017 (UTC)

Cochrane reviews are notable. Yes I know you disagree with Cochrane. Take it up with them. We tend to refernce multiple reviews. Doc James (talk · contribs · email) 20:33, 13 March 2017 (UTC)

Belknap et al found that the primary source finasteride clinical trial reports are not a reliable source of information about adverse drug events. Thus, the findings of Belknap et al deprecate the findings of Tacklind. It is simply wrong to cite Tacklind on the issue of adverse drug events. Doc James ignores the main result of a high-quality secondary source but provides no justification for his opinion. Perhaps others might read Belknap et al and opine. — Preceding unsigned comment added by Sbelknap (talk • contribs) 04:14, 14 March 2017 (UTC)

You'd expect Cochrane to update if there was a significant change in the evidence, which is why the five-year window guidance doesn't apply per WP:MEDRS. The current wording is fine I think. Alexbrn (talk) 07:26, 14 March 2017 (UTC)

The original Cochrane investigated at both the general safety and efficacy of using 5 mg of finasteride to treat BPH, not specifically the potential for persistent side effects of using finasteride for both alopecia and BPH. The JAMA Dermatology meta-study specifically cast a critical eye on the quality of the existing conclusions on the safety profile, but not efficacy of finasteride use. You wouldn't expect the JAMA Dermatology meta-study to replace the original Cochrane reference. However, I do believe that the newer study deserves its due weight. There isn't consensus on this issue right now so I think we need some kind of a compromise. Would the other editors consider moving up the text on the JAMA Dermatology to ensure that it receives its due weight as being a more recent, high quality, secondary source? Doors22 (talk) 14:15, 14 March 2017 (UTC)

I agree that the efficacy findings of the Cochrane review still stand. The Cochrane review erred in not assessing quality of adverse event reporting in the primary RCT reports. The JAMA Dermatology meta-analysis deprecates the toxicity findings of the Cochrane review but not the efficacy findings.Sbelknap (talk) 14:59, 14 March 2017 (UTC)

Well JAMA-Dermatology is not that weighty a source, and comments have been made in the lay medical press[1] about the methodology of the Belknap review, and the fact the work was funded in part by an advocacy organisation. So I think, being cautious, the current balance is about right. Alexbrn (talk) 15:03, 14 March 2017 (UTC)

The "lay medical press" article you refer to is not WP:MEDRS compliant, but more importantly it does not even refer to the same publication we are discussing. The article was primarily supported by a grant from the NIH but in any case, the source of funding for an article is not addressed under WP:MEDRS, likely because being peer reviewed in a quality journal is a strong check and balance. Don't you think it is a bit inaccurate to claim that JAMA Dermatology, with an impact factor of 5.1, is "not that weighty". Doors22 (talk) 15:36, 14 March 2017 (UTC)

The current impact factor for JAMA Dermatology is 5 The current impact factor for the Cochrane Review is 6.1

The statnews article linked by Alexbrn is about a 2017 article in PeerJ and is not about the 2015 meta-analysis in JAMA Dermatology. Also, there is no criticism in the statnews article about either the 2015 meta-analysis or the 2017 PeerJ article.Sbelknap (talk) 15:30, 14 March 2017 (UTC)