Talk:Finasteride/Archive 6

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)

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)

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)

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 about the methodology of the another 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); amended Alexbrn (talk) 15:51, 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)

Of course it's not MEDRS, but there is no proposal to use it to support a health claim. A source of funding can be pertinent in assessing a source, as can many items of context around it. The IF of JAMA-Dermatology is another indication we shouldn't be leaning on it too heavily, yes. Alexbrn (talk) 15:49, 14 March 2017 (UTC)

Evaluating a source based on its source of funding constitutes WP:OR which is prohibited. Much of the literature was directly funded by the drug's manufacturer who has direct financial interests in the outcome of the scientific consensus but that is not taken into consideration on Wikipedia per WP:MEDRS. Moreover, the IF of JAMA-Dermatology is basically on par with Cochrane and the source is more recent so it is pretty clear per WP:MEDRS that the newer respectable study deserves weight.Doors22 (talk) 22:39, 14 March 2017 (UTC)

The current impact factor for JAMA Dermatology is 5 ^[1] The current impact factor for the Cochrane Review is 6.1 ^[2]

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)

Yes apologies: I confused the reviews. Yet there is a great deal of advocacy around this topic (we see it on this very page), and we should not be letting conflicted views push this article away from neutral. Conflict of interest is like "dirt in a gauge" on Wikipedia as it can skew the proper formation of consensus. Alexbrn (talk) 15:56, 14 March 2017 (UTC)

The finasteride article in wikipedia is not neutral. The most important source of bias is the economic interest of those who profit by selling finasteride. The "dirt in the gauge" for finasteride has been there for 30+ years. Recent scientific literature has begun to wash that dirt away. Unfortunately, some patients will rely on the finasteride article in wikipedia, and as a result will be harmed.Sbelknap (talk) 16:22, 14 March 2017 (UTC)

Wikipedia editors are presumably not selling Finasteride. On the other hand there are the financial interests of those who might benefit from legal action against the Finasteride industry. All we can do is attempt to reflect the settled knowledge, which at the moment appears to contain a lot of uncertainty. Alexbrn (talk) 16:27, 14 March 2017 (UTC)

Alexbrn, all Wikipedia users benefit from the same presumptions per the WP:AGF policy. However, it appears as though you are ignorant to how the judicial process works in the United States. If a juror conducts independent research on evidence for a trial they are overseeing, they may be found in contempt of the court which is punishable by a prison sentence. Similar penalties occur in the UK. Wikipedia will have no influence on any legal matters for it will be prohibited to jurors.Doors22 (talk) 22:58, 14 March 2017 (UTC)

As I'm sure you know the issues are broader than that. Editors with a COI should not be editing this article. Indeed you are prohibited from doing so. The article is not here to reflect a particular POV tailored to a group's interests. Alexbrn (talk) 03:34, 15 March 2017 (UTC)

It is clear that at this point in time Belknapp et al represent a minority view on the safety issues. Per WP:NPOV we acknowledge that perspective but it cannot dominate this article. NPOV is policy. It may be that the field and regulators move that way in time but it is not there now. Jytdog (talk) 17:44, 14 March 2017 (UTC)

You have not presented any evidence that this newer publication represents a "minority view" on the safety issues, a claim which is untrue. Per WP:MEDRS, the newer source deserves at least as much weight as the source that is more than 5-years old, especially given the journals have a similar impact factor. You cannot make the claim it is a low quality article. Right now, the wiki page gives undue weight to the older view. I am being more than fair by offering to give it similar weight.Doors22 (talk) 22:44, 14 March 2017 (UTC)

The evidence is the other recent reviews, the labels in various jurisdictions, etc. all of which are already cited in the article. Jytdog (talk) 03:43, 15 March 2017 (UTC)

The finasteride wikipedia article does not have a NPOV. It does not properly reflect findings from the high-quality secondary sources. The assertion that adverse effects from finasteride are rare is prominently quoted in the wikipedia article but this erroneous statement from the Tacklind article has been deprecated by later high-quality secondary sources. — Preceding unsigned comment added by Sbelknap (talk • contribs) 15:05, 15 March 2017 (UTC)

As I noted at the Dutasteride article, you are putting WP:UNDUE weight on the sexual side effects. Drugs can have, and do have, a broad range of side effects on various systems, and outside of the sexual side effects, these drugs are relatively safe... almost remarkably so. Which is probably why the FDA approved this drug for something as non-life threatening as hair loss. Jytdog (talk) 03:26, 16 March 2017 (UTC)

Jytdog asserts without evidence or citation that outside of the sexual side effects, that finasteride and dutasteride are relatively safe, almost remarkably so. The high-quality secondary sources contradict this assertion by Jytdog. For example, Traish's KJU review states that, "Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5α-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life." This statement by Traish accurately summarizes the consensus view of researchers who are studying the toxicity of finasteride and dutasteride. There are more than 100 primary source peer-reviewed scientific papers on this topic. The wikipedia articles cherry pick non-representative secondary sources and selectively and inaccurately quote from them. The wikipedia articles suppress high-quality secondary sources that summarize the toxicity literature on finasteride and dutasteride. — Preceding unsigned comment added by Sbelknap (talk • contribs) 12:49, 16 March 2017 (UTC)

The same dispute seems to be taking place here and on Dutasteride, so I've protected both for three days. Please try to reach consensus on talk regarding how to prioritize the studies. SarahSV ^(talk) 03:13, 16 March 2017 (UTC)

Thanks SlimVirgin. btw now that Doors22 is no longer active, I am going to directly edit this article again. Jytdog (talk) 03:16, 16 March 2017 (UTC)

Removed the most recent edition as it was copied and pasted from the source in question. Doc James (talk · contribs · email) 03:38, 16 March 2017 (UTC)

Perhaps the best way forward is to identify relevant but uncited secondary literature vis-à-vis finasteride toxicity. Here are some obvious ones:

Motofei IG1, Rowland DL2, Manea M3, Georgescu SR4, Păunică I3, Sinescu I5. Safety Profile of Finasteride: Distribution of Adverse Effects According to Structural and Informational Dichotomies of the Mind/Brain. Clin Drug Investig. 2017 Feb 4. doi: 10.1007/s40261-017-0501-8.

Traish AM, Mulgaonkar A, Giordano N. The dark side of 5α-reductase inhibitors' therapy: sexual dysfunction, high Gleason grade prostate cancer and depression. Korean J Urol. 2014 Jun;55(6):367-79. doi: 10.4111/kju.2014.55.6.367. Review. PMID: 24955220

Seale LR, Eglini AN, McMichael AJ. Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review. J Drugs Dermatol. 2016 Apr;15(4):414-9. Review.

Traish AM, Melcangi RC, Bortolato M, Garcia-Segura LM, Zitzmann M. Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know? Rev Endocr Metab Disord. 2015 Sep;16(3):177-98. doi: 10.1007/s11154-015-9319-y. Review. PMID: 26296373

Irwig MS. Safety concerns regarding 5α reductase inhibitors for the treatment of androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes. 2015 Jun;22(3):248-53. doi: 10.1097/MED.0000000000000158. Review. PMID: 25871957 — Preceding unsigned comment added by Sbelknap (talk • contribs) 22:39, 16 March 2017 (UTC)

Sbelknap, if you write PMID 25871957 without a hyphen, it turns into a magic link. The developers have proposed removing that functionality, so it may not work for much longer, but for now it does. SarahSV ^(talk) 01:54, 17 March 2017 (UTC)

Thanks, SV!

I propose adding this text, paraphrased from a high-quality secondary source, to the article adverse effects section:

"Persistent erectile dsyfunction and persistent low libido have been associated with finasteride exposure, although causality has not yet been established" ^[1]

We already say that "Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear." and do not need to say it twice.

-- Doc James (talk · contribs · email) 18:36, 17 March 2017 (UTC)

There are many problems here. Lets take them one at a time. Is it possible that Doc James is confusing the 2015 article by Belknap et al with the 2017 article by Kiguradze et al? Doc James has made several puzzling and incorrect statements about Belknap et al. Perhaps interested editors might reread the Belknap article and then establish an opinion as to what it says. The 2015 article by Belknap et al is a meta-analysis of Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia (hence its title). Several points worth noting:

1. This Belknap 2015 meta-analysis is *not* solely about quality of reporting sexual adverse drug events. It is instead about quality of reporting of *all* adverse drug events.

2. Given its scope, the findings of the Belknap 2015 meta-analysis should be given at the beginning of the Adverse Effects section and not under a subsidiary subheading.

3. Of course, since sexual adverse effects are the most common adverse effects associated with finasteride exposure, the Belknap meta-analysis contains analysis and discussion of sexual adverse effects in the article.

4. However, the discussion of sexual adverse events in the Belknap 2015 meta-analysis is *not* about *persistent* sexual adverse effects.

5. Thus, the wrong citation is used to support the assertion "Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear."

6. The assertion of equivalence made here by Doc James is false, as the two following statements make very different claims. Please read them carefully so as to understand how these statements differ:

"Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear."

"Persistent erectile dsyfunction and persistent low libido have been associated with finasteride exposure, although causality has not yet been established" — Preceding unsigned comment added by Sbelknap (talk • contribs) 23:02, 17 March 2017 (UTC)

Jytdog has not provided any reason for reverting most recent edit to the finasteride article. Edits were frozen for several days. Why are attempts to correct serious errors in the finasteride being blocked by Jytdog and others? There seems to be an emphasis on process without due attention to content. As may be seen by reviewing Jytdog's actions over the past week, Jytdog has repeatedly made erroneous statements. The result of this is that the finasteride article is seriously in error.Sbelknap (talk) 18:53, 19 March 2017 (UTC)

New data has been published in an article entitled "Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride" (https://peerj.com/articles/3020/). They conclude, based on the Northwestern Medicine electronic medical record data repository, that 1.4% of men with exposure developed persistent erectile dysfunction that continued a median of about 4 years after stopping the drug. Also, men with a "long" (they drew a line at 205-209.5 days) period of use of the drugs were about 5 times more likely to present persistent erectile dysfunction than those with a "short" period of use. The page in its present form does not do a good enough job conveying this danger. AmiLynch (talk) 17:58, 5 April 2017 (UTC)

thanks for posting. that is a primary source, which we don't use per WP:MEDRS. Jytdog (talk) 18:15, 5 April 2017 (UTC)

WP:MEDRS does not say primary sources are never used. Anyway, my point stands, maybe someone will find even better sources before I do. AmiLynch (talk) 23:07, 7 April 2017 (UTC)

I'll reply to some of this on your Talk page. MEDRS is a widely respected guideline and what it says about this, is that there needs to be a very good reason to cite a primary source. You haven't provided one. Jytdog (talk) 23:12, 7 April 2017 (UTC)

Are you sure this is a primary source? I don't think they treated the patients themselves, they simply examined a database of medical records for 691,268 men, of whom 17,475 had 5α-RI exposure. Anyway I'm just citing it in talk for now. AmiLynch (talk) 23:53, 7 April 2017 (UTC)

Yes that is primary research for the sort of thing they did. Jytdog (talk) 00:51, 8 April 2017 (UTC)

The above analysis is a statistical analysis of raw patient data, and hence is primary. PMID 21176115 while not as recent, is secondary. Boghog (talk) 06:22, 8 April 2017 (UTC)

Two recent meta-analyses deprecate the findings of Tacklind et al (2010). Despite this, the first sentence continues to be a summation of Tacklind. This is misleading and inaccurate. The current scientific consensus can be more accurately reflected by reorganizing the existing statements in the section. The Tacklind meta-analysis could either be omitted or included after descriptions of the first two metaanalyses.

I recommend that the first paragraph of this section be structured as follows:

First: A 2016 review of 5α-reductase inhibitors for prostatic hyperplasia found that sexual dysfunction was 2.5 times more likely in those who used them.[1]

Second: A 2015 meta analysis found that none of the clinical trials testing finasteride in hair loss had adequate safety reporting and did not provide sufficient information to establish the safety profile for finasteride as a treatment for hair loss. The study concluded the existing clinical trials of finasteride for hair loss provide very limited information on toxicity, are of poor quality, and seem to be systematically biased toward under-detection of adverse events. Moreover, the trials submitted to the FDA for approval for hair loss excluded most men who would normally be prescribed finasteride for androgenic alopecia. Belknap SM, Aslam I, Kiguradze T, Temps WH, Yarnold PR, Cashy J, Brannigan RE, Micali G, Nardone B, West DP (June 2015). "Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis". JAMA Dermatology. 151 (6): 600–6. doi:10.1001/jamadermatol.2015.36. PMID 25830296

Third: Mention of Tacklind could then follow these two, with indication that this reference is 7 years old and is deprecated. — Preceding unsigned comment added by Sbelknap (talk • contribs) 19:45, 15 April 2017 (UTC)

Jump up ^ Liu L, Zhao S, Li F, Li E, Kang R, Luo L, Luo J, Wan S, Zhao Z (September 2016). "Effect of 5α-Reductase Inhibitors on Sexual Function: A Meta-Analysis and Systematic Review of Randomized Controlled Trials". The Journal of Sexual Medicine. 13 (9): 1297–310. doi:10.1016/j.jsxm.2016.07.006. PMID 27475241 Sbelknap (talk) 16:12, 17 April 2017 (UTC)

I added the following new secondary reference to the adverse events section: A 2017 meta-analysis found that exposure to finasteride increased the odds of both erectile dysfunction and hypoactive sexual desire to about 150% of comparison controls in men with BPH.^[1]

This edit was reversed by jytdog, who also threatens to tag this as an edit war. This new reference has never been included in the article previously. It is a high-quality secondary reference.

— Preceding unsigned comment added by Sbelknap (talk • contribs) 22:16, 30 April 2017 (UTC)

As you have before, you are trying to push alarm about the sexual side effects to the very top of the adverse effects section. Have you actually read the section? It has already bent over backwards, probably way too far to accommodate the concerns of you and others who have come here so focused on this issue. Where is your evaluation of WP:WEIGHT here? Jytdog (talk) 23:04, 30 April 2017 (UTC)

• • What was the absolute risk difference? Doc James (talk · contribs · email) 01:38, 1 May 2017 (UTC)

I've been reflecting on the longer-term situation. SBelknap, how about proposing here on Talk, a well sourced, truly NPOV replacement for the entire Adverse effects section, (keeping in mind to WEIGHT of various things within it, as well as the WEIGHT of the section in the article overall) that would make sense next to an article about any other drug here in WP? I am interested to see what you would produce if you were address the whole article and not just this bit. Thanks. Jytdog (talk) 00:39, 1 May 2017 (UTC)

The adverse events section should be organised as one would expect in any other drug article. Start with potentially life-threatening reactions, the discuss the remainder by frequency of occurrence (less common to least common). JFW | T@lk 12:04, 1 May 2017 (UTC)

The following was added by Medgirl131:

DHT is involved in the pathogenesis of acne, and there is good reason to believe that 5α-reductase inhibitors like finasteride may be effective in the treatment of the condition.^[1] However, very little research has been done in this area, in the case of women likely due to the risk of teratogenic effects with 5α-reductase inhibitors.^[1][2] In any case, finasteride has been found to be effective in the treatment of acne in women in at least one small study.^[3][4]

I think this is WP:WEIGHT. It has not been fully researched, is not licensed for this use, and is unlikely to ever be used for acne in a major way. I appreciate that the small clinical study has been cited in a secondary source but that is hardly enough to give it this prominence. JFW | T@lk 11:33, 17 July 2017 (UTC)

@Doc James: why did you revert the last two edits without explanation? I'm moving discussion here per your request. Saying side effects are "generally mild" includes two weasel words and is unsourced. And if you look at the second statement you will see the cited reference doesn't say anything about the existence side effects being unclear. It presents an opinion based on original research that is not supported by a source. One of the key principles of Wikipedia is presenting a neutral point of view and both of these statements present opinions, not facts.

THe changes were not supported by the sources already present. Jytdog (talk) 06:08, 27 December 2017 (UTC)

Jytdog, your response is off point because the edits removed statements that were unsupported by sources or Wiki guidelines. My question was also directed to Doc James and would appreciate it if you let him answer for himself. — Preceding unsigned comment added by 2604:2000:E0CF:5100:247E:E472:91FA:2296 (talk) 07:43, 27 December 2017 (UTC)

The revert was good. Any editor can respond here. Also see WP:SOCK. Alexbrn (talk) 07:50, 27 December 2017 (UTC)

I moved the discussion here so people can offer their own opinions. However saying "the revert was good" also doesn't add anything to the discussion without providing explanation. @Doc James: any response to this?

@Jytdog: your addition of the distressing nature of sexual side effects is probably closer to being accurate than the statement before but none of it is accurately sourced. The Cochrane source doesn't say side effects are generally mild and while it is obviously true that the sexual side effects can be very distressing, it also as opinion based as how it previously was. I don't feel like that's the goal of Wiki.

Not sure why the ping does not work? Anyway have restored the ref for:

"Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear"

Ref says “permanent sexual adverse events have yet to be established in higher quality studies, such as randomized controlled trials.” Doc James (talk · contribs · email) 05:07, 28 December 2017 (UTC)

Thanks for your input. I don't agree that "permanent sexual adverse events have yet to be established in higher quality studies, such as randomized controlled trials" should translate to whether finasteride causes long term sexual dysfunction... is unclear. A more recent high quality study was published showing evidence of this which deprecates that prior claim. Do you have any thoughts on this? I'll leave this unchanged until you respond.

You didn't mention why you reverted my edits to the society and culture section to move the patents to history. I don't believe drug names or patents have anything to do with society and culture and those two sub-sections contained a lot of information found elsewhere in the article. For concision I'll restore that part of the edit but please feel free to discuss if you feel that doesn't make sense. — Preceding unsigned comment added by 2604:2000:E0CF:5100:287E:6057:8CAA:6367 (talk) 06:38, 28 December 2017 (UTC)

@Doc James: the edit you made by trying to cite the Belknap study is clearly an example of WP:SYNTH. The article draws your own conclusions based on statements that have been pieced together in the text and are unlikely to be represented by the author text. I also see your action to have the article locked for "disruptive editing" as an abuse of power given you apparently hold status in this community, especially when you have failed to follow up with discussions on the talk page. I have been working with other editors on the talk page to reach a consensus which is a Wikipedia best practice and makes your action completely unnecessary and abusive.

Since you do not sign your comments pinging me does not work. You will need to find better wording and get consensus for that. Doc James (talk · contribs · email) 06:11, 29 December 2017 (UTC)

The above text in section 1.3 (Scalp hair loss) is not supported by a cited source. This wording may cause harm by providing false hope to men who are at a vulnerable point in their combat with male pattern baldness. Many men who are losing their hair seek a simple and permanent solution, and this phrase makes it seem that Finasteride is the "silver bullet." — Preceding unsigned comment added by 184.155.94.41 (talk) 19:01, 6 January 2018 (UTC)

1. "Side Effect" is a deprecated term because side effects could be beneficial, neutral, or harmful. Beneficial effects have their own section. Why use the term "side effect"? There should also be a section entitled "adverse effect," not "side effect" which is vague and confusing.

2. The efficacy section mentions that the evidence is derived from "long-term clinical trials." The evidence in the adverse effects section should also mention that the evidence is from clinical trials when that is the case. Why downplay the quality of evidence regarding adverse effects?

3. The recent edit changes a precise description of the evidence on sexual adverse effects to language that is wrong. It is not the case that the 2017 review is of "men with BPH." This implies an observational study. However, the Corona meta-analysis is of published reports of placebo-controlled clinical trials of finasteride in men with BPH. Perhaps lay language is desirable, but said lay language ought to be as accurate and precise as possible.

4. The term "review" used in the adverse effects section is vague. The precise language would be "systematic review and meta-analysis of reports of clinical trials." These terms are also in wikipedia and could be hyperlinked. That would be preferable to "lay language" that is wrong.

1) No side effects are generally used to mean negative efforts in the English language. Either is fine per MEDMOS though.

2) We write in simpler language generally and can just state the conclusions.

3) The current wording gets the meaning across just as well and in less words.

4) "Review" is a perfectly reasonable summary. Doc James (talk · contribs · email) 21:57, 27 January 2018 (UTC)

1 In English, "side effect" carries the implication of a mild effect that is tolerated because it does not outweigh the beneficial effect. You are favoring language that minimizes the significance of drug toxicity. Why do you think you do that?

2 You have not answered the question, which is: Why do you favor more precise and accurate information about beneficial effects than about adverse effects? I note that you do this consistently across many topics that you edit. Do you consider adverse effects of drugs to be less important than beneficial effects? Surely, you agree with "Primum Non Nocere." If so, why is this not reflected in your edits?

3 Why do you use more accurate and precise description of the information source when benefits of drug therapy are being described?

4 Disagree, "review" is not an accurate description of the data source. "Review of clinical trials" is perfectly acceptable layman's language. — Preceding unsigned comment added by Sbelknap (talk • contribs) 02:28, 28 January 2018 (UTC)

This statement in the lede is flat-out stupid, and yet isn't being challenged or corrected:

"Finasteride is a 5α-reductase inhibitor and works by decreasing the production of dihydrotestosterone (DHT), an androgen sex hormone, in certain parts of the body like the prostate gland and the scalp."

Really? DHT is now produced...by the scalp? As should come as no surprise, there is zero reference to this in the accompanying citation. My layman's understanding is that hair loss from male pattern baldness is due to side-effects from how some people's bodies (i.e., DNA expression) handle testosterone *breakdown* products in the bloodstream, and thus high testosterone levels --> increased baldness. Finasteride all but certainly reduces baldness by reducing testosterone levels, but if someone actually thinks that the scalp *produces* testosterone, I have a bridge in NYC I want to sell them. Cheap.

--104.15.130.191 (talk) 00:15, 13 February 2018 (UTC)

Thanks for your note. It wasn't exactly incorrect but i added some nuance. Jytdog (talk) 01:07, 13 February 2018 (UTC)

What are the sub-sections "generic names" and "brand names" doing under the Society and Culture section? These sub-sections have nothing to do with society or culture and should be either moved into a more relevant section or deleted.2604:2000:E0CF:5100:2C58:7BB2:B950:9CC0 (talk) 04:31, 20 March 2018 (UTC)

I suggest a revamp of the scalp hair loss section, which is incredibly small considering this is one of the main applications for the medication.

Here is some data that should be included in some form:

"Based on hair counts, no further hair loss was observed in 83% of finasteride-treated men with vertex hair loss after 2 years and in 70% of finasteride-treatment men with frontal hair loss after 1 year. Based on standardized clinical photography, the chances of mild to moderate visible regrowth are 61% on the vertex (with an additional 5% achieving great visible regrowth) after 2 years and 37% on the frontal area after 1 year."

"Hair counts, which increased with finasteride treatment during the first year of the study, remained above baseline over 5 years. In contrast, men treated with placebo progressively lost hair over 5 years, confirming the effect of continued miniaturization of scalp hair that is the hallmark of this disorder. Thus, the treatment effect of finasteride on hair count relative to placebo increased progressively over time, leading to a net improvement for finasteride-treated men of 277 hairs in the target area compared to placebo at 5 years. Most (65%) finasteride-treated men had increases in hair count at 5 years, compared to none of the placebo- treated men, but even for those finasteride-treated men with a lower hair count at five years compared to baseline, the average magnitude of loss was less than that observed in the placebo group."

"90% of finasteride-treated men either maintained (no further visible hair loss from baseline), or sustained visible improvement in, scalp coverage over 5 years, while 75% of placebo-treated men sustained visible deterioration in scalp coverage"

All of this information is included in a review article detailing clinical trials on the drug for androgenic alopecia. Use of Finasteride in the Treatment of Men With Androgenetic Alopecia (Male Pattern Hair Loss)^[5]

So, in summary:

• No hair loss observed in 83% of men treated with finasteride after 2 years; no hair loss in 70% of those treated for frontal hair loss after one year.
• Hair counts remained above baseline over 5 years compared to placebo, who lost hair over 5 years.
• Net improvement of 277 hairs in target area after 5 years for finasteride-treated men.
• 90% of finasteride treated men maintained or had visible improvement in hair over 5 years.

I'm hoping some editors can take a look at this and help me break it down into something more palatable to add to the Scalp Hair Loss section. Jojomuju (talk) 06:18, 14 April 2018 (UTC)

PMID 12894990^[5] is a primary source (at least according to PubMed; it just summarizes the primary literature, doesn't critically evaluate it) and per WP:MEDRS, secondary sources (i.e., review articles) are needed. PMID 15102575^[6] would appear to be a more appropriate source. Boghog (talk) 07:26, 14 April 2018 (UTC)

More up-to-date reviews are preferable, and also available.^[7][8][9] Boghog (talk) 07:39, 14 April 2018 (UTC)

Thank you for those. I'll look into them. PMID: 23768246 seems promising as a source regarding efficacy; however, I'm having trouble accessing the full text and have requested it from the authors. In the meantime, I'll look into more meta-analysis and reviews. Jojomuju (talk) 09:10, 14 April 2018 (UTC)

More importantly, I think it would enhance the section if we added references about how finasteride actually works in the scalp, like the role of androgens in hair miniaturization and how finasteride decreases scalp dht levels. This is a good overview to draw information from that I'll be looking into: PMID: 22235201. If there are any suggestions on ways to flesh this out, please let me know. I think individual hair counts, hair weight, etc from the studies is less necessary than how it works and its efficacy compared to other treatments. Jojomuju (talk) 05:55, 15 April 2018 (UTC)

I added the most pertinent information from reviews and meta-analysis on the method of action. If anyone has additional suggestions to improve this section, let me know. I'll continue reading through these papers. Jojomuju (talk) 08:50, 15 April 2018 (UTC)

@Jytdog: - The source added by Jojomuju doesn't belong in this article for several reasons. The journal in which it was published is unranked and low quality, 75% of the authors have been paid consultants for Merck, one of the authors is the editor of said journal, and the article itself is rife with factual, scientific, and grammatical errors. How do you expect to maintain an article of neutrality when you let such poor sources stand to summarize an evolving issue? If you want to include a mention of the nocebo effect that is fine, but this article does a poor job evaluating the existing body of literature and is already out of date. The nocebo effect is also does not last for many years has already been demonstrated in many PFS patients.2604:2000:E0CF:5100:31A0:FF7E:9D8:6891 (talk) 21:57, 15 April 2018 (UTC)

Thanks for opening a discussion. We are discussing this diff by you, in response to this edit adding the content and source.

Not sure what you mean by "unranked" (no impact factor?). Your critique of the content is meaningless in WP. With regard to the authors, yes they have disclosed working for Merck in the past along with other companies; if we excluded every review written by people who had consulted for pharma we would have no sources. I am not convinced. Have posted at a note at WT:MED to get others to comment. Jytdog (talk) 22:12, 15 April 2018 (UTC)

would agree w/ Jytdog argument--Ozzie10aaaa (talk) 23:00, 15 April 2018 (UTC)

I agree with Jytdog also, and the secondary source fits within WP:MEDRS guidelines. As for the article's neutrality, the article is currently giving undue weight WP:NPOV to the prominence and consenus on persistent sexual side effects as they relate to finasteride, which was the purpose of adding other research and viewpoints. There is currently no scientific consenus on this issue, so it's important to provide opposing views, especially given how controversial this subject is in the scientific community. The article is currently providing an overwhelming view of negative sexual side effects that needs some balance, and the article needs more information about the use of the medication and its biological effects. I have another rewrite available with another source if Jytdog or any of the other editors feel the current source is inadequate for the section in question. Jojomuju (talk) 00:08, 16 April 2018 (UTC)

I am not saying that we should use the source; I definitely don't agree with all the reasons the IP editor give but this is worth discussing. Jytdog (talk) 00:39, 16 April 2018 (UTC)

Jytdog If you guys decide the source needs to be removed, here is a rewrite with another source. There are quite a few studies referenced here that are reviewed on the prevalence of nocebo effects in several studies, so this could actually be expanded further, though I feel this rewrite summarizes pretty well. Feel free to change/improve the wording if you'd like:

Current studies on persistent sexual side effects document contrary findings. In some studies, incidence of sexual adverse effects with finasteride has been comparable to placebo. A significant nocebo effect has also been documented that might explain the high prevalence of reported persistent sexual side effects on websites and blogs.^[1] — Preceding unsigned comment added by Jojomuju (talk • contribs) 01:27, 16 April 2018 (UTC)

@Jytdog:, the problem per se isn't that it is written by Merck consultants but you are ignoring that this is in a complete throw away journal with fact/science/grammar errors. I think it is would be OK to mention the nocebo effect but I don't think that source should be used. The underlying sources also have to be properly summarized. Throughout this article are diffs which don't actually reflect what the underlying sources say.2604:2000:E0CF:5100:ED1F:D5E0:C69F:92B0 (talk) 04:11, 16 April 2018 (UTC)

You are not raising an objection that is useful in Wikipedia. Nobody here cares about your critique of the "fact/science/grammar errors." In any case perhaps you are more comfortable with new PMID 25900939 discussed below? Jytdog (talk) 03:50, 17 April 2018 (UTC)

We're talking about PMID 28232919, right? This is a review that's all "sexual dysfunction and mood changes", and which is published in "The first journal exclusively dedicated to research and treatment of hair, nail and skin gland diseases", right?

I believe that a quick review of MEDRS's section titled ===Predatory journals=== will lead you to a sentence that says "Other indications that a biomedical journal article may not be reliable are...its content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal). I think that mood changes in a journal about hair and fingernails fits that description of "outside the journal's normal scope", don't you? So, yes, I think that there are objections to this source that are exactly what Wikipedia cares about. WhatamIdoing (talk) 04:19, 17 April 2018 (UTC)

The article is about side effects of a class of drugs used in treating hair growth and glandular problems. I think it fits well within the scope of the journal. --Cincotta1 (talk) 23:08, 17 April 2018 (UTC)

"The aim of this study is to review the existing medical literature for evidence-based research of permanent sexual dysfunction and mood changes during treatment with 5-alpha-reductase inhibitors including finasteride and dutasteride." does not sound much like "Let me tell you something about treating baldness", even though those drugs are sometimes used for that purpose. If they said they were reviewing the role of these drugs for preventing prostate cancer or HIV infection, I'd be equally concerned that the journal might not have the resources and connections to provide a solid review. Or: Why didn't the authors – all dermatologists, from the looks of it – publish this in a journal that specifically knows something about psychiatry or sexual health? WhatamIdoing (talk) 15:50, 18 April 2018 (UTC)

In the introduction: "The Postfinasteride Syndrome Foundation, which was created to raise awareness about PFS, recently sent an email to dermatologists practicing in the United States to inform them about the syndrome and its inclusion into the National Institute of Health's Genetic and Rare Diseases Information Center." Later in the results section: "[W]e hope that the PFS Foundation will start to involve dermatologists in their advisory board in order to generate data from prospective and not retrospective studies. As dermatologists dealing with hair loss patients, we need to keep in mind that finasteride 1 mg is an improved medication and that Propecia (finasteride) labeling includes warnings of possible sexual dysfunction including persistent sexual dysfunction." It is a review of post-market studies of a dermatology medication searching for reports of side effects that match claims a vocal, but non-academic, third party.

Either way, I do not see other signs that the journal is predatory. The editors-in-chief are based at accredited universities; most of the editors are based at universities, hospitals or clinics (though two have private practice). It currently in the Web of Science Emerging Source Citation Index and under evaluation for inclusion in the Impact Factor databases. The journal is not included in Beall's list.--Cincotta1 (talk) 18:23, 18 April 2018 (UTC)

The complaint seems to about this paper by Fertig et al.

A generic search on PubMed for "post finasteride syndrome" lists 22 papers, of which four are review articles. One of the papers is actually about hirsutism. "Postfinasteride syndrome" (without a space) lists only four papers. One of these is Fertig's paper.

The dearth of relevant papers inclines me to think that "syndrome" is currently a neologism. As such, it may be better to avoid mentioning it in this article. (This situation may change in the future.) If editors really think that this is important to this article, it warrants at most a single sentence. Axl ¤ [Talk] 10:00, 21 April 2018 (UTC)

People are confusing this topic with my rewrite suggestion thread. As of now, there is not a consensus that the original source should be removed, so it stays. I reverted an edit where someone said they removed this source because of discussions on the talk page then someone just reverted my revert. They are confusing this topic with the suggested rewrite thread which has not been implented and used a different source. If Doc James or Jytdog could take a look and revert that last edit, I don't want to get in an edit war with someone because they aren't understanding these topics and have an agenda.Jojomuju (talk) 01:19, 30 April 2018 (UTC)

I noticed several recent edits on the 28th that might be considered disruptive editing that should probably be reverted unless they are discussed, so perhaps Jytdog, you could take a look. It looks like there is a concerted effort in the past few days to put undue weight on the side effects and revert material that contributed to a neutral article. Jojomuju (talk) 07:00, 29 April 2018 (UTC)

Are you financially tied to any websites that sell finasteride online or any other commercial enterprises that are involved in the hair loss industry? I am only asking because I noticed you are largely a WP:SPA that is very focused on including a poor-quality source by Shapiro and Tosti. Both of whom are scientific advisors at Keeps.com which sells finasteride through telemedicine online. If so, you need to declare your potential financial interests that may conflict with editing the encyclopedia. I don't believe it precludes you from editing, but I believe disclosure is required. — Preceding unsigned comment added by 2604:2000:E0CF:5100:EDBB:E46C:81EA:44D (talk) 04:31, 30 April 2018 (UTC)

I don't have a COI, and this is not the appropriate place to post something like that. You are more than welcome to file an inquiry, though. Almost all of my edits have been open for discussion in the talk page with the intent of making this article more neutral. Please refrain from reverting my edits, and though you may feel the source you mentioned is a bad one, that is not the consensus here. I suggest the admins semi-protect the page to avoid some of this, and also look into recent disruptive edits by a user who might have a COI who shares a name with the author of adverse events study. Jojomuju (talk) 07:53, 30 April 2018 (UTC)

This article's factual accuracy is disputed.

A secondary source reviews primary sources and describes the evidence that finasteride has a significant effect on sexual function and that finasteride exposure also lowers testosterone. https://www.ncbi.nlm.nih.gov/pubmed/26296373 The cited journal has a high RG impact factor. https://www.researchgate.net/journal/1573-2606_Reviews_in_Endocrine_and_Metabolic_Disorders — Preceding unsigned comment added by Sbelknap (talk • contribs) 01:09, 3 May 2018 (UTC)

This would not be considered a reliable secondary source. The author of the review is citing his own study, which is where the information you are citing from the review is coming from. Traish is citing Traish in the source you are using. Jojomuju (talk) 08:08, 3 May 2018 (UTC)

The cited article by Traish is a high quality secondary source, which summarizes the scientific literature. This article has been peer-reviewed. It reflects the opinion of peer reviewers and editors and of other experts. It has been published in a high-impact journal. This article has been cited more than 30 times in the scientific literature. — Preceding unsigned comment added by Sbelknap (talk • contribs) 11:45, 3 May 2018 (UTC)

I wasn't speaking to the review itself, just this specific use of this citation in the review:

In men with prostatic hypertrophy, exposure to finasteride reduces blood testosterone levels and increases the severity of erectile dysfunction, as measured by the International Index of Erectile Function (IIEF). In contrast, tamsulosin does not reduce blood testosterone level and does not worsen erectile dysfunction as measured by the IIEF.

Within the review, this comes from author's own study, which is the particular citation you used. This is not a reliable secondary source in this instance because it's the same author. Here is the study he is referencing PMID 26053014.

Somebody please provide a citation supporting the assertion that the author of a secondary source is unreliable when he cites primary sources that he has also authored. If this assertion is not supported by some evidence, then I would favor including this statement about finasteride reducing testosterone levels and increasing the severity of erectile dysfunction. Note that many authors of secondary sources cite their own work, as many such authors are also conducting primary research in their discipline. There are many examples in wikipedia where this is done. Journal editors and peer reviewers are aware of this issue and the final published secondary source literature must pass their vetting.

The link to the wikipedia article antiandrogen was deleted without explanation. Finasteride is an antiandrogen and this is described in the wikipedia article on antiandrogen.— Preceding unsigned comment added by Sbelknap (talk • contribs) 12:37, 3 May 2018 (UTC)

Jytog had previously reverted your edit that contained this and then you put it there again. If your edit is reverted, I would post on the talk page before adding something back. Jojomuju (talk) 20:53, 3 May 2018 (UTC)

I have added the relevant information with Traish citation about adverse effects to the lead, removed the dated Tacklind citation from the lead.

This is adding undue weight to adverse effects and does not belong in the lead, especially given that the next sentence summarizes the adverse effects, which essential says what you added but uses a neutral voice. Hopefully other editors will take a look at this and the additions and removals in the adverse effects section and share their views. Jojomuju (talk) 20:53, 3 May 2018 (UTC)

The hyperlink antiandrogen was removed from the lead. I suggest that this hyperlink be restored to the lead of the finasteride article. As the mechanism of action is highly relevant to both the therapeutic effect and toxic effects of finasteride, the link to antiandrogen provides the reader with a link to more information about the class of drugs that finasteride is in. — Preceding unsigned comment added by Sbelknap (talk • contribs) 13:11, 3 May 2018 (UTC)

Why was the Cochrane review removed? It is still perfectly appropriate. Doc James (talk · contribs · email) 01:31, 4 May 2018 (UTC)

User:Jytdog's changes look good. Doc James (talk · contribs · email) 02:31, 4 May 2018 (UTC)

The Cochrane review does not assess the adequacy of adverse drug event reporting, and thereby underestimates the severity and frequency of erectile dysfunction in men exposed to finasteride. — Preceding unsigned comment added by Sbelknap (talk • contribs) 04:14, 4 May 2018 (UTC)

What is your source for that statement? Jytdog (talk) 04:27, 4 May 2018 (UTC)

Cochrane generally does assess adequacy of reporting. So yes evidence for your statement is needed. Doc James (talk · contribs · email) 05:52, 4 May 2018 (UTC)

Here is the source: Tacklind J, Fink HA, Macdonald R, Rutks I, Wilt TJ. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD006015. doi: 10.1002/14651858.CD006015.pub3. Review. PMID: 20927745

Nowhere is there mention in Tacklind et al that individual clinical trial reports were assessed as to the methods and adequacy of assessment and reporting of adverse drug events. The methods of the primary sources vary considerably. Some primary sources used spontaneous reporting by subjects (which is known to be unreliable), some primary sources do not provide information about methods of assessment of adverse events. Tacklind is simply not a reliable secondary source when it comes to finasteride-associated adverse events. — Preceding unsigned comment added by Sbelknap (talk • contribs) 17:11, 4 May 2018 (UTC)

Here in Wikipedia, no editor has the authority to analyze a source in this way. See the last sentence of WP:MEDASSESS. Jytdog (talk) 18:02, 4 May 2018 (UTC)

Ascertaining the presence/absence of some assertion is not "detailed academic peer review." Tacklind did not assess methods of reporting adverse drug effects. It is simply not present in his meta-analysis. This is no more complicated than checking to see if the secondary source author was also the author of one of the primary sources cited in that secondary source. — Preceding unsigned comment added by Sbelknap (talk • contribs) 19:38, 4 May 2018 (UTC)

I fixed your indenting above. That is the last time I will do that. I will just ignore comments that disdain community etiquette in the future.

Editors are nobodies; none of us have the authority, here in Wikipedia, to analyze the contents of a source in that way. I understand that you are used to writing that way in the literature. WP is not like that. Please engage with the policies and guidelines of editing Wikipedia. It is different by design, in ways that deal with the differences in authorship here. The essay WP:EXPERT attempts to explain this. I have pointed you to that essay before. This is the last time I will try to call these differences to your attention. Jytdog (talk) 20:23, 4 May 2018 (UTC)

The following is my rewrite of the Adverse Effects section. If the other editors could take a look and let me know what you guys think or if this could be improved further, that would be great. The current Adverse Effects section has some WP:Weight issues and some redundancies. My goal with this rewrite is to provide the information in a way that flows better and improves the weight.

Adverse effects==

When finasteride was originally approved for hair loss in 1997, the FDA approval review reported that it appears well tolerated, with the most common side effects being related to sexual function.^[2] In many people these side effects resolve if the medication is stopped and occasionally resolve even if the medication is continued.^[2] A 2010 Cochrane review concluded that adverse effects from finasteride are rare when used for BPH ^[3]; however, a 2015 meta analysis found that none of the clinical trials testing finasteride in hair loss had adequate safety reporting and did not provide sufficient information to establish the safety profile for finasteride as a treatment for hair loss. ^[4][5]

The FDA has added a warning to 5α-reductase inhibitors concerning an increased risk of high-grade prostate cancer, as the treatment of BPH lowers PSA (prostate-specific antigen), which could mask the development of prostate cancer.^[6][7] Although overall incidence of male breast cancer in clinical trials for finasteride 5 mg was not increased, there are post-marketing reports of breast cancer in association with its use.^[8][9] Some men may also develop breast enlargement (gynecomastia) following finasteride usage.^{[10][11][12][13]}

Sexual dysfunction===

Finasteride causes short-term sexual dysfunction in some men.^[14] Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear.^[4] There are case reports of persistent diminished libido or erectile dysfunction after stopping the drug and the FDA has updated the label to inform people of these reports.^[14][15][16]A 2017 review of men with BPH found that finasteride resulted in a 45% greater risk of erectile dysfunction and a 54% greater risk of hypoactive sexual desire.^[17]

The 2010 Cochrane review found that compared with placebo, men taking finasteride are at increased risk for impotence, erectile dysfunction, decreased libido, and ejaculation disorder for the first year of treatment; the rates of these effects became indistinguishable from placebo after 2–4 years and these side effects usually got better over time.^[3] Another 2010 review found that when used for hair loss finasteride increased rates of sexual problems.^[18] A 2016 review, a meta-analysis found that sexual dysfunction, including erectile dysfunction, loss of libido, and reduced ejaculate, may occur in 3.4 to 15.8% of men treated with finasteride or dutasteride.^[19] This adverse effect has been linked to lower quality of life and can cause stress in relationships.^[20] There is also an association with lowered sexual desire.^[21] It has been reported that in a subset of men, these adverse sexual side effects may persist even after discontinuation of finasteride or dutasteride.^[21]

Jojomuju (talk) 20:22, 16 April 2018 (UTC)

@Jojomuju:, I think this is fine but in my opinion the last two sentences don't reflect the related reference source at all. The source (#22) mentions the inherent conflict between induces nocebo effect and full disclosure of potential side effects. It seems to me that experiencing temporary nocebo effect is not as significant suffering from a lifelong syndrome. Special care should be taken to make sure that readers don't think all side effects are caused by nocebo. It is also important to recognize that over time, more and more doctors have acknowledged the persistent side effects. As you would expect, the holdouts are specialists like dermatologists and hair transplant surgeons that aren't specialists in relevant fields to post finasteride syndrome.2604:2000:E0CF:5100:4D5C:D45D:EC6E:457F (talk) 01:52, 17 April 2018 (UTC)

I believe you mentioned your issues with the last source in the last topic that was posted. Once that is resolved and we get a consensus from more editors, I'll edit that section as needed. Thank you for taking time to look over it! Jojomuju (talk) 02:59, 17 April 2018 (UTC)

@Jojomuju:, I was referring to the latest source you put at the bottom of your revised edit. It discusses the nocebo effect in dermatology treatments and briefly mentions finasteride but doesn't talk about persistent side effects.2604:2000:E0CF:5100:4D5C:D45D:EC6E:457F (talk) 03:23, 17 April 2018 (UTC)

That's incorrect. Here is direct quote from the source.

"...sexual adverse effects due to finasteride seem to have a strong component of nocebo response. Certain studies have documented contrary findings, particularly with respect to the 'post-finasteride syndrome'. [42],[43],[44] This syndrome, characterized by sexual and certain non-sexual adverse effects experienced at least 3 months after stopping the medication and persisting indefinitely, has generated a commotion in the scientific community. However, the existing evidence from systematic surveys and anecdotal observations is not robust enough to prove or disprove the biological plausibility of this syndrome." Jojomuju (talk) 03:29, 17 April 2018 (UTC)

The two of you are making a mess of this page. Neither of you need to ping the other. Jojomuju please thread properly. IP editor you obviously have edited WP before. Would you please login to your account to resolve the clutter of your IP address so we don't have to deal with your signature clutter as well as whatever argument you are trying to make? It is hard enough working through the issues without this logistical mess. Jytdog (talk) 03:36, 17 April 2018 (UTC)

"Please login" presumes that an account exists. Wikipedia has multiple editors who have never created accounts. I talked to one tech-savvy IP editor about this last year. He just didn't want to bother with creating yet another account, especially since he'd need to login across multiple devices. (It's not widely known, but it's pointless to ping IPs, because the pings aren't sent.) WhatamIdoing (talk) 04:25, 17 April 2018 (UTC)

That PMID 25900939 source is something; it is unusual in so directly critiquing the PFS stuff. Hm. Jytdog (talk) 03:47, 17 April 2018 (UTC)

Sorry about that, I'm new to this; I think I got it now. PMID 25900939 is a good source. It seems others are unhappy with the orginal source, so I included this source in the last two sentences of the rewrite. If it's that contentious, we can just take it out and hopefully the weight can be improved by other editors who are better equipped. I'm curious to hear what people think of the rewrite and how it can be improved, though. Jojomuju (talk) 04:59, 17 April 2018 (UTC)

in regards to I think it may be best, removed...IMO--Ozzie10aaaa (talk) 10:47, 17 April 2018 (UTC)

Okay, removed the last two sentences from the suggested rewrite. Jojomuju (talk) 20:14, 17 April 2018 (UTC)

Seems better to me. I like how it simplifies the previous text and it remains balanced. Of note, there is a primary source from 2017 that has much stronger statistical evidence in favor for persistent sexual dysfunction that is more recent than any of the references here. When that information finds its way into a MEDRS secondary source, this article should be updated. Thanks for your good work. 2604:2000:E0CF:5100:1834:939A:68B4:17FE (talk) 22:25, 17 April 2018 (UTC)

The suggested rewrite used a different source that I removed, but this rewrite is not finalized. Please refrain from reverting perfectly good sources on the article until a consensus has been reached on both topics. Jojomuju (talk) 01:21, 30 April 2018 (UTC)

• So above, folks objected to a citation because the authors had industry ties. For the Traish ref (PMID 26296373), the disclosure notes that "Drs. Melcangi and Bortolato have received research grants from the Post-Finasteride Syndrome Foundation." Jytdog (talk) 01:53, 4 May 2018 (UTC)

This strikes me as odd, too. The original source was PMID 28232919, which had objections because some of the researchers had consulted for Merck. Even though a consensus was not reached, this source was reverted after I restored it and remains off the article, which is a bit confusing. Jojomuju (talk) 23:59, 5 May 2018 (UTC)