No Conflict of Interest?

On 2012 Jan-Apr. the Indian Dermatology Online Journal published this Article:

Finasteride and sexual side effects
Author information:

Venkataram Mysore
Consultant Dermatologist- Hair Transplant Surgeon, Venkat Charmalaya- Centre for Advanced Dermatology, Bangalore, India Address for correspondence: Dr. Venkataram Mysore, Venkat Charmalaya- Centre for advanced Dermatology, 3437, 1 G cross, 7th Main, Subbanna Garden, Vijay Nagar, Bangalore – 560040, India. E-mail: mysorevenkat@hotmail.com

INTRODUCTION: “Some of the commonly faced questions by a physician while treating a patient of pattern hairloss are about the possible sexual side effects caused by finasteride. Reports in the press, internet sites, and misinformation by practitioners of alternative medicine, all have contributed to this image of the drug, and has lead to apprehension in the minds of patients. Often even dermatologists seem to hesitate to prescribe the drug on a long term basis. This article examines this subject in the light of evidence available.” by practitioners of alternative medicine: Like?:
Michael Irwig (George Washington University), AM Traish (Boston University), Irwin Goldstein (chief editor of the journal of sexual medicine), Eugene Shippen (author of the book "The Testosterone Syndrome"), M. Zitzmann (University Münster), A. Jacobs (neuroendocrinologist, New York), John Crisler, (Director, All Things Male - Center for Men's Health) and many more...

Conflict of Interest: None declared Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/ Why? He is a member of International society of hair restoration surgeons www.ishrs.org and vice president, Bangalore dermatological society www.bds.org

“Dr Venkataram is currently the vice president of cutaneus surgeons association www.ascinet.com ( India), coordinator of taskforce on dermatosurgery( Indian association of dermatologists, venereologists, leprologists) www.iadvl.org , vice president, Bangalore dermatological society www.bds.org, founding member-chairman of ethical committee Association of hair restoration surgeons( India) www.ashrsindia.com. He has been a member of International society of hair restoration surgeons (www.ishrs.org) since 2002 and a member of their training committee. He is the editor in chief of Journal of cutaneus and aesthetic surgery. “

Source: http://www.bangalorehairtransplant.com/aboutus.html

Source: http://www.bangalorehairtransplant.com/index.php

Dr. Venkataram Mysore is also coordinator of taskforce on dermatosurgery (Indian association of dermatologists, venereologists, leprologists) www.iadvl.org The journal (IDOJ) that published this article is by the IADVL!

“Indian Dermatology Online Journal (IDOJ) is a maiden open access electronic journal of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)”

Source: http://www.idoj.in/aboutus.asp

What does the ISHRS do?
“The health and well being of our patients is the utmost concern of the 900 physician members of the ISHRS – whether prescribing medications like Propecia or performing hair restoration surgery,” said ISHRS President Dr. Jennifer Martinick.

Source: http://www.ishrs.org/pr-pr34.htm

The ISHRS, MERCK (MSD) and the BDS:
Dr Venkataram is currently the vice president, Bangalore dermatological society www.bds.org The clinical meeting of the BDS is sponsored by MSD (Merck Sharp & Dohme) and the Makers of: Finasteride.

“The 1 clinical meeting of this academic year is scheduled on 19/06/2011... This Program is sponsored by MSD, Makers of: - Pilogro, Pilogro Plus, Elocon, Emolene and Alaspan.“

Source: http://www.bdsmembers.com/meetings/1st meeting for 2011.pdf

The ISHRS, MERCK (MSD) and Bosley part 1:
The ISHRS and this press release is nothing more than a front for Merck payrolled/Propecia-pushing derms trying to protect their drug in the face of pending lawsuits. Timing of the release is of course suspect for these very reasons. Many of the ISHRS conferences are sponsored by Merck as well Bosley also sponsored the ISHRS conference. (Bosley sells Propecia)

Source: http://www.ishrs.org/PDF/ISHRS 19thASM DetailedPrelim Program 2011.pdf

The ISHRS, MERCK (MSD) and Bosley part 2:
The findings of this press release are not surprising at all, considering many members of the ISHRS, including its past president Edwin Epstein, have been/are involved with Merck in some capacity over the years.
“Edwin S. Epstein, M.D., F.A.C.S., A.B.H.R.S.- Bosley Richmond Physician” “He has served on the Board of Governors of the International Society of Hair Restoration Surgeons (ISHRS) since 2004, and was elected President for 2009-2010” “He is a Diplomate of the American Board of Hair Restoration Surgery, has served as a board examiner, and is a Fellow of the American College of Surgeons. He has been on the Hair Loss Advisory Board of Merck and Co, and is a member of the Medical Society of Virginia.”

Source: http://www.bosleymedicalrichmond.com/physicians.php

The ISHRS, MERCK (MSD) and Bosley part 3:
Bosley Medical Richmond sell´s Propecia! Dr. Edwin S. Epstein, a Physican of Bosley Medical Richmond (Also sponsor of the ISHRS) who was on the Hair Loss Advisory Board of Merck & Co,was the President of the ISHRS, sell´s Propecia and Merck is still a big sponsor of the ISHRS.

Source: http://www.bosleypropeciarx.com/

The ISHRS, MERCK and Bosley part 4:
“PROPECIA VICTIMS FURIOUS BOSLEY KNEW OF DRUG'S DANGERS BUT DID NOT WARN PATIENTS”
"When the Food and Drug Administration approved the hair-growth drug Propecia in 1997, a number of doctors and medical researchers voiced their strong concerns about the drug’s severe side effects. One outspoken critic was well-known hair-restoration expert L. Lee Bosley who publicly denounced Propecia as a "serious health concern" in the wake of its FDA approval—only to allow his doctors to enthusiastically recommend the medication to patients a few years later.”

Source: http://www.examiner.com/article/propecia-victims-furious-bosley-knew-ofdrug-s-dangers-but-did-not-warn-patients

Conflict of Interest: None declared ???

Now, they finaly try to use it in children:
Finasteride for recurrent priapism in children and adolescents: A report on 5 cases. http://www.ncbi.nlm.nih.gov/pubmed/23131509

How do MERCK (MSD) work?

Vioxx maker Merck and Co drew up doctor hit list
AN international drug company made a hit list of doctors who had to be "neutralised" or discredited because they criticised the anti-arthritis drug the pharmaceutical giant produced. Source: http://www.theaustralian.com.au/news/drug-company-drew-up-doctor-hitlist/story-e6frg6n6-1225693586492 "We may need to seek them out and destroy them where they live," a Merck employee wrote, according to an email excerpt read to the court by Julian Burnside QC, acting for the plaintiff.

VIOXX and Merck:
http://www.youtube.com/watch?v=CfNULvGcMsc

Maker of Vioxx Is Accused of Deception
http://www.washingtonpost.com/wpdyn/content/article/2008/04/15/AR2008041502086.html

Merck vaccine fraud exposed by two Merck virologists; company faked mumps vaccine efficacy results for over a decade, says lawsuit
http://www.naturalnews.com/036328 Merck mumps vaccine False Claims Act.htm l

What can Finasteride cause?
The post-finasteride syndrome (PFS)[1] describes persistent sexual, neurological, and physical adverse reactions in patients who have taken finasteride, a 5-alpha reductase enzyme type I and II inhibitor[2] used to treat hair loss (under the brand name Propecia or generics) or enlarged prostate (Proscar or generics).[1][3] This presumably rare condition may persist for months to years even though the medication has been discontinued, in most cases the damage may be permanent.[1][3][4][5][6][7][8][9] The syndrome can result both after very short periods of intake or after many years of use.[10]
• • • • • • • • •

1 Symptoms 2 Frequency 3 Causes 4 Other potential consequences 5 Therapy 6 Public interest 7 The Post-Finasteride Syndrome Foundation 8 External links 9 References

Symptoms
PFS include the following symptoms:
• • • • • • • • • • • • • • • • • • • •

Decrease or complete loss of libido [3][4][6] no reaction or decreased reaction to sexual stimuli [3][4][5][6] Erectile dysfunction, impotence[3][4][5][6][9][11] Sexual anhedonia, loss of pleasurable orgasm or complete loss of orgasm (anorgasmia)[3][4][5][6] Genital anesthesia[9] Decreased ejaculation volume, poor semen quality and infertility[4] Penile shrinkage[6][7][12][13] Curvature of penis (Peyronie‘s disease)[6] Testicular pain[4][5][6][9] Testicular shrinkage[6] and insensitivity of the scrotum Gynecomastia[4][7][9] Chronic fatigue (lethargy and listlessness)[10] Muscle weakness, atrophy and twitches[10] Dry skin Amnesia (disorder of short-term and long-term memory)[3][6] Slowed thought processes, impaired comprehension[3][6][9] Depression,[3][4][5][9] including suicidal depression[8][14][15][16] Anxiety disorder and panic attacks[10] Emotional flatness and anhedonia[3][5] Insomnia[3][10]

Often the symptomatology worsen after the discontinuation.[1][3][6]

Frequency
The frequency of PFS is not known,[3][9] but the incidence rate must be considered as low. However, due to the large number of persons using finasteride worldwide, the number of cases is at least in the thousands.[6] After previous label changes in Europe, on April 11 2012, the FDA mediated a label change in the United States which now includes libido disorders, ejaculation disorders, and orgasm disorders and possible male infertility that continue after discontinuation of the drug.[17] Further studies are demanded from science and patients.[1][3][6][9][18]

Causes
The cause of PFS is currently still unknown.[3][6][5][9] Finasteride inhibits the conversion of testosterone to DHT, but it also changes the levels of testosterone, LH and FSH. [19] The biosynthesis of DHT and various neurosteroids such as Allopregnanolone (ALLO) and Tetrahydrodeoxycorticosterone (THDOC), are dependent on known isoforms of 5α-reductase. They are positive allosteric modulators of GABAA receptors, which have the same mechanism (of action) of euphoric and anxiolytic drugs, such as Benzodiazepines. [16][20] It was shown that finasteride prevents their biosynthesis and, hence,[16][21] this effect is one of the possible causes of the emotional and sexual side effects.[14][16] However, some symptoms, such as muscle wasting, loss of body hair and the permanent side effects long after discontinuing the medication cannot fully be explained. Since some patients have normal to high testosterone levels - while at the same time presenting the clinical picture of hypogonadism - it is supposed that these patients have become resistant to androgens.[10]

Other potential consequences
The FDA has announced that finasteride may raise the chances of developing highgrade prostate cancer, a more serious form of the disease.[22][23]

Therapy
Currently, there is no effective therapy to generally treat PFS since its exact cause is still unknown.[3][6] Affected patients often do not react well to androgen supplementation. In some cases, they even show a negative reaction and worsening of symptoms. PFS patients also often do not respond well to antidepressant therapy.[6]

Public interest
In the United States media interest on regarding PFS has increased due to the coming out of affected patients and legal action taken against the manufacturer.[24][25][26][27][28] Recently, a PFS patient and the parents of Propecia suicide victim conducted a hunger strike in front of Merck headquarter.[29] Certain scientists and doctors publically have issued warnings regarding the potential of long term or permanent health damage arsing from 5AR inhibitor use.[3][6][9] To name a few: Michael Irwig (George Washington University), AM Traish (Boston University), Irwin Goldstein (chief editor of the journal of sexual medicine), Eugene Shippen (author of the book "The Testosterone Syndrome"), M. Zitzmann (University Münster,Germany), A. Jacobs (neuroendocrinologist, New York), John Crisler, (Director, All Things Male Center for Men's Health)

The Post-Finasteride Syndrome Foundation
In August 2012 the Post-Finasteride Syndrome Foundation (PFS Foundation), headquartered in the United States, was founded. Its objectives are to help fund research on the characterization, underlying biologic mechanisms and treatments of the post-finasteride syndrome. A secondary goal is to help increase public awareness of PFS.[30]

External links
• •

Homepage of the Post-Finasteride Syndrome Foundation http://www.propeciahelp.com/

References
1. ↑ a b c d e Clinical analysis in young patient with persistent sexual dysfunctions after finasteride assumption to prevent male pattern hair loss, Author(s): Trombetta, C.; Mazzon, G.; Liguori, G.; Ollandini, G.; Cauci, S.; Toffoli, G.; Erika, E. Journal Title: European Urology - Supplements ISSN: 1569-9056 2. ↑ Human type 3 5α-reductase is expressed in peripheral tissues at higher levels than types 1 and 2 and its activity is potently inhibited by finasteride and dutasteride, Yamana, Kazutoshi; Labrie, Fernand; Luu-The, Van, ISSN (Online) 1868-1891, ISSN (Print) 1868-1883, DOI: 10.1515/hmbci.2010.035, 8/ 2010 3. ↑ a b c d e f g h i j k l m n o p q An Old Problem with a New Cause—5 Alpha Reductase Inhibitors and Persistent Sexual Dysfunction Irwin Goldstein MD Editor-in-Chief, DOI: 10.1111/j.1743-6109.2011.02368.x 4. ↑ a b c d e f g h i Propecia leaflet, Merck 5. ↑ a b c d e f g h Michael S. Irwig, Swapna Kolukula: Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss. In: The Journal of Sexual Medicine

6. ↑ a b c d e f g h i j k l m n o p q r Persistent Sexual Side Effects of Finasteride: Could They Be Permanent? Michael S. Irwig MD Article first published online: 12 JUL 2012 7. ↑ a b c 5α-Reductases in Human Physiology: An Unfolding Story,Abdulmaged M. Traish, PhD, MBA 8. ↑ a b Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride With Persistent Sexual Side Effects, Michael S. Irwig, MD 9. ↑ a b c d e f g h i j k Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. fulltext 10. ↑ a b c d e f The Journal of Sexual Medicine: Special Issue: PROCEEDINGS OF THE WORLD MEETING ON SEXUAL MEDICINE, CHICAGO, USA, AUGUST 26-30 2012 11. ↑ Incomplete recovery of erectile function in rat after discontinuation of dual 5alpha reductase inhibitor therapy. Oztekin CV, Gur S, Abdulkadir NA, Lokman U, Akdemir AÖ, Cetinkaya M, Hellstrom WJ. 12. ↑ Effect of androgen deprivation on penile ultrastructure, Zhou-Jun SHEN1, Xie-Lai ZHOU, Ying-Li LU, Zhao-Dian CHEN 13. ↑ A. M. Traish, P. Toselli u. a.: Adipocyte accumulation in penile corpus cavernosum of the orchiectomized rabbit: a potential mechanism for venoocclusive dysfunction in androgen deficiency. In: Journal of andrology. Band 26, Nummer 2, 2005 Mar-Apr, S. 242–248, ISSN 0196-3635. PMID 15713830. 14. ↑ a b A new look at the 5alpha-reductase inhibitor finasteride. Finn DA, Beadles-Bohling AS, Beckley EH, Ford MM, Gililland KR, Gorin-Meyer RE, Wiren KM. 15. ↑ Finasteride induced depression: a prospective study. Rahimi-Ardabili B, Pourandarjani R, Habibollahi P, Mualeki A. 16. ↑ a b c d Römer B, Gass P: Finasteride-induced depression: new insights into possible pathomechanisms. In: Journal of Cosmetic Dermatology. 9, Nr. 4, Dezember 2010, S. 331–2. doi:10.1111/j.1473-2165.2010.00533.x. PMID 21122055. 17. ↑ April 2012 – FDA Mandates New Safety Labeling Changes for Propecia, Proscar 18. ↑ The Effects of Chronic 5-Alpha-Reductase Inhibitor (Dutasteride) Treatment on Rat Erectile Function, Michael R. Pinsky MD, Serap Gur PhD, Anthony J. Tracey MD, Andrew Harbin MD, Wayne J.G. Hellstrom MD, FACS* DOI: 10.1111/j.1743-6109.2011.02425.x 19. ↑ Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study. Uygur MC, Arik AI, Altuğ U, Erol D. 20. ↑ Gunn BG, Brown AR, Lambert JJ, Belelli D: Neurosteroids and GABA(A) Receptor Interactions: A Focus on Stress. In: Frontiers in Neuroscience. 5, 2011, S. 131. doi:10.3389/fnins.2011.00131. PMID 22164129. Volltext bei PMC: 3230140. 21. ↑ Vermeulen A, Giagulli VA, De Schepper P, Buntinx A, Stoner E: Hormonal effects of an orally active 4-azasteroid inhibitor of 5 alpha-reductase in humans. In: The Prostate. 14, Nr. 1, 1989, S. 45–53. PMID 2538808. 22. ↑ Finasteride (Propecia) and the Promotion of High-Grade Prostate Cancer W.R. Pitts, Jr. [Archives of Dermatology 2004;140:885–886]

23. ↑ FDA Drug Safety Communication: 5-alpha-reductase-inhibitors (5-ARIs) may increase the risk of a more serious form of prostate cancer, 9. Juni 2011; [1] 24. ↑ Merck Propecia Side Effects Class Action Lawsuit By Matt O’Donnell 25. ↑ Hair-Raising Side Effect It’s a common baldness remedy, but its side effects may be more than you—or your girlfriend—can handle: Men’s Health 26. ↑ The Australian Financial Review: Looking at care with a critical eye, PUBLISHED: 26 Sep 2012 27. ↑ FrenchTribune: Medication Can Cause Sexual Side-Effects, says study, 09/28/2012 28. ↑ Sydney Morning Herald: Hair-loss drug a downer in the bedroom, Sept. 27, 2012 29. ↑ The Australian Financial Review: Hair-loss therapy accused of link to impotence, PUBLISHED: 26 Sep 2012 30. ↑ Foundation Launches Website to Fund Research into the Post-Finasteride Syndrome, Source: 26. August 2012.PFS Foundation

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