The Nocebo Effect with Finasteride & Side Effects

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I think everyone is very familiar with the concept of the placebo effect, which simply means that if someone was given like a sugar pill that should not have any efficacy or benefit that, they would actually get the purported benefits of the of the men of the pill, whatever that may be hair growth, you know, lower blood pressure, Etc. Just because the the individual thinks they’re getting a benefit in the makes their body create the benefit. And therefore there is a

benefit per se less well known as the concept of the nocebo effect, which is basically a negative effect that a person experiences when that person is told they could experience a negative effect, even if that person is getting a placebo or getting the actual Medicaid medication. So study that was very interesting. That came out in the Journal of sexual medicine in 2007 and November. I was looking at finasteride 5 milligrams in the sexual side effects and a limited number of individuals that they looked at, which is about 55 and one group and 52 in another group. And so it wasn’t a huge number. And again, this was a finasteride at 5 mg dosing, not 1 mg, which is the standard dose for for, for men, or for postmenopausal women that are dealing with hair loss. And they looked at the nocebo effect and other words, what they looked at was was the percentage of individuals that had side effects sexual side effects in particular, or any side effects, without telling them that they could have sexual side effects. And then the percentage that had it when they were Council, that they could experience sexual side effects. So with any kind of side effects whatsoever without counseling, there was 15:3 153%. And with counseling the issue, the percentage was 436 so almost triple all the number of people, because they’re told they could have sexual side effects actually had sexual side effects in that arm. In terms of erectile dysfunction. It was 96% that complaint erectile dysfunction with 5 mg finasteride without counseling. And it was 309% with counseling. So again, triple the number of individuals that actually had side effects, because they were told that they could have side effects. Ejaculate dysfunction was 57% without counseling and 163% with counseling. So once again, tripled the number of individuals that had side effects because they thought that they could have side effects. And then finally, libido had a 77% incidents without counseling. And with counseling, it was 236% once again, three times, roughly three times the number. Now, please keep in mind. Also. This is a smaller study, but it’s pretty convincing results. And number two is keep in mind. This is 5 mg finasteride. So what one milligram dosing when they looked against Placebo? It was about a 12 percent that had side effects, and Placebo had about one percent. So it was about one percent net Delta on those that actually had side effects of typically a very, very small percentage. And they found that 50% of 57 percent of men that continued with the medication actually had reversal of the side effects within a month. But it’s very interesting to understand this. And so it’s very it’s very difficult, because as a physician, I need to counsel someone on side-effects. But by doing so, I almost generate side effects. So this is an interesting study of the nocebo effect. And I think that as a patient, you can mentally think you’re not going to get a side effect, because it’s very rare.

I told you about one percent at the one milligram dosing, and that may help you counteract this nocebo effect.


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