I have created this account to report my story. I know it is another anecdote and might not sway opinions but I would like to share it. I have been lurking here for a while now and have read both sides of the argument.
Around November 2019 I stumbled on Kevin Mann and MPMD channels. At the time even Derek didn't seem too concerned about finasteride. They painted a picture that all sides are rare, temporary and most probably nocebo. I had a close friend who took it many years ago and had been dealing with depression ever since but I dismiss it his experience as probably unrelated. I read tressless and understood that nocebo is very real and then even read the propecia help forum and thought these people are crazy. They must be very unhealthy and overweight. I am a gym rat and take meticulous care of my diet and health this would never happen to me. I even consulted my dermatologist friend who has been taking it for a few years with no sides according to him. He encouraged me to start I decided to start treatment for the new year and went to my family doctor and he agreed to give me a script for a few weeks and referred to a derm for the rest who prescribed the rest. They both mentioned side effects but said it was transient and only affected less than 2% of people. Pharmacists are so busy they just hand you the med and mention briefly sides like lowered sperm quality. Of course I didn't care, at that time my mind was fully made up and was convinced 'DHT is a trash hormone'. Still, I had a little seed of doubt in my heart and wanted to play safe, so I asked a compounding pharmacist I knew to make it into a topical solution. I used it for a total of 3 weeks.
Within those 3 weeks all hell broke loose. My nipples start itching and burning by the 2nd week and by the beginning of the 3rd week I had an even worse side effect. When I was young I dealt with an autoimmune in one specific tiny area that turns the skin white. It was restricted to my ball area and faded in my teenager years all good. The finasteride somehow reactivate it and my ball was now burning and skin depigmented. I immediately stopped. Read this
LINK and I understand that 5AR or DHT seems to have a protective effect on auto-immune disease. It seems to the reason females are more prone to them due to lack of protective androgens.
After discontinuation, my breasts continued to be swelled. I didnt not get gyno but the shape of my chest has changed drastically to look more droopy like an old female despite me exercising daily with a strict diet. The white spot continued to burn but subsided after a month however still de-pigmented. I thought the worse was over and I dodged the libido bullet. In fact, my sex drive was much higher than usual during and right after the finasteride. I was very wrong because my real problems would start a few months down the line. One day I woke up with a dead penis. No more morning wood no sex drive. Even masturbating which I used to do daily many times was no longer enjoyable. Worse, my penis atrophied immediately. It started to retract as I walk to sit. Flaccid size has gone to nothing while my erect length is at least 1.5 inches shorter and lost girth as well. Keep in my mind I had an above average penis over 7' which is in line with OP theories.
Over the years other side effect kicked in. Weight gain around midsection, Constipation, Complete loss of sexual desire, Nail problems, Dry skin, Social anxiety (I used to be very introverted). Those side effects rotate but I still maintain a healthy lifestyle and an exercise regimen but it is much harder. The way my penis looks makes me experience depersonalization and suicidal thoughts. I have completely stopped checking on it.
So far I have spent around $7,000 in multiple therapies. PRP (to the penis), Shockwave, mind therapies and many supplements. Some areas are slowly improving although to date my penis remains non-functional but hoping for improvement one day.
I thought I had good medical knowledge when I signed up for finasteride but in reality I was very ignorant and misinformed. I didn't understand how important the 5ARs that I am blocking are and their role beyond creating DHT. I thought if anything topical wouldn't go systemic (wrong). I wish I had read the studies that Pigeon linked. This is why his work here is very important. The sad part is my hair loss wasn't even that bad and was doing well with dermarolling. I was NW2 at 34 and well settled with a gf. Now my life is a mix of anxiety and doom and gloom but I am trying to be positive. I am an unreported statistic, the prescribing dermatologist has no idea. I have informed my family doctor who is clueless and visited countless urologists who couldn't help. I am not going to be reported as a victim that's how the system works and it is not like I can sue anyone.
I am not sure how many guys will get side effects. My gut feeling is that it is much higher than Merck claims. Maybe a certain genotype is more prone to getting them. Maybe some bodies aren't that reliant on 5AR but that doesn't make sense to me. I cannot really explain how people go 10-20 years on this medication when I was decimated in few weeks. It is hard not to hold resentment in my position. In my opinion, a risk-benefit analysis makes sense for serious conditions not cosmetic. I agreed to low risk of TRANSIENT side effects not permanent life altering ones. And my story is not that unique you can find much worse online. The drug should not be approved by the FDA