Re: Is there anyone here who took months/ years to recover?
They can all be in range, and still cause a lot of trouble. How the levels are in relation to each other, is just as important as that they're in range. Incompetent doctors will just take a look at the numbers, see that all are in range, and close the case.
That's likely part of the issue, but of course vast majority did not get bloodwork done for every single hormone or ratio in their body (which is impossible anyway) prior to Finasteride use, while on, or since quitting the drug to compare against -- making it impossible to know the true baseline.
Indeed, as has been noted by Dr. Crisler, it would seem the issue goes far beyond simply "increasing Testosterone". He notes many ex-finasteride users present with normal testosterone levels and all the symptoms of hypogonadism (ie, possible androgen resistance):
[youtube:2o1i40ke]http://www.youtube.com/watch?v=BEGCTMtlgoc[/youtube:2o1i40ke]
Second, Neuroendocrinologists like Dr. Alan Jacobs has posted the following, wondering if the issue of persistent Finasteride side effects/acquired hypogonadism/possible partial androgen resistance may be due to epigenetic (molecular) changes in those men who are susceptible, based on their androgen receptor CAG repeats.
Another Piece of the Post-Finasteride Hypogonadism Puzzle?
http://blog.alanjacobsmd.com/alan-jacob ... uzzle.html
The persistence of male sexual side effects (hypogonadism) after discontinuation of finasteride is a serious problem for a significant subset of men who use the drug.
I had previously written about whether the propensity of finasteride to cause lasting hypogonadism could be due to the development of partial androgen resistance and whether this relates to the number of CAG repeats in exon 1 of their androgen receptor genes.
Recently, a patient of mine brought to my attention a research paper from Csoka, et al.(J Sex Med 2008;5:227-233) titled "Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors". They added 3 well-characterized case reports to the half dozen or so that were already in the literature and cited studies probing underlying mechanisms for the problem.
Their fourth proposed mechanism relates to a growing field that has caught my attention in a big way, the field of epigenetics. They note that antidepressants can cause complex changes in the expression of genes. They cite animal research that has linked SSRI treatment during youth to permanantly decreased sexual behavior that persits into adulthood and that has explored underlying mechanisms for this including brain epigenetic changes at the molecular level.
Epigenetics is a field that concerns the complex web of proteins that surround our DNA. These proteins include histones, which help package and unpackage our genes to either turn on or turn off their function. "Acetylation" and "methylation" are chemical reactions that alter the histone's function, which in turn alters the expression of our genes. Within this emerging field may lie a new mechanism by which a drug can cause persistent changes in gene expression that can influence sexual behavior.
This brings up the idea that there is a common epigenetic mechanism that may apply generally to medications that cause persistent sexual dysfunction. It may be the case with finasteride that a common epigenetic effect interacts with a less common variant in the androgen receptor gene CAG repeat profile to cause its syndrome of crippling persistent post-finasteride hypogonadism.
Human research in this area has yet to be done, but holds promise for new therapies to treat this troublesome side effect of finasteride and other widely used medications.
IF acquired androgen resistance due to epigenetic changes from Finasteride use were proven to be the case, then "balancing hormones" will likely make no difference, because the root cause of issue lies at the molecular level. The treatment would thus lie in reversing these molecular changes (if this is in fact what has occured), providing they can figure out what changed.
Of course, none of this has been proven/disproven (yet), but based on all the evidence and experiences thus far from doctors treating this problem, it seems like an area worth investigating further.
