Mentioned 16 times on 2 shows. Most recently heard 20/04/2026.
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“clinician. I'm going to spend some time towards the end of this discussion on something that I also think is dangerously underappreciated, which is the interaction between a drug called finasteride. This is a drug that literally millions of men are taking for hair loss prevention, and how that drug interacts with our ability to interpret PSA correctly.”
“a class of drugs called five alpha reductase inhibitors. The most common of these is finasteride, but there's another one called dutasteride, and how they impact prostate cancer screening. So the use of finasteride has exploded in recent years, largely driven by men using it to prevent or treat hair loss.”
“many times on other podcasts, both in the context of hair loss and testosterone use. We've discussed the potential risks of finasteride and prostate cancer development elsewhere, but I want to have some dedicated sections here where I talk about that. So I want to focus on one specific issue, which is that finasteride, as far as we can tell from the data, does not cause prostate cancer.”
“physician doesn't know how to adjust for it. Now here's the mechanism. Finasteride blocks the conversion of testosterone into dihydrotestosterone or DHT in the prostate. And that reduction in local DHT also dramatically reduces PSA production.”
“As a practical matter, you can expect PSA to drop by about a third within six months of starting Finasteride and to be roughly cut in half by a year. That suppressed baseline persists for as long as the patient stays on the drug.”
“is simpler but equal. After about 12 months on finasteride, you should not expect your PSA to rise at all. The ongoing suppression from the drug should roughly offset the natural age-related increase in PSA.”
“finasteride should be treated as a serious, warning sign. And here's where I get concerned. Most general practitioners are not aware of this, it appears. A retrospective analysis of VA patients undergoing PSA screening found that men on finasteride were diagnosed with metastatic cancer at a rate more than double that of men not taking 5-alpha reductase inhibitors, 6.7% versus 2.9%.”
“face value, not realizing they needed to double them or more. The two groups had nearly identical PSA levels at the time of cancer diagnosis, about 6.8 versus 6.4. But once you correct for the Finasteride-induced suppression, the true comparison is more like 13.5 versus 6.4. Those are wildly different clinical pictures, and the physicians unfortunately missed it.”
“because even in men who were getting screened. The screening was rendered useless because the physician didn't understand how to correct the results. And I think that's especially urgent because many men are getting finasteride prescriptions from online clinics and then not even mentioning it to their primary care doctors because they don't think it matters.”
“can't account for it if they don't know the patient's taking it. So, if you're listening to this and you're taking finasteride, the onus may fall on you. Please be sure that you not only advocate for regular PSA testing, but make sure that your doctors know about every prescription, including and especially those that involve 5-alpha reductase”
“inhibitors, and ensure that whoever is interpreting your PSA understands both the drug and its suppressive effects. Again, finasteride does not appear to increase your actual risk of developing prostate cancer, but it can absolutely prevent your doctors from catching it on time.”
“in finasteride users and dutasteride. And it is not much different than placebo in very, very rigorous and significant high number of subject studies that were well, well constructed studies.”
“That seems like a legit pathway for for like a little bit skittish about potential side effects with the oral um drugs as well, because like the Finasteride and do what is the other one? Dutasteride. Dutasteride um you know you mentioned the the erection but like is there are there any other serious side effects with those?”
“depending on if you've seen the podcast where people talk about it or not. I've heard of this like post Dutasteride or post Finasteride syndrome. Interesting you'll never have you you'll never hear about post Dutasteride syndrome though yeah even though it's a way more potent drug because it's largely a media driven construction.”
“like the mild Ketoconazole which probably is not going to be sufficient but like over the counter pretty benign helpful good shampoo regardless that's why I use it but Finasteride or Dutasteride or topical antiandrogen probably going to be necessary for most people.”
“I do think if there's some sort of direct study, though, that would be interesting. I was just going to say the same thing. I'm pretty sure there is some anti-aging studies on Finasteride and Dutasteride, though, that might, I wish we could pull up, but we don't have the. Yeah. Well, it's something to dive into later for sure.”