madman
Super Moderator
2.3 | RECOMMENDATIONS
All drugs carry a risk of adverse events. As clinicians, when prescribing drugs, we strike a balance between the risk of developing adverse events and the benefit of the treatment. While some drugs such as finasteride are effective in the treatment of the underlying disease, the controversy surrounding the risk of adverse events clouds patients’ willingness to use the drug. This is a dilemma frequently faced by pediatricians when attempting to immunize children. Pediatricians attempt to overcome the resistance to immunization by educating parents with evidence from controlled studies.
While physicians should avoid controversial topics, finasteride is unfortunately the only U.S. FDA-approved drug with significant efficacy in arresting the progress of AGA. The other common alternative, minoxidil, has relatively low efficacy; less than 40% of patients regrow hair following 16 weeks of daily application of 5% minoxidil (Olsen et al., 2007). Prior to prescribing finasteride, physicians should adequately educate patients and thoroughly assess their current sexual and psychological well-being. To that end we have developed the following short workup questionnaire:
• Do you experience any symptoms of sexual or erectile dysfunction?
• Do you experience nocturnal erection three or more times per week?
• How often do you have sex?
• Are you using any anti-depressants
• Do you suffer from hypertension?
• Do you suffer from diabetes?
• Do you have a history of depression?
Together these questions help assess the risk a patient has or is likely to develop sexual dysfunction. Patients that are not suffering from sexual dysfunction or are less likely to develop sexual dysfunction, are good candidates for finasteride. In patients that are candidates for finasteride, it would be appropriate to explain the evidence from the controlled studies presented on the finasteride FDA label. It is ultimately up to the patient to decide if the relatively low risk of sexual dysfunction outweighs the benefit of finasteride in the treatment of AGA, but the evidence speaks for itself.
All drugs carry a risk of adverse events. As clinicians, when prescribing drugs, we strike a balance between the risk of developing adverse events and the benefit of the treatment. While some drugs such as finasteride are effective in the treatment of the underlying disease, the controversy surrounding the risk of adverse events clouds patients’ willingness to use the drug. This is a dilemma frequently faced by pediatricians when attempting to immunize children. Pediatricians attempt to overcome the resistance to immunization by educating parents with evidence from controlled studies.
While physicians should avoid controversial topics, finasteride is unfortunately the only U.S. FDA-approved drug with significant efficacy in arresting the progress of AGA. The other common alternative, minoxidil, has relatively low efficacy; less than 40% of patients regrow hair following 16 weeks of daily application of 5% minoxidil (Olsen et al., 2007). Prior to prescribing finasteride, physicians should adequately educate patients and thoroughly assess their current sexual and psychological well-being. To that end we have developed the following short workup questionnaire:
• Do you experience any symptoms of sexual or erectile dysfunction?
• Do you experience nocturnal erection three or more times per week?
• How often do you have sex?
• Are you using any anti-depressants
• Do you suffer from hypertension?
• Do you suffer from diabetes?
• Do you have a history of depression?
Together these questions help assess the risk a patient has or is likely to develop sexual dysfunction. Patients that are not suffering from sexual dysfunction or are less likely to develop sexual dysfunction, are good candidates for finasteride. In patients that are candidates for finasteride, it would be appropriate to explain the evidence from the controlled studies presented on the finasteride FDA label. It is ultimately up to the patient to decide if the relatively low risk of sexual dysfunction outweighs the benefit of finasteride in the treatment of AGA, but the evidence speaks for itself.
