The concept of a nocebo (a psychogenic effect of a drug) has been discussed in the various studies which focus on the sexual side effects of the drug Propecia (finasteride). The significant ‘hype’ on the internet, has driven many people to the conclusions that if they take this drug, they will become impotent. As doctors, we must discuss potential and known side effects of any drug we prescribe, but what happens following the disclosures, the patients read the internet and find many, many panicky young men who report sexual impotence from taking the drug. Is it real? We don’t know but what we do know is that many studies from other countries have not shown the high sexual side effects reported in the United States. So is this a Nocebo effect resulting from panicky people who read bulletin boards and web sites which focus on this issue.
Dr. Robert Haber, a very respected hair transplant surgeon from Ohio, started to test the concept of a nocebo effect and the general side effects on sex drive and sexual performance using patients who came into his office. This is an early report of his initial findings.
“While I also doubt the existence of PFS, about a year ago I started asking my finasteride patients to complete an anonymous sexual dysfunction survey. For years I frankly addressed the topic at every visit, and my impression was that the incidence of sexual dysfunction in my patients was similar to the 1-2% reported in the studies. I wondered if a more objective survey would reveal anything different. Many of you may recall that I suggested we all gather this data in our offices, but there was little interest.
I have data now on over 500 patients, and much to my surprise, the overall incidence of sexual dysfunction in my finasteride patients is 25%. When I started seeing this number develop, I started giving a similar survey to all male patients not on finasteride as well. I have a much smaller sample size thus far, but the overall incidence of sexual dysfunction in my non-finasteride patients is 24%!