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self_made_human  Grippy socks, grippy box  1mo ago (open.substack.com)   1589 thread views

Escaping the Jungles of Norwood: A Rationalist’s Guide to Male Pattern Baldness

open.substack.com

Out of enlightened self-interest, I did a deep dive into the topic of male pattern baldness, and after freshening up on my rather rusty Bayes', I decided that I'd gone to enough effort to justify a proper blog post. Here you go.

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My understanding is that this is a contested finding, but even assuming the usual relative risk of ED while actively taking finasteride (~1.5x baseline), the absolute risk is not so high that you need to run away screaming. That being said, unless my hair falls out by the fistful overnight, I would personally take my chances with minoxidil first.

I am weakly agnostic on this claim, but my primary motive was to explain that the claim by this pharma professor half a decade back was hyperbole.

the absolute risk is not so high that you need to run away screaming

You suggest this ED is some sort of lizardman finding and if you examined the health database you'd find 1.5% 15-42 male are getting ED that lasts 5 years even even if they don't use finasteride?

https://cks.nice.org.uk/topics/erectile-dysfunction/background-information/prevalence/

Erectile dysfunction is a very common disorder, and the incidence and prevalence increases with age [Hackett, 2018; Muneer, 2014; EAU, 2022]. The Massachusetts Male Aging Study (MMAS) in the USA, a community-based, random sample, prospective observational study of non-institutionalized men in the Boston area, used a self-administered sexual activity questionnaire, and found [Feldman, 1994]: A self-reported overall prevalence of erectile dysfunction in 52% of men aged 40–70 years. The specific prevalence for mild, moderate, and severe cases was 17.2%, 25.2%, and 9.6% respectively. The prevalence increased with increasing age (increasing three-fold between men aged 40 and 70 years).

A large German postal survey (the 'Cologne Male Survey') of men aged 30–80 years (n = 8000) reported [Braun, 2000]: A prevalence of erectile dysfunction of 19.2%. The prevalence of erectile dysfunction increased from 2.3% at 30 years to 53.4% at 80 years of age. Expert opinion in a review article

These are not really comparable, method or cohort wise. Postal survey is probably biased towards bored old people..

Also it's strongly suggestive that on the link paper claims length of exposure to finasteride was correlated with the ED..

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