Finasteride delays atherosclerosis progression in mice and is associated with a reduction in plasma cholesterol in men

https://www.jlr.org/article/S0022-2275(24)00012-9/fulltext

Finasteride is commonly prescribed to treat benign prostate hyperplasia and male-pattern baldness in cis men and, more recently, trans individuals. However, the effect of finasteride on cardiovascular disease remains elusive. We evaluated the role of finasteride on atherosclerosis using low-density lipoprotein (LDL) receptor-deficient (Ldlr −/−) mice. Next, we examined the relevance to humans by analyzing the data deposited between 2009 and 2016 in the National Health and Nutrition Examination Survey. We show that finasteride reduces total plasma cholesterol and delays the development of atherosclerosis in Ldlr −/− mice. Finasteride reduced monocytosis, monocyte recruitment to the lesion, macrophage lesion content, and necrotic core area, the latter of which is an indicator of plaque vulnerability in humans. RNA sequencing analysis revealed a downregulation of inflammatory pathways and an upregulation of bile acid metabolism, oxidative phosphorylation, and cholesterol pathways in the liver of mice taking finasteride. Men reporting the use of finasteride showed lower plasma levels of cholesterol and LDL-cholesterol than those not taking the drug. Our data unveil finasteride as a potential treatment to delay cardiovascular disease in people by improving the plasma lipid profile.

Sounds promising. I take finasteride to preserve my hair and per Dr. Stanfield recommendation for reducing prostate cancer. If the above is true, then yet another reason to take this inexpensive medication.

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It’s only inexpensive if you get 5mg prescribed and split it into quarters.

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You can even split the 5mg in to 1/8’s or even 1/16s :rofl:
It’s clinically effective for hair loss down to 0.2 mg.
Personally I use 0.5 mg.

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In the North New Jersey area 30 x 5mg generic finasteride tablet’s cost less than $9.00 pay out of pocket with a GoodRx card/coupon code.

1mg is less than $7.00 for 30x generic tablets

How much cheaper?

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Yup, I just buy the 1 mg and cut them in half.

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I’ve been considering taking for years… but am nervous about adding yet another drug to my regimen. I know it’s suppose to help with future hair loss… but I haven’t seen a lot of evidence for its efficacy in older individuals.

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Finasteride is generally better at maintaining hair than is at regrowing them. Even if you get regrowth, it can take many years to see visible progress.

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What do you mean? The medication is FDA approved for male pattern baldness. There are multiple studies proving its efficacy. I would suggest seeing a dermatologist. They can spot beginning of early hair loss, you definitely want to catch it early, because yes it probably won’t work very well once the baldness sets in.

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Yes, many of us are taking trace amounts of finasteride of 0.5 to 5mg per day. But the study here says 10, 100, and 1000mg/kg of body weight for CVD protection— isnt that up to 75g per day for a 75kg person? How plans to take this? You’d be a eunuch!

Pups were weaned three weeks after birth onto a breeder diet for an additional week, and then fed Western diet without finasteride or the same diet supplemented with 10, 100, and 1000 mg finasteride/kg of diet for 12 weeks.

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DHT suppression is non-linear with 5ari. In humans where finasteride inhibits 5ar2 only, 1mg of finasteride suppresses 70% of serum DHT and at 100mg up to 80%. Dutasteride, which is a dual 5ar1/2 inhibitor like finasteride is in mice, suppresses over 90% of serum DHT at the standard 0.5mg dose and 97% at 2.5mg.
If the cholesterol-lowering effect of 5ari is related to tissue accumulation then of course the standard doses lead to much lower DHT suppression (40% and 50% for finasteride and dutasteride respectively) and the effect would be smaller. The anti-inflammatory effects of finasteride on the other hand would be realized even on the standard dose.

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@Ericross2 Per kg of diet, not per kg body weight

To this end, we fixed our maximum dose of finasteride at 1000 mg of finasteride/kg diet. Because mice typically eat 2.5 g of Western diet/day, this dosage corresponded to approximately 2.5 mg of finasteride/day/mouse

The mice on 10mg fin/kg diet weighed 29.5g, so this comes to 88mg/kg body weight, which is a human equivalent dose of 7.2mg/kg body weight. For a 70kg human this is about 500mg/day.

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Thank you, @jnorm , that is a good catch — chaulk another one up to my reading comprehension skills.

500mg/day sees fairly high as well. Too high for me to consider, even with ASCVD protection.

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That’s what I am hoping for. I would not go over 1mg because (in spite of weak evidence), I am still weary of the PFS boogey man. Main reason to use it is for hair retention and some effect on BPH and PC reduction. Atherosclerosis reduction would only be a bonus.

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There is another study which appears to present evidence that Finasteride and Dutasteride are detrimental to metabolic health:

it is postulated that men treated with these drugs are in a state of androgen deficiency and are at high risk of developing NAFLD IR, T2DM, dry eye disease, potential kidney dysfunction, among other metabolic dysfunctions

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Here are videos of Mann discussing and dismantling this review.

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This guy is hilarious, he seems very well read up on 5-alpha-reductase inhibitors though. His rebuttal to Attia and some urologist discussing PFS is literally a stand up comedy piece.

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Aren’t most women is state of a relative androgen deficiency ? DHT levels in women are much lower than in men and yet they tend to live longer and healthier.

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I guess I might be a lone voice on this one - but, one of the reasons why I’ve never Rx’d this, has been pretty significant experience among those who educated me on the endocrine aspect of the Anti-Aging and Regenerative Medicine fellowship regarding concerns, which they had personally dealt with, with multiple patients of persistent sexual dysfunction after these agents, even upon cessation of therapy.

I recently treated someone with exactly that issue, and it seemed likely to be causative.

There are multiple articles on this - here is one of many:
https://pubmed.ncbi.nlm.nih.gov/22789024/

I’ve taken to using an interesting topical combination that has 5% minoxidil, 12.5% Azelaic Acid, 0.1% Finasteride and 2% ketoconazole for hair loss or thinning in men. It is a logical combination, but not likely to see much systemic effect.

Yes most men don’t have those effects, but having a lovely head of hair and sexual dysfunction that isn’t responsive to treatment isn’t a great outcome.

I’ve not had enough experience on the use of this product as my time has primarily been in the ER, and outside that, I’ve never prescribed this class of medications orally.

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Out of curiosity… have you ever prescribed or recommended oral NSAID’s ?

Yes I have prescribed NSAIDs for the short term, and used evidence based approaches, being well aware of the risks and benefits. Any time I prescribe, I always look at risks, benefits, and alternatives. Long term prescriptions need significant contemplation, as one needs to be well versed in understanding the longer term risks.
I don’t think I’ve ever advised more than 7 days of an NSAID as I’m well aware of the risks.
I’m not sure where this ties in to finasteride. This is an Rx for a medication that is anticipated to be a long term medication.

Prescribers need to be aware of the risks.

Is there some highly controversial, and likely incorrect data showing long term NSAIDS might impact sexual function - sure there is. But even if I were to prescribe long term NSAIDS and be ignorant of the risks (which I’m not), I don’t see that two wrongs would make a right. It is a little off topic.

My point was simply that this is not a benign medication and people have to be well aware of risks and benefits. I’d never take this myself, not would I prescribe it. I think there are better alternatives - and I’m completely unconvinced this would have any feasible mechanism to improve longevity.

There are better candidates with lower risk profiles.

The underlying principle remains, don’t harm yourself (or your patients) while trying to improve health/lifespan. Stick to low risk, likely high yield interventions. Even with that principle, there is some risk of getting it wrong, but hopefully not on the risk side. This drug fails my risk assessment.

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