Hacker News Reader

Comment by georgewfraser | Hacker News Reader

Propecia is basically a cure for baldness as long as you start taking it before you lose too much hair. It’s very widely used—walk into any gay bar in San Francisco and you will notice there is hardly anyone under 40 who is bald.

There is a strange phenomenon online where in every discussion of propecia, someone will show up and claim they had terrible sexual side effects. But in the original clinical trials, the rate of such side effects was nearly the same as placebo. And I personally know about 10 men who take it and none have experienced side effects. I think people make these claims to get attention in forums, or it’s simply a placebo effect.

View on HN

Why the cut off at the age of 40? Either it's a "cure" or it's not. I think that you'll find that actually it only slows down hair loss and only for a percentage of people.

Maybe the reason you're not seeing bald men in these bars is the swimmer effect. i.e. bald men aren't successful there so bald men don't show up.

The reason you don't see many bald men on TV shows or that you can count the number of world famous bald "leading man" actors on the fingers of one hand isn't because there's already a magic cure for baldness that actors use but other don't.

It's simply because casting agents don't cast bald men.

It’s absolutely the swimming effect.

To any fully-haired people who don’t believe it, shave your head as if you’re going bald, then go to a club alone and see how much fun you have. Prediction: probably not much

It's also because there is a "cure" for baldness, but it's not magical. A ton of actors and media personalities in general use hairpieces or get hair transplants.

I'm not sure how it's a strange phenomenon. There are 1,300+ lawsuits for permanent sexual dysfunction. More recent studies show increased problems the first year and the drug masking prostate cancer development. Drugs have risks, right? You can't blanket it as 100% safe because of a gay bar anecdote and ten acquaintances.

No, you can't, but the vast literature contradicts the claims of these lawsuits.

Please see my comment and feel free to do a pubmed search. https://news.ycombinator.com/item?id=20534351

> drug masking prostate cancer development

This is only an issue if you're over 50 and have trouble peeing (isn't that a sign of prostate cancer anyways?). Remember the demographic these are derived from. Propecia wasn't brought to market as a hair loss drug.

> a gay bar anecdote and ten acquaintances.

Yes let me get on hn to talk about sex. It's not like I can't delete this or anything.

> There is a strange phenomenon online where in every discussion of propecia, someone will show up and claim they had terrible sexual side effects. But in the original clinical trials, the rate of such side effects was nearly the same as placebo.

"Known sexual side effects may appear" is a chilling phrase for a man to read. So before considering using a 5-alpha reductase inhibitor (finasteride or dutasteride) I pored over the literature.

What I read was almost comical and made me grateful that I've developed a bit of scientific literacy to dig into these studies for myself.

In a finasteride trial of nearly 1500 men, here's what "known sexual side effects" looked like:

> Only 11 men (1.4%) in the finasteride group and 8 (1.0%) in the placebo group dis-continued the study because of sexual adverse events, which resolved after discontinuation. These adverse events also resolved in many of the patients who reported them but who remained on the finasteride regimen and continued in the study. [0]

The absolute numbers are ridiculously low. I felt relief b/c I just imagined myself in a venue with 1500 other guys. Guess what, there are probably 8 of them experiencing some kind of sexual dysfunction.

It doesn't take long to realize that the general population has numbers of sexual dysfunction that align with the study participants. Hell, I found out riding a bike has a greater probability of causing sexual dysfunction than using one of these medications. Mind you, there are reams literature, with long-term studies, and meta-analysis all basically reporting the same data about side effects.

Moral being, do your homework and make a decision for yourself.

[0] http://sci-hub.tw/10.1016/s0190-9622(98)70007-6

Could you please share what you found re: effects of riding a bike? Thanks!

The gist is that putting too much pressure on your perineum is bad for sexual function in males.

The Bad - Cycling, especially with certain seats and handlebar arrangements, can cause a lot of pressure in the perineum

The Good - Certain seats and maintaining your handlebars at a lower level than your seat lessen the risk

I don't have the sources I originally looked at (this was several years ago!) but a Google search pulls up some that jive with what I recall.

https://www.health.harvard.edu/blog/biking-and-sex-avoid-the...

https://www.health.harvard.edu/staying-healthy/can-cycling-c...

https://www.webmd.com/men/features/biking-and-erectile-dysfu...

Never heard of Propecia. So I googled it and I immediately found that it was not recommended in my country (France) due to the side effects.

I am a trans woman who was taking Propecia before switching to stronger anti-androgens. Propecia destroyed my libido and made erections difficult to achieve - yes, more than having a testosterone that is close to zero. I constantly felt weak, as if I was about to faint.

These were also some of the darkest months of my life. I was constantly having sudden suicidal thoughts, the kind that jumps on you even when you're healthy. I'd go on with my day and my head would ask me "should we die?" to which I would have to answer "no". There was no voice of course, I'm describing feelings.

All symptoms I've never had before and have never had since.

Reducing testosterone has stopped all hair loss, so I no longer need to take Propecia anymore.

I am not saying that those side effects are common, merely that they exist. Could it be that the people you met online were also telling the truth and that there is no conspiracy?

How does this relate to gay bars? Is it something that gay men take for other reasons?

Many gay subcultures are thoroughly obsessed with appearance. I'm not a bad looking guy, but I wandered into a gay house party one day and was amazed at how every single guy there was much better looking than I was. They all, and I mean every last one of them, and there were hundreds crammed into that penthouse suite, simply cared about their appearance way more.

> Many gay subcultures are thoroughly obsessed with appearance. ... I wandered into a gay house party one day was amazed at how every single guy there was much better looking than I was.

Sorry, but your one accidental foray into a single gay party is not exactly convincing evidence for your theory.

More importantly, even if gay men care about their appearance more than straight men, I'm not convinced that the behavior is purely linked to them being gay, as much as social norms that have developed around what "being gay" is "supposed to be".

Sure gay people often run in different social circles as straight people, and it makes sense that they would have different norms. But similarly, people in Paris are generally far more attractive and fashionable than folks in St. Louis. There is little genetically different from these people, it's just the norms that they develop in.

I didn't claim to have a proper explanation for my observation. Your guess is as good as mine.

Explanation: gay men are trying to attract men, and men care a lot about (the other person's) appearance.

> gay men are trying to attract men, and men care a lot about (the other person's) appearance

Even if this is true today, I'm not sure it's anything more than a modern day social trend. Why should men care more about appearance than women? On a "selfish gene" level, in choosing a mate, both sexes should mostly care about passing on their genetic material. Appearance certainly can be a factor in that decision, but it's only one of many (e.g., responsibility, trustworthiness, work ethic, etc.).

If in today's society, men do care more about appearances than women, I strongly suspect that is a function of the structure of our society itself than anything genetic or innate.

One could easily imagine a society where gay men care less about appearances than straight men.

> Even if this is true today, I'm not sure it's anything more than a modern day social trend.

You're in luck! Records of the last several thousand years exhaustively document that ornamenting your appearance is characteristically a female behavior. For example, check out this text from the Iliad:

> [The Carians] were commanded by Nastes and Amphimachus, the brave sons of Nomion. He came into the fight with gold about him, like a girl; fool that he was, his gold was of no avail to save him, for he fell in the river by the hand of the fleet descendant of Aeacus, and Achilles bore away his gold.

About that specific example, this could be because "girls" were perceived to be greedier in that ancient culture. In the modern day, I certainly wouldn't first associate "fighting for gold" with "wanting to look prettier".

It's "wearing gold", χρυσὸν ἔχων, not "fighting for gold". They're fighting for Helen.

Thanks for the clarification, I get it now.

From a purely functional point of view the man's entire contribution to reproduction can last as little as a few minutes. Therefore the cost of trying again is low, so it's not strictly necessary to consider the personality factors you mentioned. They take a long time to assess, which creates a trade-off between investing in marginal gains for the offspring vs. simply creating more. In short, men have the option of r-style reproduction which skews the selection criteria toward immediate visibility.

Women on the other hand have to invest significantly more time and energy into reproduction every time, so the incentive is to find a mate with the best genes overall. Men are more likely to help raise their own offspring than another's, so a woman's best bet is to find one who is most likely and capable of doing so. Those traits are more difficult to discover but the marginal payoff is huge compared to a man who jets after five minutes.

All of the above is pure conjecture on my part and I have no expertise. But consider the counterfactual: given sexual divergence and the asymmetry of reproduction, why would men and women have the same selection strategies on average?

> From a purely functional point of view the man's entire contribution to reproduction can last as little as a few minutes. Therefore the cost of trying again is low, so it's not strictly necessary to consider the personality factors you mentioned.

Under your reasoning, it's also not strictly necessary to consider physical factors either. The fact that men have to invest less in child-birth could suggest that men are genetically more prone to promiscuity than women, but it does not suggest that men are more interested in appearance.

Under a "selfish-gene" presumption where everyone wants to spread there DNA, and men, for physiological reasons have to make less investment than a women, it still does not follow that men would weigh physical appearance more than women. Given two women, one with better looks and one with more responsibility or power, genetically, it makes more sense for the man to choose the one with more responsibility.

I suspect that there is no genetic basis for men "caring more about looks" than women, it's entirely a social construction. If society deems physical appearance to be important, it can easily skew any underlying genetic preference. In the nature verses nurture argument, I suspect nurture has at least 80% of the power.

"social norms that have developed" are a big part of what a culture, or "subculture", is.

This is definitely true, can see it anywhere I go. Out of maybe 10 gay friends we currently have, there is 1 which cares about himself on normal guy level. Rest have at home more beauty chemistry than my wife (or her friends), always perfect hair trim, new trendy clothing matching perfectly with each other, also obsession with taking perfect selfies (meaning 30 minute sessions for 1 photo).

Yes there are straight guys similarly obsessed with appearance/presentation (is the term 'metrosexual' still in?), but in far lower numbers

I would argue that it is not that gay culture that is obsessed with appearance, but that it is male heterosexual culture that is adverse to self-care.

There are many men who do not even consider taking care of themselves for fear that their masculinity will decrease. Many gay men are free from these fears.

From my perspective as someone who has had an insider's perspective of heterosexual male culture, gay male culture, and then female culture (I am a transgender woman), homosexual men do not make more effort in their appearance than most women when they go out.

Going to a gay bar is a often big event of the week or month, some people travel far to go there. It's not the same as going to a dive bar to get drunk. It's a place where you can be at your best and meet people - it's a community hub. The people you meet there are the best on sunday's best. The same way you would wear a suit or at least clean up before a business meeting or recruitment day.

Often, it is an outlet for being yourself, since some people are conscious when they are in public or at work and censor themselves.

As someone else said, "Maybe the reason you're not seeing bald men in these bars is the swimmer effect. i.e. bald men aren't successful there so bald men don't show up."

It would be erroneous to believe that the behaviours observed in such a place are representative of their daily lives.

I agree with you in principle, but this house party really was something else. They didn't just primp themselves up to look good for this event. They all looked like male models, fit, tanned, healthy. You can't look like these guys did without a lot of work. Diet, exercise, I felt like I'd walked onto a Hollywood set. I wish I could have stuck around and mingled, gotten a sense for what in the holy heck I was witnessing, but large masses of people make me super uncomfortable. So I went back down to my apt.

Enter any nightclub and you will find masses of slender, tanned women in great shape, wearing makeup and sexy clothes.

But this house party sounds like survivor bias at play. One fit person invited their best looking friends, who then invited their friends, who then invited theirs. Anyone who does not fit the narrative (straight, gay or other) will feel the same unease you did and leave.

Sure, but at some point describing it as a 'subculture' becomes appropriate.

Reply on news.ycombinator.com