J Urol. Epub 2012 Jul 12. Q12: I currently take finasteride but dont have any PFS symptoms. WebPost-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) A: Thats a key question in the PFS riddle. Research also suggests that DHT can stimulate the growth of cells in the prostate, contributing to benign prostatic hyperplasia. On the other hand, there are reports of people developing PFS within a few days of stopping finasteride. Minoxidil doesnt block DHT. However, its still possible to take action and reduce the severity of your hair loss without using finasteride. Learn more about our editorial standards here. Scary just how much of an adverse affect nnEMFs have. Q17: Can finasteride have an impact on male fertility? But the PFS Foundation is working as fast as possible to facilitate research that promises to identify the underlying biological mechanisms of PFS while laying the groundwork for the identification or development of effective therapies. Do explosive exercises, such as uphill sprints, muscle-ups, jump squats, burpees, etc. Why is anxiety more common in women with PCOS? PMC Clipboard, Search History, and several other advanced features are temporarily unavailable. A small subset of patients claims hormonal, psychological, and neurological symptoms that persisted despite stopping taking the medication. A deterioration in the quality of life in affected individuals does not justify use of the drug. I think androsterone and allopregnanolone, or topical DHEA and progesterone would be good options. Below, weve looked into reports of post-finasteride syndrome, as well as the latest research on this rare reported side effect of finasteride use. Perhaps you mean hgh ? Thank you so much for your time. Regulatory Effects of Thai Rice By-Product Extracts from. Online ahead of print. 8600 Rockville Pike Hi man, what have you done so far that helped you to 80% recovery? Finasteride binds to 5-R type 2 with high affinity and dissociates very slowly with a half-life of 31 days. Furthermore, finasteride inhibits CYP3A4 (which is the enzymes that detox finasteride) and that can cause a significant buildup of finasteride in the body over time. I am quite distressed atm and hope this is not permanent and everyone is telling me Im just hypochondriac but I know my sexual function is inhibited for the time being. Careers. PEA has been studied in 40 clinical trials involving 6000 subjects over the years and has shown a quite favorable risk/benefit ratio. WebWhen we established the PFS Foundation in 2012, our mission was simple: to facilitate research on the characterization, the underlying biologic mechanisms, and potential treatments of post-finasteride syndrome. shrink penis. After using finasteride at a 5mg daily dose for one year, men reported the following side effects: Erectile dysfunction (reported by 8.1 percent of men), Decreased ilbido (reported by 6.4 percent of men), Decreased ejaculatory volume (reported by 3.7 percent of men), Ejaculation disorder (reported by 0.8 percent of men), Gynecomastia, or male breast enlargement (reported by 0.5 percent of men), Breast tenderness (reported by 0.4 percent of men). In mouse models PEA increased brain allopregnanolone levels and reduced anxiety-like and depression-like behaviors. 3 reasons why eating raw bull testicles for boosting testosterone is useless! Its available as a liquid and as a foam and is applied directly to the areas of your scalp affected by male pattern baldness. Yes TRT does seem to help people, but dont solve everything. Free shipping on Rx medication, if prescribed. You can argue with the theoretician but you cant argue with the anecdotal stories of successful recovery. Dutasteride was the second inhibitor to be approved and has a similar safety profile. The Post-Finasteride Syndrome Foundation was founded in 2012 to support research into post-finasteride syndrome, a term use by some researchers to describe persistent side effects of the drug. Epub 2020 Jun 26. According to the Post-Finasteride Syndrome Foundation, these may include: Reduced memory and difficulty recalling information, Impaired ability to solve problems and comprehend information, General cognitive impairment and slowed thought processes, Depression, anxiety and/or suicidal ideation, Anhedonia (inability to feel pleasure) and emotional flatness, Insomnia (difficulty falling asleep or staying asleep). If youve searched online for information about these side effects, you may have come across mentions of long-lasting, persistent issues that are referred to as post-finasteride syndrome, or PFS. WebPost finasteride syndrome is a persistent adverse reaction to taking finasteride, a 5-alpha-reductase type II enzyme inhibitor that is extensively prescribed by doctors for hair loss or Im not beholden to trT. Finasteride is a 5-alpha reductase inhibitor thats used to treat androgenetic alopecia (a clinical term for male pattern baldness) and benign prostatic hyperplasia (non-cancerous growth of the prostate gland). 2022 Oct 27;10(11):2725. doi: 10.3390/biomedicines10112725. Please enable it to take advantage of the complete set of features! HCG increased my anxiety. Finasteride is known to deplete Allopregnanolone and this supplement should help you increase it which may provide relief to brain fog, depression, or insomnia. Natural solution without any success. They report very high stress symptoms, which often develops into an episode of panic attack or anxiety attack. My blood level are ok only progesterone and colesterolo are higher than the max range. According to the Post-Finasteride Syndrome Foundation, post-finasteride syndrome may result in an increased risk of suicide attempts. You might thus benefit from things that stimulate bile flow such as taurine and TUDCA. Re: Post-Finasteride Syndrome: A Surmountable Challenge for Clinicians. The study also showed that the longer men are on finasteride, the more likely they are to develop PED. Is your diet scattered all over the place? A few additional tests you can do include: Hey mate I have just stopped finasteride after 7 yrs on it. Q2: How many men who take finasteride get PFS? Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Do you generally feel overstimulated and suffer from insomnia? Outcomes after discontinuation of finasteride Dysfunctions I think its a combination of low energy production due to cellular damage and excess ROS production. There are some nice recovery stories on TR. Hi Gary, I want to try a solution like HCG low dose: WebDr Jordan Grant and Gil T talk about Post Finasteride Syndrome Recovery (PFS recovery). They include sexual, neurological, physical and psychological adverse reactions in patients whove taken finasteride, a 5-alpha-reductase type II enzyme inhibitor used to treat hair loss (Propecia, finasteride 1 mg) or enlarged prostate (Proscar, finasteride 5 mg). I had no noticeable sides until sexual problems which started 3 weeks ago so I stopped. But future studies may involve patient testing. After registration is submitted, you will receive a confirmation email, which should contain a link to confirm your intent to register for the forum. A: Unfortunately, PFS is still not known or recognized by the large majority of all medical professionals, and many doctors cruelly stigmatize patients. -DECREASED OR NO LIBIDO -DECREASED SEMEN VOLUME LOSS OF AM ERECTIONS It appears promising that treatment with PEA, by increasing allopregnanolone levels in PFS patients brains, could improve mood and reduce anxiety. This issue can have a serious impact on a persons risk of experiencing side effects after taking medication, as healthcare providers are required to inform their patients about the potential side effects of medication as part of the treatment process. Federal government websites often end in .gov or .mil. The first of these is the nocebo effect. We just dont have enough knowledge yet to know which risk is greater, but we know for sure that the risk of developing PFS increases with increased duration of drug use. Hair transplant surgery provides permanent results, but it can be costly. I got Post Accutane Syndrom, which is related to PFS, there is a down regulation of 5 alpha reductase 1. Alterations of gut microbiota composition in post-finasteride patients: a pilot study. Furthermore, finasteride inhibits CYP3A4 (which is the enzymes that detox finasteride) and that can cause a significant buildup of finasteride in the body over time. Ive made a 80% recovery so far and I keep improving however your hypothesis is quite scary. My total t is 650 ng/dl. Epub 2018 Oct 6. A: At the moment, theres no known test for determining whether any finasteride patient will develop PFS. This is a difficult question to answer as there is a small minority of PFS patients who have reported anecdotally that they have developed PFS only after quitting finasteride. Other PFS patients anecdotally report PFS symptoms while using finasteride that get worse after quitting the drug. A: In the Resources section of the PFS Foundation website, we have a page called Medical Professionals. The study also showed that the longer men are on finasteride, the more likely they are to develop PED. Overall, men who take finasteride for at least 205 days are nearly five times more likely to develop PED than men who take it for less than 205 days. 5 Apr 16, 2019 #1 Im very desperate for any success recovery story from finasterid side effects.. I know, that there are people who recoveredTo you PLEAAASE post some encouraging stuff for the rest of us.. Im 5 weeks off propecia, und total numbness in my penis, low libido, suicide ideation und shooting pain in my shaft.. This would suggest that tapering might be a safer approach. Thanks for helping people with this truly debilitating syndrome, in my case I was an othewise healthy active 66 year old that was prescribed Dudasteride for an enlarged prostate 3 months ago , after 7 weeks I stopped taking the drug and within several days I came down with a host of symptoms. To help with sleep I am also I use Magnesium , Lemon Balm, Taurine, Theanine and other sleep-aid herbs . 2021 Jun;44(6):1263-1273. doi: 10.1007/s40618-020-01424-0. Thanks for the positive feedback and Im glad its helpful. Are antidepressants safe for PFS patients? The treatment worked miraculously well and within a few months I was Careers. I have to recommend Hims to any guy whos experiencing thinning., Cost effective and affordable. (You must log in or sign up to reply here. Gonadin review: the most unique testosterone booster? But a handful of PFS patients have reported to us that theyve felt 80%, 90% or even 99% better over a period of one to five years. Unfortunately, medical science has yet to determine which factors, genetic or otherwise, make patients disposed to developing the condition. Disclaimer. on average a 10% increase in hair count over balding areas). A: Most likely, yes. In theory, the effects could be additive, but it is not known if the added effects would be beneficial or harmful. The Post-Finasteride Syndrome Foundation 2023, Support Program Connects PFS Patients Worldwide, Genetic and Rare Diseases Information Center, Persistent erectile dysfunction in men exposed to the 5-reductase inhibitors finasteride or dutasteride, Finasteride use in the male infertility population: effects on semen and hormone parameters, Single and repeated dose of finasteride topical solution in subjects with androgenetic alopecia. I started losing hair about 18 yrs old if that helps, Hi I got post finasteride syndrome like side effects from saw palmettherbal blend of dht natural inhibitors from amazon https://www.amazon.com/product-reviews/B004PVLWW0/ref=acr_dp_hist_2?ie=UTF8&filterByStar=two_star&reviewerType=all_reviews#reviews-filter-bar and i did blood work (rosch eclia methodology) but endos cant find anything that could cause all the side effects im dealing with. I am on the transcrotal cream. Epub 2020 Mar 25. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. This site needs JavaScript to work properly. But we hope that in the coming years, clinical research will demonstrate precisely that. Q20: Im a PFS patient and Id like to do my part for PFS research by participating in a clinical study on the condition. official website and that any information you provide is encrypted If estrogen is high, focus on lowering that, as estrogen is a potent inducer of serotonin and prolactin. National Library of Medicine Generic for Rogaine, this FDA-approved over-the-counter version of topical minoxidil is used for regrowth on the crown of the head. Maybe the poison is in the dose. Although the symptoms of post-finasteride syndrome are alarming, its important to keep in mind that they are incredibly rare, even in long-term finasteride users. This field is for validation purposes and should be left unchanged. No libido Will start vitamin K soon. RX MEDS SHIP FREE, IF PRESCRIBED. Q7: Are there any cases of PFS patients whove gotten 100% better? I took and i am taking many of the supplements listed with no real improvements. We discourage the prescribing of finasteride for hair loss by any physician. more https://www.jasonemermd.com/cosmetic-dermatology/regenerative-medicine/hormonal ARE THE SEXUAL SIDE EFFECTS WORTH THICK HAIR? It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. The Impact of 5-Reductase Inhibitor Use for Male Pattern Hair Loss on Men's Health. We strive to use primary sources and refrain from using tertiary references. Rather, these Frequently Asked Questions are meant as a starting point for ongoing discussions among patients, doctors and researchers. A: Most likely, yes. When used together, men saw better results in clinical trials compared to using either alone. For example, in a one-year trial, men with male pattern baldness who were treated with 1mg of finasteride per day reported the following side effects: Decreased libido (reported by 1.8 percent of men), Erectile dysfunction (reported by 1.3 percent of men), Ejaculation disorder (reported by 1.2 percent of men). Gonadorelin vs HCG: which is best for TRT? Clinicians should be alert for any unusual effects if patients ingest saw palmetto supplements while taking 5-alpha reductase inhibitors. Sure man. My hair keeps growing thicker, fuller, and at a fast rate., I noticed a huge change in the overall health and fullness of my hairline., Now after 5 months Im able to style waves first time in 10 years!, I decided to jump right in and I'm so glad I did. Overall, men who take finasteride for at least 205 days are nearly five times more likely to develop PED than men who take it for less than 205 days. Reported symptoms include loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronies disease, penile shrinkage, chronic testicular pain, gynecomastia, muscle atrophy, cognitive impairment, insomnia and dry skin. My test blood is perfect. A: Yes. WebAfter finasteride is discontinued, the body must produce new 5-alpha-reductase molecules to replace the ones that were inactivated by the finasteride. I am 29 now and started at 22. Unauthorized use of these marks is strictly prohibited. Diviccaro S, Giatti S, Cioffi L, Falvo E, Herian M, Caruso D, Melcangi RC. The site is secure. Keywords: Sex Med. Androsterone worked wonders for me. WebBased on patterns in firsthand experiences, the course may be understood in terms of three phases: post-withdrawal, adaptation and stabilization: This figure shows three outcomes: recovery, partial recovery and no recovery: Figure. This article is for informational purposes only and does not constitute medical advice. As for hair loss shampoos, many include ingredients such as ketoconazole and saw palmetto to block DHT at the scalp level. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities. 2022 May 5. doi: 10.1038/s41443-022-00568-2. In the meantime, we are working hard to publish as much medical literature and other news about the condition as possible on our website. An official website of the United States government. Start Hair Visit, Medically reviewed by Katelyn Hagerty, FNP. A few of the best ways to lower prolactin include: For more a comprehensive guide on lowering prolactin, check out this article: Serotonin is most often high in all mental and physical disorders and there is always a serotonin receptor/s gone rogue. 2015 Sep;16(3):177-98. doi: 10.1007/s11154-015-9319-y. The depression of PFS can be very debilitating and finding effective treatments for the depression of PFS can be challenging and require considerable trial and error in consultation with your doctor. Post-finasteride syndrome is a term thats used to describe a range of persistent symptoms that occur in a small percentage of men who use the medication finasteride. After finasteride is discontinued, the body must produce new 5-alpha-reductase molecules to replace the ones that were inactivated by the finasteride. However, we may soon see more data. Finasteride is a 5-alpha reductase inhibitor and this blocks the conversion of testosterone to DHT. ). CO2 keeps serotonin in check. If you have a northern European haplotype with a bad SNP profile and you get no or limited sunlight = no sulfated vitamin D3 = altered estradiol = altered testosterone = no progesterone = dehydration due to poor mitochondrial flux = no sex drive = no sex = no oxytocin = Tensegrity 7 blog. Sex Med Rev. Sure I can do that for you. ***POST FINASTERIDE SYNDROME CAN LAST 3 MONTHS or PERMANENTLY. We rely on peer-reviewed studies, academic research institutions, and medical associations. What few people know is that there are 5-R and 3 types of 5-R enzymes and that theyre not only involved in the conversion of testosterone to DHT, but also in the: Many of the benefits of testosterone, such as enhanced insulin sensitivity, reduced catabolism, higher dopamine, increased thyroid hormone production, are mediated by DHT, and blocking DHT production prevents those effects/benefits. Muscle pain My hypothesis is that finasteride can cause brain damage which needs to be reversed. It also improves blood flow to the scalp, which may help to supply your hair follicles with extra nutrients. Practo Plus. However, it can shift hair follicles into the anagen, or growth, phase of the hair growth cycle, which stimulates growth. Borgo F, Macandog AD, Diviccaro S, Falvo E, Giatti S, Cavaletti G, Melcangi RC. However, there have been no published medical studies that report on the effectiveness of SSRIs to treat PFS. Based on the symptoms and descriptions provided online, post-finasteride syndrome can sound like a severe, untreatable condition. In the near future oral allopregnanolone analogs will be available to use in attempting to treat PFS patients. It is known that post-finasteride syndrome (PFS) patients suffer from treatment-resistant depression and anxiety. You are using an out of date browser. ). You must log in or register to reply here. One of the PFS Foundations chief goals is to achieve universal awareness and acceptance of PFS as a bona fide and serious medical condition. wow very helpful articular and explains my symptoms exactly. Berrima in the Southern Highlands in NSW, its a beautiful area. I think he would suggest you "train" your skin to absorb more UV buy doing that yeah. WebRecovered from Post Finasteride Syndrome! But that does not mean you have to live with all the symptoms for that long. Separately, Sage Therapeutics has allopregnanolone and allopregnanolone analogue products that are currently in trials for various indications, including major depressive disorder and insomnia. Several studies over the past decade, for example, from Dokras,[], Illustration by Marta Pucci. In a small study published in the Journal of Sexual Medicine in 2007, men with benign prostatic hyperplasia were divided into two groups and treated with finasteride. But check your bilirubin just in case. 2022 Hims & Hers Health, Inc. All rights reserved. Acta Derm Venereol. This site uses Akismet to reduce spam. Discussion in 'My Optimal Journal' started by JPB, Dec 31, 2018. Lets say your DHT is low, here are the top 7 supplements you can use to increase it: If you want additional methods on increasing DHT apart from supplements, check out my comprehensive article on boosting DHT: If DHT is normal and you still feel off, mainly anxious, not confidence, shy, nervous, experiencing brain fog, etc., you might be low in allopregnanolone. Physical improvements down below as well. No doctor-patient relationship is implicit or implied. Considering the amount of stress in our daily lives and the constant negative feedbacks from exogenous estrogens leading to GNRH suppression, HCG is probably the best drug there is on the market right now. Here is how you focus specifically on increasing allopregnanolone: The optimal range for estrogen is around 20pg/ml and if yours is much higher, it would be best to make it a priority to lower it. A functional medicine doctor would help, but anything outside of health insurance coverage is out of my reach for the moment. Important: FOR MEDIA ONLY. It can and does, although they typically arent common. With that in mind, DHT can take anywhere from4 weeks to 2 years or more to recover(R). Bone pain To date, there are no evidence-based effective treatments for PFS. The https:// ensures that you are connecting to the So thankful to have found this article. We have received many reports of PFS-like symptoms from dutasteride patients. In fact, most evidence shows that side effects from finasteride become less common the longer the medication is taken. Dirt cheap too. Epub 2018 Oct 6. My hair is back to what it was in my mid twenties.. JoeKool said: After nearly 4 years of suffering, I have finally & fully recovered from Post Finasteride Syndrome. This improvement was blocked by finasteride, which blocks the synthesis of allopregnanolone. Epub 2022 Jul 14. There is evidence indicating that the longer someone takes finasteride, the higher the risk of developing PFS. That, according to 2013 study published in the American Society for Reproductive Medicines Fertility and Sterility journal, titled Finasteride use in the male infertility population: effects on semen and hormone parameters. I am investigating other solutions. Therefore, we recommend caution and discussion with your physician about the potential risks before deciding to treat it with SSRIs. Alternatively, you can use other treatments, such as those available in our Non-Prescription Hair Loss Kit, to treat male pattern baldness without taking oral finasteride. Curr Urol Rep. 2018 Jun 16;19(8):65. doi: 10.1007/s11934-018-0814-z. But always do blood tests first to see what is really going on. Keep me posted if you like. Co-use is likely to be common by patients, but the effects of co-use are not known. The .gov means its official. You definitely want high dopamine and low serotonin to optimize cognition and mindset. It just means that you might have to implement certain strategies and use certain supplements for quite some time before the enzymes normalize. Have you tried getting loads of sunlight? It was described that the prolonged use of 5-steroid reductase inhibitors in patients with alopecia can cause persistent side effects called a post-finasteride syndrome (PFS), that is not just a simple coexistence of events, but rather a definite syndrome with an iatrogenic background. Overall, although there are lots of incidental reports of post-finasteride syndrome online and in popular media, there isnt very much in the way of high quality scientific evidence to support its existence, at least not like there is for other medical conditions. Love the site. J Endocrinol Invest. I want to try HCG 50 UI per day. I just picked up Gaba, im assuming this is a good idea? When you send us your Patient Support form, include a note in your email letting us know youd specifically like to connect with fellow PFS patients who are willing to share their coping strategies. Can you help me? It is a severely underrated and misunderstood drug. This reduction in DHT greatly reduces prostate growth and either slows down, stops or reverses hair loss caused by male pattern baldness. For example, our Hair Thickening Shampoo features saw palmetto to target DHT and prevent it from damaging your hair follicles. As a precautionary measure, however, I want to quit the drug. Keywords: In some people with PFS, DHT might be normal, but testosterone and cortisol low and estrogen and prolactin high. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. 2022 Oct 26;12(11):1567. doi: 10.3390/biom12111567. Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. I suffered PFS till 4 years with many problems: I suggest you see an expert for internal workup, we do this frequently in our practice. 2020 Sep;204(3):602. doi: 10.1097/JU.0000000000001168.01. In some cases, there was no difference in side effect rates between the two treatments. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? A: None of the studies being sponsored by the PFS Foundation currently are actively recruiting patients. Another related symptom is insomnia or light and disturbed sleep. How do you explain that? Post-finasteride syndrome is a rare condition that some men may experience after taking finasteride (Proscar, Propecia). Oral testosterone: Hows the best way to take it? However, many men who were treated with a placebo medication also reported the same side effects: 1.3 percent of men who received the placebo reported decreased libido, 0.7 percent of men who received the placebo reported erectile dysfunction, 0.7 percent of men who received the placebo reported ejaculation disorder. What do you think of TRT is PCT to recover from PFS? Q16: I know there are currently no effective treatments for PFS, but can you recommend any special diet, exercise regimen, etc., that might help? Do you have any digestive issues? There are no known scientific reports of PFS patients returning to full health. 2020 Jan;113(1):21-50. doi: 10.1016/j.fertnstert.2019.11.030. If youre looking for something effective but dont want too many steps in your routine, this once-a-day pill could be right for you. Most of the research used to support the idea of post-finasteride syndrome is low quality, with issues such as selection bias believed to affect results. Since testosterone is an important hormone for sexual desire and function, this could cause a reduction in libido. Q11: Id like to get in touch with other PFS patients in my area, or anywhere in the world, for that matter. You do think that these hypothetical damages can be reversed ? Finasteride, which is sold as a generic and under the brand name Propecia, is one of the most popular medications on the market for treating and preventing male pattern baldness. The Interplay between Finasteride-Induced Androgen Imbalance, Endoplasmic Reticulum Stress, Oxidative Stress, and Liver Disorders in Paternal and Filial Generation. Q4: Is there any way to know if Im susceptible to PFS? Sexual functioning is returning to some extent. Feel free to reach out to any of them with questions you might have, including appointment requests. Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases. MeSH In these trials, researchers found that finasteride did cause several of the side effects mentioned above, including decreased libido, erectile dysfunction and ejaculation disorder. Q13: I understand we dont know which is riskier, quitting finasteride or staying on it, but I still want to quit. 2016 Mar;4(2):245-50. doi: 10.1111/andr.12147. I have had PFS for 15 years, just came across your article, would you be interested in looking at my labs for comment? If I do, could I develop PFS after stopping? The men in one group were informed that they would use finasteride and told about the sexual side effects associated with the medication. The men in the other group were not told that they would use finasteride and did not receive a briefing on potential side effects. You may need to have multiple procedures if your hair loss worsens. Would it be safer to just use Minoxidil (sporadically) or will I still potentially have symptoms? Prostatis From frail and hypogonadal, to gaining 60lbs of muscle, boosting testosterone over 1,000ng/dl and becoming a successful entrepreneur. The .gov means its official. We offer minoxidil liquid and minoxidil foam online. Before/after images shared by customers who have purchased varying products, including prescription based products. Support inquiries will not be addressed. If so, well reach out to our entire PFS patient population to let you know and to provide you with participation parameters. there is a big thread about the Aussie donut hole - where JK gave us tons of info. This is especially true once the placebo and nocebo effects are taken into consideration.
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