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- Three Clinical Alerts Worth Reading Slowly — and a Word About AI in Clinic
Three Clinical Alerts Worth Reading Slowly — and a Word About AI in Clinic
MHRA warnings on finasteride and dutasteride, where the evidence really sits on GLP-1s, the truth about the P-shot — and how to use AI before a consultation, not instead of one.
Three Clinical Alerts Worth Reading Slowly — and a Word About AI in Clinic
MHRA warnings on finasteride and dutasteride, where the evidence really sits on GLP-1s, the truth about the P-shot — and how to use AI before a consultation, not instead of one.
In This Issue
| Clinical alert: MHRA strengthens finasteride and dutasteride warnings | |
| Clinical alert: GLP-1s and male sexual function — what we know, what we don't | |
| Clinical alert: the P-shot for ED — why SMSNA and AUA say research only | |
| When you arrive at clinic with ChatGPT's opinion | |
| Updated fees from 1 June 2026 — and bundled pricing coming |
Clinical Alert
Finasteride and Dutasteride — The MHRA Has Strengthened Its Warnings
Two of the most widely prescribed drugs in their categories have just been given strengthened safety warnings by the MHRA — finasteride (for benign prostatic enlargement and for male-pattern hair loss) and dutasteride (for BPE). The news isn't a recall, and it isn't a reason to panic. It is, however, a reason to read carefully if you're on either of them — or thinking about starting.
What the MHRA Said, and What It Means For You
On 11 May 2026, the MHRA strengthened warnings for finasteride (1mg and 5mg) and dutasteride 0.5mg, citing the risk of depression, suicidal ideation, and sexual dysfunction that may persist after stopping treatment. The Yellow Card scheme has recorded 170 reports of suicidal ideation and related terms for finasteride and 5 for dutasteride between 1994 and 31 May 2025, against more than 400,000 monthly prescriptions in the UK. If you take finasteride 1mg for hair loss and develop suicidal thoughts or depression, the MHRA advises stopping and contacting your healthcare professional as soon as possible. If you take finasteride 5mg or dutasteride for BPE, the advice is to consult your healthcare professional as soon as possible if those symptoms appear — but not to stop the medication on your own.
Clinical Alert
GLP-1s and Male Sexual Function — What We Know, What We Don't
Ozempic, Wegovy, Mounjaro, and the rest of the GLP-1 family are now widely prescribed for weight management — and one of the most common questions I'm hearing in clinic is whether they cause, or improve, erectile dysfunction. The short answer is: it depends on who you are. The longer one is worth a paragraph.
Two Populations, Two Patterns
In men with diabetes, GLP-1 receptor agonists may improve erectile function indirectly, through the same cardiometabolic pathway that helps the rest of the body. In men without diabetes who use them primarily for weight loss, a retrospective cohort study has flagged a signal for new-onset ED and lower testosterone — a relative risk roughly four-fold on semaglutide in one analysis. No dedicated randomised trial has settled the question in either direction. The honest take: if you're on a GLP-1 and something has changed sexually, that's worth investigating properly, not dismissing as just the weight loss.
Clinical Alert
The P-Shot for ED — Why SMSNA and AUA Say Research Only
If you've been offered a "P-shot" or PRP injection for erectile dysfunction by a private clinic — or seen it advertised on Instagram — there's a piece of context that doesn't usually make it into the marketing. The Sexual Medicine Society of North America and the American Urological Association both state that PRP for ED should only be administered in the context of clinical trials. Cleveland Clinic summarises the published evidence in one line: there is good scientific evidence the P-shot can't treat ED.
What the Evidence Actually Shows
The one published double-blind placebo-controlled randomised trial of PRP for ED showed the injection was safe — but not effective beyond placebo. Mechanistic preclinical work is interesting, but it doesn't translate today into a clinical recommendation. Two professional societies (SMSNA, AUA) explicitly position PRP for ED as a research-only intervention, not an established treatment. If you're considering it, the conversation worth having isn't about the injection — it's about what's actually driving the ED, and what a proper workup would look like for you.
Practice Update
When You Arrive at Clinic With ChatGPT's Opinion
More and more patients walk into my consultation with a ChatGPT-generated pre-diagnosis. I don't mind it. I'm honest about how I use AI in my own practice — there's a whole section on the transparency page explaining exactly what AI does and does not do for me. But the patient-side question matters too: when does AI help you prepare for a consultation, and when does it lead you somewhere you'd rather not be?
The short version. Large language models are good at information retrieval, summarising what you've read, and helping you formulate questions. They are markedly less good at clinical reasoning under uncertainty — the bit where your specific history, examination findings, and risk factors all weigh against each other to decide what to do next. The honest framing is: use AI before a consultation to prepare, not instead of one to decide. If you arrive with three pages of ChatGPT printout, I'll read it with you. If you bring questions distilled from it, that's even better.
Practice Update
Updated Fees from 1 June 2026 — and Bundled Pricing Coming
I review my fees every year. The latest review was completed in May and is effective from 1 June 2026. The full list is on the practice transparency page — nothing hidden, no surprises, every line item visible. One thing I'm working on for later this year: bundled pricing for surgical pathways at Chelsea & Westminster Hospital, where the surgeon fee, hospital fee, and anaesthesia all sit in one single transparent number.
How the pricing works. Insurance covers most patients (around 76% of my practice). Self-pay rates are listed in full on the practice transparency page, with the principle that you should know the cost before you commit. Complex cases — extended operating time, combined approaches, or significant comorbidities — may require fee adjustment, which I'll always discuss openly before proceeding. Bundled package pricing for Chelsea & Westminster Hospital pathways is in development and expected to launch later in 2026.
Need to Talk?
If anything in this issue has sparked a question — about a medicine you're on, a treatment you've been offered, an AI summary you're not sure about, or just what something costs — that's exactly the conversation worth having.
Dedicated to Your Urological Health
Consultant Urological Surgeon · Andrologist
GMC: 7074458
Chelsea & Westminster Hospital Private Care · Nuffield Health Highgate · Virtual Consultations
Tel: 020 4576 5779 · Email: [email protected]
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