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Ibuprofen alters human testicular physiology to produce compensated hypogonadism (nih.gov)
300 points by wallace_f 6 months ago | hide | past | web | favorite | 234 comments



"Ibuprofen and hypogonadism — bench to bedside to misinterpreted hype?" at https://www.nature.com/articles/nrurol.2018.26 :

> A recent study suggests modulation of luteinizing hormone signalling within the hypothalamic–pituitary–gonadal axis and downstream transcriptional effects caused by sustained ibuprofen use. However, this study cannot be used to draw any clinical conclusions regarding effects of ibuprofen on male androgenic or reproductive health. Thus, the andrological effects of its use remain unclear and would benefit from further investigation.


Sounds like the industry responding with "we cant really know guys, right?" I'm throwing away my Advil right now. Screw that.


I get what you're saying, but ibuprofen and acetaminophen save lives. The problem is the western (American?) tendency to self-medicate and to over medicate with really potent stuff. That shouldn't be as normal as it is.


I am not aware of any common uses of Ibuprofen and Acetominophen that saves lives?


Fevers kill. Ibuprofen and acetaminophen reduce fevers.


Not necessarily. Fevers can cause seizures and they can have detrimental effects in paediatric patients. For the bulk of the general population, these painkillers/anti inflammatories are simply symptom relief.

For those talking about hyperthermia killing, yes but in almost all those cases the cause is not an infection.

In fact, I would say that paracetamol kills a hell of a lot more patients than it actually ‘saves’.

A study I have taken to heart is that permissive hyperthermia (up to 40 deg c) in ICU patients has a greater survival than those where fever is treated aggressively.

Physiologically, this resonates because high temperatures activate the immune system and raised temperatures are non-optimal for bacterial proliferation; so the immune system is primed by fever; suppressing it can dull immune system response.

In fact, malaria was used as a treatment for syphillis in the early parts of the 20th century because high temperatures kill spirochetes. There are also a decent number of case reports of cancers going into remission following fever.

However in my quick mobile google then I could only see the following study that demonstrated no advantage for either control of permissive hyperthermia group in ICU patients; so perhaps I was relying on a study that has been superceeded.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1508375


Fevers are used by the body in an attempt to weaken invading bacteria and viruses, and make it easier for the body to heal.

You don't want to stop a fever ~ just keep it within the safe zone where it's healing, but not dangerous.


I use my hot tub at 105 degrees to give me fever benefits without the bodily energy expenditure.


Fevers do not kill. Fever is a symptom, which is subjective, not a cause of death.


Fever can indeed kill. Raise the body temp a few degrees, no matter the cause, and things start going wrong very quickly. Google hyperthermia.

In fact, i cannot think of any disease that literally kills. Even with the big stuff like cancer or aids, it is always the symptoms that get you. They damage body systems and the decline of those systems (aka symptoms) eventually causes the cardiac arrest or internal bleeds that shut off nutrients to the brain. Those symptoms are just as lethal no matter thier cause. A massive fever that stops normal body chemistry, whether caused by flu or ebola, will kill you just the same.


I can confirm a fever can kill, saw and heard about it in SE Asia.


Hyperthermia differs from fever in that the body's temperature set point remains unchanged. https://en.wikipedia.org/wiki/Hyperthermia


Yes but the extra heat in the body causes the same cascade of chemical changes that will eventually kill. Initial treatment is different, to a point. If a fever is too high it will suddenly need the same treatment as hyperthermia: direct cooling.


Fevers do kill. It’s not common in western world where we have access to antibiotics but in developing world it’s more common.


I truly admire your confidence, even it I cannot have it myself.


Not a doctor: Isn’t fever (objectively, it seems) defined as a rise in body temperature? From what I’ve learned about protein denaturalization in high school, that doesn’t sound good if excessive.


Ibuprofen is anti-inflammatory medication.


>Ibuprofen is anti-inflammatory medication.

And an acetaminophen tablet is a painkiller. While your statement is in fact true, ibuprofen is still a better choice for a fever. The latter is also generally considered a safer alternative, especially in long-term use — even though alternating the two would be ideal.


Acetaminophen is actually a pretty dangerous drug that is pretty easy to overdose on. It’s been said if it were discovered today it would be a prescription drug.

On top of that numerous recent studies have shown many potential problems.

https://www.webmd.com/drug-medication/news/20150302/does-lon...

> Heavy use of acetaminophen is associated with kidney disease and bleeding in the digestive tract, the paper reports. The medication also has been linked to increased risk of heart attack, stroke and high blood pressure, the study authors noted.

> One cited study even showed that overuse of acetaminophen can increase a person's risk of early death as much as 60 percent, the study authors found.


how true would rate wikipedia's current claim that "how it works is not entirely clear" ?


If you have a fever, why not both (as long as you’re hydrated)?


That was what I used (nothing else) when I got H1N1. I thought I was going to die but I made it.


And acetaminophen reduces empathy, according to some convincing research.

What's wrong with cannabis-derived solutions, again?


What about it reduces empathy? My uneducated guess would be that it's unrelated to _which_ pain medicine you choose.

Also, FWIW, in the past, I tried both CBD and THC without any luck where Ibuprofen helped so it's certainly not 1:1


See other response.

What forms did you try? What brands? Were they lab tested?

Like any "new" drug - there's a lot of nonsense floating around.

Please don't simply buy CBD capsules from Walmart, and say "this shit doesn't work for me".


For those downvoting parent please see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015806/

And others.

True or not, parent wasn't just making up the empathy-painkiller association.


[flagged]


Your first argument discounted psychological studies primarily on the basis that there are two many dimensions to account for in relation to a measurement of behavior.

You then went on to suggest a link between gender identification and the results of a study on a single variable. It’s probably the case there are many environmental and physical dimensions at play with gender identity. While I can’t say at this point that your link is wrong, it may be best to hold back on the last assumptions; especially a biologically based one, given the scope of the impact.


You're literally replying to a comment which makes this exact point.

> Well, we can introduce a protocol, and study it, and know conclusively in perhaps 10 years. But, between then and now...


As a cognitive neuroscientist you may guess my opinion about your loosely constructed and ranting 'argument' about my field of study. While I will not vouch for the study I cited above, I will vouch for the scientific integrity of my colleagues.


It's an interesting study. One thing I'm not sure about is: were the participants in (any kind of) pain originally? Was it chronic, or acute?

Intuitively, and from my experience of 15 years of fighting with chronic pain, it's incredibly hard to emphasize with anything at all when you're in serious pain. It's hard to even think about anything other than pain. I'd say - again, from the perspective of a chronic pain patient - that reducing the pain with medication makes it possible to have empathy towards others. Obviously, I have no neurochemical data to back this up, I'm just saying how it looks like to me, psychologically.

If I had to guess, I'd say that being in pain does little good for empathy and it's a memory of being in pain that counts. When I'm in pain I'm not going to care too much about yours, but when I was in pain, and I remember it clearly, I'm going to care a lot.


Wow! A psychoactive substance that's actually helpful!

(Even though it's clearly not net-helpful due to the serious physiological side-effects.)

That's amazing!

... why isn't there more research on isolating this particular side-effect?


[flagged]


If you'd rather your kid step on others to succeed than fail, don't have a kid.


Please don't reply to egregious comments (a.k.a. please don't feed the trolls). This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html. Instead, flag the comment by clicking on its timestamp to go to its page, then click 'flag' at the top. (There's a small karma threshold before flag links appear.)


This. Just had friends visiting. Their teenage son had had his wisdom tooth pulled last week. Dentist had then given him (as a standard practice?) prescription for Ibuprofen (800mg tabs?) AND some opioid based pain killer! Needless to say, latter they said went directly to trash after they realized what it contained and for ibuprofen they halved the dosage.

To me and his parents this was pain management gone way over dose! But we’re not medical experts and should not be doing clinical decisions since at one end of this rabbit hole you will find anti-vaccination and other nut jobs.

So what to do?


I just had wisdom teeth extraction a few weeks back. I was given 800mg Ibuprofen and Norco. The pain was bad enough to wake me up at night when the meds wore off — and I did take both. Oral surgery is no joke. It took me about 8 days to taper to 400mg Ibuprofen.

These doctors don’t just give pills out randomly, they do it for a reason based on evidence and science. A side note is that my pharmacist made it very clear to only use the painkillers as necessary. You should always consult the doctor and pharmacist after major surgery to clarify these things if needed.


The pain varies wildly from person to person. A friend of mine was out of order for two weeks after having a single tooth removed. I had all 4 removed and recovered in a few days and without much painkillers.

IMHO the doctors should prescribe less at first and see if it would be enough, but I also get that they are overcrowded and the same patient coming back for just more painkillers might be a little too much.


> So what to do?

One thing is not to put medicines, OTC or not, into the trash. They are nasty stuff to have in the dump.

As for the drugs: don’t take analegics if you don’t need to; do if you can’t tolerate the pain. Everybody has a different level of pain and tolerance and I bet the prescription said something along the lines of “...as needed”

As for other prescriptions, do your research; odds are you do need it but not always.


Wisdom teeth extraction is a major oral surgery. What was prescribed was not an overdose at all.


What to do? IMO: follow the doctor's/pharmacist's instructions precisely. In my case we were instructed to only break out the opidoid in the event of severe pain (has never happened to me but I guess it's possible), and there were quite specific instructions regarding it. If you don't end up needing it, dispose of it.


Exactly this. Removing wisdom teeth in particular seems to affect everyone in totally different ways that can't easily be predicted, so doctors over-prescribe and give strict only-as-needed instructions.


I had a similar experience. My oral surgeon, who did a great job, highly recommended I fill the painkiller prescription and take it. He recommended this several times throughout the process, before and once before I left, as did the nurses (?) at the counter, as I expressed some concerns about it.

I finally caved and then took a half dose right after the extraction because I was fearing terrible pain, especially since the surgeon said mine was a fairly difficult job that would probably end up causing more pain than is typical.

The half dose of painkiller made me extremely nauseous, and so I decided to just try the 800mg of ibuprofen, and it did the job perfectly. I did feel a little sore and stiff, but never in pain unless I waited too long for another ibuprofen dose. It was the same for my girlfriend, who was also prescribed the pain killer but didn't take it because she didn't feel she needed it either.

The pain killer being prescribed didn't bother me per se, and neither did the recommendation, and I don't think anything nefarious was going on. Also, everyone's body is different. But given the side effects, and potential side effects, I just felt that even a simple "we recommend you get this prescription filled, but please see how the ibuprofen works first, and only take the pain killer if you can't handle the pain on ibuprofen alone" would have been a better way to handle it.


There's probably nothing wrong with taking 800mg of ibuprofen at least for a short period of time. Ibuprofen can have some negative effects from long-term use though.

Regarding opioid based pain-killers... for all the negative attention they get, they're also usually fine for most people - when used as directed and, again, for a short-period of time.

Not everybody who takes a few Oxycodone tablets winds up addicted and then reduced to using heroin to get their fix.


This is why I hate reading these type of posts on HN. Especially like in this case where there's still a lot to be researched on and to drawn conclusions from, and the outlook isn't positive.

My recommendation is to go and talk to your doctor and confront him or her with this "finding".

Also, most importantly, this "finding" has been out for almost a year now. I wonder what's the more recent development on it.


Move to Europe where we don't get as many drugs prescribed? I think the only time you get opioids is after major surgery. Personally I don't know anybody who had to take them.


No opioids after my wisdom teeth extraction would have resulted in potentially suicide. The pain was unbearable, and 3-4 days of hydrocodone was absolutely proscribed.

There is nothing wrong with opiates being used for acute pain relief. They are a modern miracle when put to such uses.

The problem comes when you start using them for long-term pain relief - a use-case in which they are neither appropriate or effective.

A typical 2-3 day prescription after major dental (or other) work is not remotely a problem, and I really have no idea why this is where the focus is. It's always been long-term abuse as the actual problem - the weird overreaction over a few days use for acute pain is utterly absurd and only hurts people in some bizzare way for folks to feel they are "helping" fix the abuse problem.


Definitely varies by individual, and by the nature of the situation. My personal experience, as somebody who considers himself to have a pretty high threshold of pain tolerance, is that I never needed any of the Vicodin I was prescribed after wisdom tooth removal... but I can't imagine how I would have survived without Oxycodone in the first week after rotator cuff surgery.


Co-codamol (codeine and paracetamol) is widely prescribed IME in the UK, eg for back pain, muscle pain.

I had Oramorph for abdominal pain (in hospital, no surgery thankfully). The condition may have been caused by medium term use of Ibuprofen (in my non-medical opinion).


So you mean like Spain where 800mg tabs of ibuprofen are over-the-counter?


I doubt anyone is interested in protecting ibuprofen from a commercial point of view. Generic ibuprofen is extremely cheap; if anything the industry would probably like people to stop using it so that they could sell novel NSAIDs.


OTOH acetaminophen is known to be toxic; is there an alternative here for non narcotic inflammation, fever, and pain relief that is shown NOT to have tradeoffs for use?


Acetaminophen/paracetamol is really only toxic in higher doses due to its metabolism, as only the intermediate metabolite NAPQI is toxic, but that cannot build up in low doses.


Still, it seems just as easy to have too much of a dose or acetaminophen in a single day as it is to use ibuprofen continually for an extended period of time.


I just started using CBD, it’s possible it’s just placebo, but I feel no more pain in my joints in the Am, am more relaxed, less anxious, more agreeable and more aware of my body.

I’m taking 5Mg capsules 2x a day.


> OTOH acetaminophen is known to be toxic

This is news to me. What exactly does "toxic" mean? Do you have a citation I can read?

Acetaminophen is not for inflammation anyway.


Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose[1] (this is one of the reasons you are told not to drink alcohol when taking paracetamol -- if your liver is struggling to process alcohol you're more susceptible to liver failure).

In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2]. And in 2006, [3] found it was the most commonly used compound for intentional overdosing (i.e. suicide by overdose).

But of course, this depends on taking a very high dose -- paracetamol isn't dangerous in moderate doses.

[1]: https://en.wikipedia.org/wiki/Paracetamol_poisoning [2]: https://www.ncbi.nlm.nih.gov/pubmed/18312195 [3]: https://www.ncbi.nlm.nih.gov/pubmed/16805658


> In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2].

No, it isn't, and for the people who die from paracetamol it's an intentional overdose, it's very rarely an accidental overdose.

In the US about 500 people die each year from acetaminophen overdose per year, compared to over 70,000 from opioids.

Your link number 3 is talking about compounds containing paracetamol. For example, this includes coproxamol. Anyone overdosing on coproxamol was dying from the opioid (dextropropoxyphene), not from the paracetamol.

In the UK we have the ONS deaths related to drugs poisoning. Figure six shows deaths compared by drug type, and paracetamol clear isn't the highest: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

We also have the NCISH data. Item 120 here: https://documents.manchester.ac.uk/display.aspx?DocID=38469

3095 deaths by self-poisoning.

    Substance                    Number   
  Opiates/opioids                 947    33%
  - opiates only                  746    26%
  - paracetamol/opiate compound   201     7%
  Non-opiate analgesics           205     7%
  Antipsychotics                  302    11%
  Antidepressants                 587    21%
  - tricyclics                    271     9%
  - SSRI/SNRIs                    260     9%
  - other antidepressants          56     2%

Paracetamol is dangerous in overdose, but that says nothing about its safety in normal usage.


I can't cite a source, but I recall being told when I was prescribed a few days of vicodin+acetaminophen after an appendectomy that acetaminophen is (often? sometimes? always?) combined with some potentially-addictive painkillers to limit the extent to which they can be abused without the user needing treatment for liver issues.

This doesn't really undercut anything you say, but if I was given accurate information I assume a subset of those acetaminophen OD deaths are from people abusing painkillers it's combined with. I haven't looked into it, but I assume this is also a partial explanation of why OTC cold medications with Dextromethorphan in them tend to be combined with a relatively high dose of acetaminophen. I would guess there are other good examples of abusable pharmaceuticals combined with acetaminophen.


There's a little bit of truth to this--historically, lower doses of hydrocodone and oxycodone mixed with acetaminophen were a lower drug schedule in the US, allowing for less stringent requirements on security during production and transportation. Presumably, this was because the DEA thought there was less potential for abuse in the combinations drugs.

However, there's a more important medical reason: acetaminophen accentuates the analgesic affects of opioids, although the mechanism for this is not clearly understood. This makes acetaminophen-enhanced opioids more effective drugs.

Opioid abuse has become so rampant, though, that we're moving away from prescribing acetaminophen-enhanced opioids like Vicodin and Percocet to try to stop them entering the recreational drug market. As opioid use has increased, so has the number of liver toxicity deaths due to the acetamiophen in some prescription opioid drugs.


This was mentioned in the Wikipedia article about paracetamol poisoning (though the reason paracetamol is added to opiod painkillers is because apparently the combination works better than either drug separately).

But the original point was about whether paracetamol is toxic, not how often people overdose on Panadol (though that does happen in suicides). And the answer is "yes, but not in the dosages you'd normally see".


> Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose

Sure, and drinking too much water causes hypernutremia that can also kill you. Toxicity is always dose dependent, so the initial unqualified claim seemed to imply toxicity at normal dosages.


Botulinum toxin (botox) doesn't kill most people in the standard dosage, but it is obviously toxic (it's in the name).

Paracetamol poisoning is fairly common, hypernutremia isn't. Don't get me wrong, I disagree with the original statement that paracetamol is toxic (with the implication that this is a reason not to use it in normal dosages). But it's definitely not harmless.


I agree it's not harmless, but strictly speaking this kind of phrase is meaningless because nothing is intrinsically harmless. Dosage dictates all harm.

Probably the closest to harmless you can get are the inert gasses, and even then they can cause harm by displacing oxygen to deadly levels.


It is easily the most lethal otc. Its not some dihydrogen monoxide fear mongering.


Cannabis with a higher concentration of CBD than THC. I like a ~2:1 ratio.


No tradeoffs? I don't think such a thing exists. Aspirin kills people every year. The only pain reliever I know of that has never killed anyone is cannabis. I don't think it does much for fever though?


Inhaling smoke into your lungs is never a good thing. Your lungs (cough) are trying to tell you something.


Where did I say anything about smoking? And I also didn't say cannabis has no tradeoffs either. But it won't kill you. That's a pretty strong pro in my book if you are looking for occasional pain relief.


You didn't say anything about not smoking it either.


Ice. (As in, frozen water.)


Naproxen / Aleve?


The naproxen molecule is very similar to ibuprofen, so I expect it would have similar effects.


The sodium part of naproxen sodium is a concern for some people.


Kratom / Cannabis oh wait these are illegal so big pharma can milk their poisons.


Here in Canada, Big Pharma are falling over themselves to get into the Cannabis business.

I honestly think the obstacle to Cannabis legalization in the US is social conservatism, not industrial lobbying.


The social conservatism about cannabis was created and stoked by propaganda and laws created in large part due to industrial lobbying, if you look back a generation or two.


Cannabis causes low T and gynecomastia, so not really


I looked for studies supporting your statement. The evidence is conflicting, and there appears to be no conclusive evidence one way or the other, although some people certainly are fond of repeating this as if it's fact.


Still appears questionable - A few studies and more information included in this article.

https://www.mdmag.com/medical-news/is-there-a-link-between-l...


As soon as they're legal enough, they'll be milked too. I mean, you know, analogs tweaked for higher potency, etc.


Same just did that.

>resulted in the clinical condition named "compensated hypogonadism," a condition prevalent among elderly men and associated with reproductive and physical disorders. In the men, luteinizing hormone (LH) and ibuprofen plasma levels were positively correlated, and the testosterone/LH ratio decreased.

Fuck that.

I wonder what I should give my kids when they have fevers though


>I wonder what I should give my kids when they have fevers though

You don't have to give them anything. Ibuprofen doesn't make the underlying infection causing the fever go away any quicker, it just alleviates the symptoms. It's a trade off between reducing short-term suffering and risking long-term defects. Personally my parents never gave me painkillers for fever and I'm grateful for it: fever pain is just a temporary feeling, but some of the uncommon side effects of painkillers are much longer-lasting.

*Edit: To whomever downvoted, I'm curious what part of what I said you disagree with.


I didn't downvote you, but you seem to lack experience/knowledge on the topic if you think it's only a painkiller.

Ibuprofen's main use is to help to keep the body temperature in check. When your body temperature goes too high you can lose consciousness and even die. I had a very high fever once and didn't want to take any medicine until I started to lose consciousness and I almost fell while waiting in a line in pharmacy. I was able to go through it only because I was adult. Children are more fragile. Fever is the reason people died so much before discovery of antibiotics.

You are right that it alleviates the symptoms, and it's actually better not to use it when the temperature is moderate because high temp kills some germs. But if it goes too high, you have to stop it before it's too late.


>Fever is the reason people died so much before discovery of antibiotics.

I thought bacterial infections were the response were the reason people died before antibiotics. Fever is the body's response to infection, a primitive means of fighting it. If somebody has a serious infection and you give them anti-fever medication but no antibiotics, they're still at serious risk of death even if their fever goes away.

According to the first article I found while Googling: https://www.google.com/amp/s/www.nytimes.com/2018/05/11/well... :

"The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen."

"In 1997, these data led to a large, randomized, placebo-controlled trial of ibuprofen in 455 patients with sepsis, a life-threatening infectious condition. In this study, ibuprofen failed to prevent the worsening of sepsis and failed to decrease the risk of death."

So there's no evidence that such drugs actually stop fever "before it gets too late" in adults, as they don't reduce risk of death. I had wrongly assumed the same applies to children.


An NSAID failing to help with a bacterial infection is not surprising


Yep, but if death was due to the combined effects of both bacterial infection and fever, we'd expect to see a reduction in mortality when fever was treated compared to when it was untreated, which the linked study didn't find.


But how is it better than an ice bath given the side effects of ibuprofen are potentially worse than an ice bath?


Ice bath has really short-term effect. If your body temp is really high, ice bath can take it down for 30-40 minutes and then it's back up. Ibuprofen takes it down for 6 hours.


True, but children are not that fragile. High (above 103/104) should be brought down, febrile seizures are bad but lots of parents hit ibuprofen/paracetamol when the kid is showing 99F.


My guess is the down vote comes from someone thinking your comment sounds like you don't have any children or know what you are talking about. You don't give ibuprofen for pain during a fever, though doctors will say it can help because often times the source of the fever will cause pain like an ear infection or strep throat, you give it to reduce the temperature. There is a serious risk of seizure in children if you let fevers run high. So to say you don't have to give them anything is certainly not true in many cases and in fact could be life threatening to just ignore. That would be my guess to the down vote. I have multiple kids and never has the thought in my mind been I will give them analgesic for the pain of their illness. It is about the temp 100% of the time. I do not like to take drugs nor give them to my children if avoided but certain things you must treat. Fever is one.


According to the first article I found while Googling, https://www.google.com/amp/s/www.nytimes.com/2018/05/11/well... :

"The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen."

"In 1997, these data led to a large, randomized, placebo-controlled trial of ibuprofen in 455 patients with sepsis, a life-threatening infectious condition. In this study, ibuprofen failed to prevent the worsening of sepsis and failed to decrease the risk of death."

The science doesn't seem to support the notion that reducing fever will reduce the risk of fatality in the general case. I had assumed the same thing also applied to children, as before this thread I'd never heard of children getting seizures from fever (at least not from any of the children/parents I knew growing up in rural Australia).


Why do you not help your kids when they are in pain?! This is truly shocking to me, it is definitely a cruel and inhumane sentiment.


Why do you pose a ridiculous question, implying the parent commenter is a bad person who doesn't love their children or whatever?

Do you give your children general anesthesia when they are in pain? E.g. they've fallen and bummed their knee or something?

Why not, since it would be the ultimate pain-killer? Because it's both dangerous and unnecessary.

The parent has the same reasoning for other unneeded and dangerous drugs.

Why can discuss whether they're really as unneeded and dangerous as the author implies, but that's another question, not loaded with "why don't you love your children" implications...


Painkillers are not side effect free; if the pain is something minor, like a bruised knee or normal headache, it's not unreasonable to decide that experiencing the pain is a better choice than risking the side effects of a drug, which in uncommon cases can be much more severe and long term. It's not as clear cut as "helping" vs not helping, as unfortunately we don't yet have any side effect free painkillers.


Also, the pain sometimes keep activity low which may help with healing. If I give my kid something pain relieving he'll be up and bouncing around and could hurt himself more.


You could also teach your kids meditation techniques to be deployed when in pain.


"Dad always thought laughter was the best medicine, which I guess is why several of us died of tuberculosis" (Jack Handey)


Unsure why this got downvoted, meditation has been show to reduce pain up to 90%.

Seems like teaching kids to meditate would have all sorts of benefits, including drug free pain management.

https://www.psychologytoday.com/us/blog/mindfulness-in-frant...


Can someone please explain the downvotes? Do you not like the idea that meditation can mitigate pain? Don’t think it’s true? Find it wrong to teach kids? What?


I meant in the sense I don't give pain killer for pain during a fever but I give it during a fever to help with the temperature. It is not to take away the pain of a fever but the temperature but often times there is something painful causing the fever so it helps. Now as for giving my kids analgesic I do give them Acetaminophen and Ibuprofen occasionally when they really need it. I encourage things like rest in a dark room and more fluids first but you get to know as a parent when they are really not well and when they just need to take a break from screen time or activity or take something like tylenol. Medicine is not my go to but I use it accordingly.


I am sure there are nuances to your statement that get lost in the short text so I assume that you don't mean it quite as hyperbolic as it comes across but my immediate reaction to that sentence is: you can't protect your child from pain forever -- physical or emotional. How will they learn to handle it if they aren't exposed to it gradually?


Your parents probably aren't doctors. The issue isn't cut and clean... To a point a moderate fever usually helps your immune system (the response exists for a reason), but anything other than a moderate fever can be a lot more dangerous than long term issues stemming from sporadic usage of antipyretics.


Replying to my own comment as it's too late to edit, I was basing my assumptions on studies showing fever reducing drugs have no positive effect on mortality in adults, like described in https://www.google.com/amp/s/www.nytimes.com/2018/05/11/well..., but was unaware that children face separate risks from high fever that can make such drugs more vital. So my comment is bad advice.


I appreciate that you followed up.


Rapid rise in temperature in infants, toddlers, and young children can cause febrile seizure. Given the trade-offs, we generally choose to medicate our child when his temperature passes ~102 and it's on a rapid uptrend.


Has this happened often? Also, how often do you measure the child's temperature and how do you establish the rapid uptrend?


>how often do you measure the child's temperature

As often as you need when they have a fever. Modern thermometers can give you the temperature in a minute or so.


yes, but is this sampling a good idea? Have you tried measuring temperatures periodically when the child appears well? What is the variation then? How do you know that the device is telling you something meaningful? Is the child getting flustered and hotter because of the attention?


You have to measure rectally for good results. Forhead thermometers, ear thermometers, under the tongue thermometers -- all crap. If you have an infant or small toddler, use a rectal thermometer. Measuring this way, results are both precise and accurate (and therefore, repeatable).


>yes, but is this sampling a good idea? Have you tried measuring temperatures periodically when the child appears well? What is the variation then?

There should be no major variation then. On the other hand, if the child reaches 38+ or so, you need to be on the lookout...


39C - seems about right as decision.


Exactly this. It just works on the symptoms and children tolerate fevers fine as long as it is not too high (above 103F). But you have to endure a lot of crap from everyone breathing down your neck about how you are ignoring the child and are a cruel parent.


These kind of sentiments really scare and provokes me. Telling anyone that they shouldn't alleviate kids fever and/or pain is absolutely revolting to me.


I didn't say that, I said it's a trade-off. Taking them reduces pain and the risk of certain complications, but increases the risk of other complications (side effects). According to https://www.consumerreports.org/prescription-drugs/too-many-..., "The amount of harm stemming from inappropriate prescription medication is staggering. Almost 1.3 million people went to U.S. emergency rooms due to adverse drug effects in 2014, and about 124,000 died from those events." So even if a medicine is side effect free when used as prescribed, there are still risks if it's accidentally misused, and painkillers are not side-effect free even when used as prescribed.

Thought effect: if you had the option to eliminate a kid's pain with an 0.01% chance of causing a lasting defect, would you do it? Not everybody would; different people have different time preferences.


"...prescription medication..."


Ah, good catch, I didn't notice that part. Here's a more relevant link, evidence for the trade-offs of OTC painkillers: https://www.sciencedirect.com/science/article/pii/S014067360... . Seems there's evidence of a link between use of paracetamol in early childhood and developing asthma.


Fever is likely a mechanism that the body exercises to fight infections, just the way diarrhea is probably a way for the body to flush out vira and bacteria quickly. In both cases, excess can be dangerous but that doesn't mean they should be stopped per default.

Would you also give your kid anti-diarrhea and let the disease spread in order to stop the immediate unpleasantness?


What if the fever is actually the body’s way of killing the infection? You’re saying it’s scary that someone would want to prioritize recovery from the root cause rather than prolonging the root cause in favor of relief of mild symptoms?

That’s the more shocking belief from my perspective.


Is the idea that you can kill your child or severely damage it because of what you did to "alleviate their fever/pain" equally revolting to you?

Or are you OK with hurting your kids, as long as they don't feel the pain?

(I'm putting the questions in the same tone you put yours)


> I wonder what I should give my kids when they have fevers though

You can use any drug containing Paracetamol (Tylenol, Panadol). It isn't that effective, but it works and as far as we know it's perfectly safe if you adhere to dosage recommendations.


You can still give them aspirin and/or ibuprofen. People have done it for over half a century, and the sky hasn't fallen.

How much/often were those people taking ibuprofen to have those effects? And how worse were they than the baseline? From what I see, they took 3 times a day for 2-3 weeks (not just to pass a small fever), and they were older men to begin with (e.g. already on a downfall for testosterone).


Except you should avoid aspirin for kids probably:

https://www.mayoclinic.org/diseases-conditions/reyes-syndrom...


Ordinarily, you should not try to suppress fevers. Fevers are beneficial and in fact, body's defense mechanism [1].

[1]https://www.health.harvard.edu/diseases-and-conditions/fever...


High fever is not good. While I think you should be restrictive with medications. There's no need to suffer more then necessary. It's also a good idea to seek medical consulting.


Unless of course you don't care about the secondary issues that fevers can cause

Strong fevers should be controlled usually

Also don't forget about patient comfort (if it gets too high it feels awful)


If it's not over 102 F and it's not interfering with sleep, you can bring a fever down some with plenty of fluids and/or a tepid bath.

My sons hated taking medication. I gave them non drug options on a routine basis for minor ailments because they didn't want to take drugs if they didn't have to.


Ironically, that title itself hypes the content of the perspective piece that follows. It does to not refute any finding in the PNAS paper. They simply question whether the observed effect on LH, which wasn't disputed, is clinically relevant or should result in modification of clinical recommendation, for which further work is needed.

>Despite the excellent quality of the work, the main point to emphasize is the confusion that has arisen concerning the study conclusions versus the real-world relevance and application of its results.


In curious how can they make a statement such as “the study cannot be used to draw any conclusions” without providing any kind of reasoning, and get published in Nature?


It wasn't published in Nature; it was published in the Proceedings of the National Academy of Science.

The rebuttal was also not published in Nature, but it was closer, published in Nature Reviews Urology.

I think the main basis for the criticism is that they didn't look at clinical outcomes like infertility or ability to conceive. As a result, we only have a (very robust) report of a relationship between ibuprofen and hormone levels, not between ibuprofen and x, where x is some directly important/meaningful clinical outcome.


Whenever I see blanket statements like this in such studies ~ it's like they're trying to avoid pissing any powerful corporations that profit from whatever we're told to not draw any conclusions about. They don't want to potentially endanger their careers.

Drug companies hate it when a cash-cow drug is threatened in any way. Anything that threatens those profits is a potential target in one way or another. Researchers studying these drugs know just how much power and influence these drug companies have, and so, are afraid of angering them.

The reasoning is simple ~ make a vaguely disqualifying statement that hopefully keeps them in the good books.


Well, except that it's also common that the people who did the study are often well aware of its limitations, and it's the media that's hyping it up to make a better story. Ignoring disclaimers is how the hype gets started.

Understanding people's incentives will often result in reasons to be suspicious, but suspicions aren't evidence and it's not a shortcut for understanding the science.


Ibuprofen is not really a cash cow though as it is now out of patent protection. So while you seem to desire maliciousness I'd venture to say.this is a rather prudent scientific approach. Should all men stop taking ibuprofen on the basis of this one study? No, obviously not.


Well, the reasons are probably explained in the text (which is not open), but I suppose Nature is peer-reviewed


>However, this study cannot be used to draw any clinical conclusions regarding effects of ibuprofen on male androgenic or reproductive health

why not?


Their argument is that we have yet to determine the real-world consequences for the correlation observed in the experiment.

In other words: yes, ibuprofen seems to affect something, but we don’t really know whether that effect is significant enough to warrant avoidance of ibuprofen. It might have no observable impact.

(Not saying I agree—this is just their argument.)


Having read half the paper, the treatment group took 600mg ibuprofen daily for 14 to 44 days to induce the reported effect of compensated hypogonadism, though the 12 and 24 hour effects on testosterone were apparently easily detectable on ex vivo testicle samples. So, maybe if you need your testosterone, keep off the OTC pain medications. And probably don't donate samples of your testicle either.

Interesting paper though.


Did the effect go away when they stopped the treatment? I can’t read it at the moment due to slow WiFi.


What was the effect in the first place?


Hypogonadism. Which is basically "Your testosterone levels drop"


> the treatment group took 600mg ibuprofen daily for 14 to 44 days to induce the reported effect of compensated hypogonadism

That phrasing is misleading. We don't know if it takes 600 mg for 14 days "to induce" hypogonadism. The study didn't test for that. It only tested if there would be an effect, and as with most pilot experiments, it did so cheaply and quickly.

That's the idea of small sample size experiments such as this. Try a big dose as see if you get an effect at all. If so, that's a jumping off point for more rigorous, expensive studies later on.


600mg per day is the recommended normal adult dosage where doctor's recommend 200mg 3 times a day, although can also be recommended 1200mg. It's not a big dosage.

Doctors can also recommend an even higher dosage of 600mg 4 times a day to about 2400mg a day if needed.

Source: Https://www.nhs.uk/medicines/ibuprofen-for-adults/


600mg is not a large dose. Ibuprofen over the counter recommends 400mg (two tablets) every 4-6 hours with up to 6 tablets (1200mg) per day.


and doctors will commonly suggest taking 4 tablets 4 times a day


Everything in moderation... Ibuprofen is probably okay for the occasional headache or pain, but avoid taking it daily... That is at least my MO.


This is terrifying. I used to take a lot of ibuprofen for frequent headaches (much better now). Military doctors were overzealous with the 800mg prescriptions (double the OTC dose).

I suppose I should just use naproxen or acetaminophen? Ibuprofen always seemed the most effective to me.


I've been suffering from migraines since ~14yo, to the point that I can wake up and know if I'm going to get a migraine or not.

I take naproxen, if I know I'll get a migraine I'll take 1x250mg, if I have a migraine I take 2-3x250mg depending on how severe it is.

Cause of mine is generally lack of sleep when stressed so I make sure to sleep properly and don't let myself get stressed out, so I only get migraines ~once a month now, compared to several times a week when I was at school.


> to the point that I can wake up and know if I'm going to get a migraine or not.

That sounds strikingly familiar. Is it my eyes? My sinuses? Allergies? My pillow? For 15 years and countless doctors nobody could figure it out. Then I went to the dentist and had my bite corrected and have not had a migraine since. I believe my bad bite was causing me to clench my jaw in my sleep.


Just as a side hint: did you ever get your vitamin levels checked? I had migraines with aura a couple of times a week until I got a full vitamine check up on B vitamines and Q10. I had a huge lack of B12 plus Q10. I managed to compensate with supplements (the expensive ones from the pharmacy) and didn't have migraine now in 3 months. Might be worth looking into :)


I haven't. I have a stack of multi vitamins & B12 here so I'll take them and see how I go. Thanks for the info.


Better check with the doc first. Otherwise you'll produce expensive piss with no effect. All vitamins I bought outside the pharmacy didn't work for me so better try to go with the 'real' but more expensive stuff prescribed by a doc.

Edit: I got Sanomit q10 and Ankermann B12 (1000ug).


As someone who's had a permanent migraine since months ago, second on naproxen. Ibuprofen does nothing to relieve my headache, and so far the only drug I've found that's effective against it at least mildly is naproxen.

Don't take it every day though. Maybe once a month if I feel like the headache hurts me more than usual.


why aren't you taking a triptan?


When I started getting migraines as a teen the doctor tried Ibuprofen first, but it didn't help at all. He then tried Synflex, this contains naproxen, and it helped.

In NZ / Singapore I have to visit a doctor to get synflex, so I usually just visit the pharmacy while I'm in Taiwan and pick up ~50 or so Naposin pills (generic naproxen) while I'm there. Costs ~$10 usd.

Never needed to go any stronger.


The paper mentions that at issue are all NSAIDs, including aspirin, etc.


Since the OP specifically mentioned "Acetaminophen" and "Naproxen", it's worth mentioning that Acetaminophen is _not_ an NSAID like Ibuprofen, but Naproxen is.

That said, like the OP, I used to also take lots of Ibuprofen for headaches, and unfortunately, Acetaminophen never seemed to work for more than an hour or two max (tested in "isolation" for 7+ days), while Ibuprofen could stop the headache cycle for a day+.


Do you have bloodwork showing reduced testosterone levels? If not, get that first - your situation sounds complicated enough without removing a solution that may not be causing you any measurable harm.


acetaminophen damages the liver and kidneys at an alarming rate. It should have been skipped prior to today.


Only if taken in excessive doses. It’s fairly harmless if taken as instructed.


> Our data demonstrate that ibuprofen alters the endocrine system via selective transcriptional repression in the human testes, thereby inducing compensated hypogonadism.

Interesting. I’m no doctor, but this sounds like a not-super-transient effect.

Amazing and slightly horrifying that they were able to measure this after a relatively short period of high-moderate sustained use.


I have to wonder how long the drug industry knew about this, but just brushed it under the rug like they do with all of their drugs, just to get them approved.

When there's money to be made, dangerous side effects don't matter to them.


I also wonder why for example the Chinese or heck the Cubans didn't discover this before, who have less of a corporate interest.

Ibuprofen (And Naproxen, etc...) is one of the most common drugs all around the world. I think most people I know have taken them at least once in their lifetimes.

It's just all too weird. Is this all a malignant cover up by the industry? Don't know what to say, especially considering this was released 1 year ago and afaik no more research has been conducted on this.


My perception is that in the US ibuprofen is used like candy, while it's not the same in other countries, where, for example, aspirin has that role.


I was prescribed to take Naproxen, another NSAID with potentially the same harmful effects as Ibuprofen, for two weeks three times a day half a dose. I'm from Spain.

But IDK. Let me reiterate that everyone all around the world uses Ibuprofen.


I'm curious, did you have naproxen/ibuprofen at home before they prescribed it to you? Probably not, but I bet you have aspirin at home.


Nope, but Aspirin, Ibuprofen and Paracetamol yes, since they are considered "staple" medicine.


Just had a kidney stone problem—first for me, quite painful experience. My ibuprofen dosage is 800mg every 8 hours, as needed. I had little choice. “Sustained” is the keyword of the study here.

On another note, maybe this will drive alternative treatments such as CBD/marijuana for those who need to sustain their pain relief.


I’ve suffered from kidney stones off and on for years. Here’s what helps.

Make sure you’re drinking enough water. 2 gallons per day minimum. If your pee isn’t clear, you’re not drinking enough. I add flavor packets to mine to make it more palatable. I carry a water bottle with me all day. Went from an attack once a month to once a year.

Mix pain meds. It’s perfectly healthy. Don’t take 800 mg of ibuprofen. Take a normal dose of ibuprofen (200 mg) and a normal dose of tylenol. Then tylenol and naproxen. Then naproxen and aspirin.

Rotate them so you don’t get a megadose of any one. Each time take one that treats pain and one that treats pain and inflammation.

A low dose of multiple drugs works way better than a large dose of just one. You’ll find yourself taking a lot less medicine overall and you won’t be in as much pain.

Buy an electic heating pad and apply it to your lower back as soon as the symptoms start.

Hope this helps.


Thank you so much! I’ve been trying to gather as many details as I can to make sure this happens less frequently. I have changed my entire diet, drastically cutting sugar consumption. I had an ER doctor tell me there’s no possibility of this being hereditary. However, kidney stones are a problem for my mother, one of her siblings, and both of my grandparents. Waiting on a urologist consultation, but it’s under control for now.


It’s hereditary in my family.


I guess it's ok for emergency/surgery etc. The bigger problem is for people who take it regularly.

A friend used to pop ibuprofen casually after gym sometimes to relieve sore muscles. That's messed up.


There is no silver bullet for targeted pain relief, or really, pretty much anything in the body. The body is an enormously complicated biological organism. Trading ibuprofen for Cvs/marijuana doesn’t trade side effects for no side effects, it trades one known and some unknown side effects for mostly unknown side effects.


As someone who is XXY, I can’t help but wonder what, if any issues would be caused by a pregnant mother taking a lot of this.


Pregnant women are advised to take Tylenol instead of Ibuprofen


This seems like an endocrine effect, rather than a chromosomal one.

I'd expect XXY to cause endocrine effects because sex-linked cells are operating with bad genetic info.

This paper suggests that Ibprofen might cause sex-linked cells to misbehave because of chemistry.

It doesn't seem like there is evidence here that Ibprofen would have had an effect on chromosomes. These are two independent causes of sex-linked malformity/endocrine issues, not a case of one causing the other.


In Australia , pregnant women are told not to take ibuprofen unless told by doctor. Paracetamol Is the pain killer suggested, and only if really required.


Long term acetaminophen usage is linked to a reduction in empathy.[0]

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015806/


As far as I can tell, the article linked says that there was a reduction in empathy (for pain) directly after being administered acetaminophen. I'm not seeing anything about long term use.


I've had frequent migraines all my life (although it's much better now) and ibuprofen is the only thing that works.

As a kid, I would take 200mg whenever I had a headache. To this day, I still haven't switched to the adult dose of 400mg. I think a lot of people will find ibuprofen to be effective even at lower doses.

I'm sad to find that ibuorofen has so many negative side effects. For me, it's been a miracle drug. I rarely feel as good as I do after taking it. I generally feel happier, with clearer thoughts and less anxiety.


Ibuprofen induced liver toxiticy:

https://livertox.nih.gov/Ibuprofen.htm

"Rates of serum aminotransferase elevations during low dose, chronic ibuprofen therapy are comparable to those that occur with placebo controls (0.4%). However, higher rates of ALT elevations occur with high, full doses of 2,400 to 3,200 mg daily (up to 16%)."


Speaking of liver toxicity, acetominophen/tylenol and alcohol can kill you. Not in the common case but if you are maxing out the acetaminophen for a prolonged period and drink and stop drinking, you should get educated on the dynamics and side effects. I was shocked to only find out about this midlife when my wife was on painkillers post surgery for an extended period and was using both painkillers and alcohol to self medicate. And her doc noticed some concerning liver results which later turned out fine. Be careful out there!


> high, full doses of 2,400 to 3,200 mg daily

Holy shit that's a lot of ibuprofen. If you are taking that much every day, you definitely have some more pressing concern than liver toxicity...


This is news to me. The more common side effect I've heard of from regular or excess NSAIDs like Ibuprofen are stomach problems (eg ulcers, gastritis, etc.).


That's a side-effect of inhibiting cyclooxygenase-1, which correlates to mucus production, such as that which protects stomach linings. Ibuprofen is a non-selective "COX"=cyclooxygenase inhibitor so inhibits COX-2, correlated with inflammation, while undesirably also inhibiting COX-1.

This gives rise to the selective COX-2 inhibitors, meant to reduce inflammation with minimal mucus inhibition, such as Celebrex and Firocoxib.


From the paper:[0]

> The so-called “over-the-counter” mild analgesics (hereafter simply called “analgesics”), such as acetaminophen/paracetamol, acetylsalicylic acid/aspirin, and ibuprofen, are among the most commonly used pharmaceutical compounds worldwide (6, 7). Increasing evidence from recent years shows that exposure to analgesics can generate negative endocrine and reproductive effects during fetal life (6). Nonetheless, no in-depth studies have analyzed the effect of mild analgesics on the human pituitary–gonadal axis. In this context, ibuprofen is especially interesting because of its increasing use in the general population and in particular by elite athletes (8⇓⇓⇓–12).

So now I wonder about acetaminophen/paracetamol, and aspirin. And naproxen. Maybe that's why I need testosterone supplementation. In addition to the fact that I'm old.

0) https://www.pnas.org/content/115/4/E715.long


So back to good old aspirin? Acetaminophen slowly kills your liver and Ibuprofen messes with testosterone production.


Aspirin kills people too. Usually from stomach bleeding. If it's pain you're trying to reduce the only one I know of that has never killed anyone is cannabis.



Please note that acetaminophen/paracetamol is incredibly safe at normal doses and does not kill your liver.

It is only when you attempt to overdose (or if you have severely limited liver function) that you run out of the liver enzymes that break it down, causing liver damage.


At normal doses, Acetaminophen can trigger Stevens-Johnson Syndrome and toxic epidermal necrolysis. You're lucky if you wind up with rashes as opposed to skin falling off.


> At normal doses, Acetaminophen can trigger Stevens-Johnson Syndrome

Probably not:

https://www.ncbi.nlm.nih.gov/m/pubmed/28963996/


In my case, it does.


So you took acetaminophen in a controlled setting and definitively established a causation? Or was it uncontrolled and could have been caused by any number of uncontrolled variables? Because a definitive causation is publication worthy.


My understanding is that Hypogonadism can also affect women. Have a similar study been made on women? I’m under the impression that a lot of women eat painkillers to get through menstrual cramps so this could be a huge problem for women too I guess?


Along with the high sustained dosage others have mentioned the small sample size (14 in the experimental group) should be noted.


This is worth reading:

The "Unreliable Small-Sample" Misconception

https://www.dailykos.com/stories/2008/11/9/656465/-

> My point here is that arguing that the sample is inaccurate simply because of how large or small it is is not correct. The size of the sample actually makes very little difference in how applicable the results are to the population. It simply makes the range of possible results smaller as the size of the sample increases.

I've noticed a trend on reddit and HN where commenters will point out small sample sizes, often with the direct or indirect implication that this makes the study mostly invalid. I believe that's false - studies with small sample sizes can be very valid. The smaller the sample size the larger the effect size needs to be for it to be a statistically significant result, but a small sample size by itself isn't bad.

And I think that the internet would be able to better appreciate research if more people were aware of the small sample size misconception.


Andrew Gelman put it very well here: https://andrewgelman.com/2017/02/06/not-kill-statistical-sig...

Or, if you want to some it all up in a single graph: https://andrewgelman.com/2014/11/17/power-06-looks-like-get-... (although your experiments hopefully have power much greater than 0.06)

The gist of the point: If your sample size is small, significant results are likely to (sometimes vastly) overestimate the true effect size, and there is a non-negligible chance that the effect size is actually estimated in the wrong direction.


Since the article doesn't mention test power (and should it be for the reason of rebuttal of that Pearson-Neyman concept) I don't think it's a worth read. Sorry.

"studies with small sample sizes can be very valid."

They could be with a certain probability but (unless you believe in a very strong prior) you can't know with sufficient certainty.


Sample size is related to the conclusions you can draw. If their goal is that ibuprofen has this effect, then 15 can be enough given the specific effects they are getting. If their goal is more complex, say that ibuprofen reduces fertility, that's be a lot harder if the effect wasn't massive and well reproduceable.


I find this topic hard to comment on specifically, but I think you are probably on the right lines about specificity of the observed phenomenon being of key here.

Using a ridiculous example "for a sample set of 10, the author found that exposure to fire causes burns" would hopefully not draw similar sampling concerns but as I don't know this subject matter deeply, I can't comment whether it is true for this case


There's also temporal sample size: you can infer that A causes B if B happens very soon after A, and nothing else around that time might cause B. For example, if A is exposure to a chemical and B is an allergic reaction.

Edit: A great example is that stomach ulcer guy.


Small sample size makes publication bias much more likely as well


Yes, this is why my anecdotes are proof only I see reality accurately.

In seriousness, this is a lazy claim when you could have actually addressed the study in question. Since you did not, I assume you have no supporting observations.


Ibuprofen, as far as I am given to understand, is one of the most common drugs all around the world. Why didn't anyone notice before now, I wonder?


Maybe their wives are taking it too.


Ibuprofen has been taken regularly in substantial doses by millions of people for decades. The prior probability that it has some heretofore unknown serious side effect is very low, so it would take a lot of evidence to convince me that this is real.


Due to an autoinflammatory condition, I've taken ~1800mg daily for periods of 6 months several times. I don't like the idea of going on opioids for longer that a couple weeks, but maybe I need to switch.



Does ibuprofen have anything to do with finasteride?


Really cool. I’ve been hearing for years now in the athletic community that ibuprofen “kills gains”. Thought it was just a fud. Turns out - likely not.


I thought that’s based on the anti inflammatory effects of it. I don’t personally understand it but inflammation is supposed to help muscle growth.


I once had an extraordinarily low level of blood testosterone reading after I had taken Ibuprofen for a few days.


Just curious-- Did your blood T levels recover? How much / what % lower than normal? Was it just by chance that the T reading was days after Ibuprofen?


600mg per day is an enormous dose, albeit not especially uncommon. I’d be more interested though in the effects of, say, 200 - 400mg per week.


Clearly you have never been in the USMC. In hind sight it was pretty stupid but I have taken up to 1600mg per day for several days/ weeks in a row.

We pretty much call the 800mg tablets grunt candy.


What is happening that gets everyone so inflamed? If you take a painkiller and go right back to the activity that damaged you you are begging for permanent injury.


Well, on the infantry side of the house thing like forced marches, ground fighting (MCMAP), field training, and live fire exercises all take a toll on the body. Most of the training requires brute force and most of the Marines because they are young don't take care of their bodies as much as they should. The other side of the equation is the fact that complaining about being hurt or injured tends to be looked down on. Everyone pretty much has a suck it up attitude.

In my 20 years I beat my body up pretty bad and I am paying for it now. I have had a couple of surgeries on my shoulders. I have bad knees, lower back, and some neck issues that I am trying to rehab and make better but I will never be 100%. I'm just shooting for less pain and more mobility.

Oh, and for going right back into the same activity after you injured yourself. That is just the job. The training keeps going. In a wartime situation you would not be able to quit if you get hurt. You just have to keep moving.


Wear and tear on the knees generally. And yes, many infantrymen do have permanent problems by their 30's.


We usually have an expression that infantrymen age in dog years.


It's not very strange. 600mg/day "as needed" is the standard otc dose.


Same in the Army. Headache, 800mg. Arm blown off, 800mg. Sigh.


And don't forget to drink water soldier!


I recently went to the doctor with a shoulder strain and without even looking at it he prescribed 1000mg daily for 2 weeks then "come back if it still hurts".


These people are only barely doctors.


It isn’t enormous at all. 400mg every 4 hours is the OTC dose (at least in the US). My prescription was 800mg.


That's the local OTC dose here (Germany), too, although I always got the somewhat strict advise that this shouldn't be kept up for more than four days in a row.

Mostly because of renal damage and gastrointestinal issues, if I remember correctly.


> My prescription was 800mg.

Sure, but it’s not like 800mg is 4x or even 2x more effective than 200mg. Ibuprofen is great, I just don’t really see the point of risking dying and whatever else for what’s at most a very marginal benefit.

It’s not enormous in the sense that it’s uncommon per se, but rather in the sense that it’s way outside the efficient frontier on the risk/reward curve.


> I just don’t really see the point of risking dying and whatever else

Ibuprofen is not the painkiller where taking 2x the recommended limit has an enormous risk of death.


Yeah it’s not like acetaminophen where you’re going to immediately die, but if you look up recent papers on NSAID mortality the risk is still a lot higher than previously thought.


How is that an enormous dose? The recommendation is 2x200mg every 4-6h. When doing competitive athletics, I probably took 1-3g of “vitamin I” a day.

600mg a day is barely above a single dose.


>How is that an enormous dose?

600mg is over half a gram of pure active ingredient.

Namely isobutylphenylpropionic acid, a cheap commodity product.

This material is not non-toxic and different people will succumb at different levels of lethality to different doses over different periods of time.

Not long ago I lost a friend to liver and kidney failure attributed by her final doctor as due to the 800mg daily recommended by her previous physician over a few year period.


What were you taking it for? Pain reduction? (Curious, no judgement, trying to understand if there was any other reason)


It's an anti-inflammatory. Helps with all kinds of things - sore muscles, tooth aches - it's not really pain relief so much as it is things-that-cause-pain relief.


I'm not sure if it counts as enormous. I'm looking at my Ibuprofen bottle and it says do not exceed 6 (200mg) tablets in 24 hours unless directed by doctor, so 1200 mg is the OTC maximum recommended dose per day.


So, if one wants to reduce sex drive in order to focus on much more interesting tasks without any interruption, ibuprofen is the way?





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