The Mossman–Pacey Paradox: Evolutionary Contradictions in Male Enhancement Treatments

The Mossman-Pacey Paradox highlights an evolutionary contradiction where men use anabolic steroids to enhance muscle growth, which may initially appear as a sign of genetic superiority, but these substances carry a high risk of infertility and erectile dysfunction, thus potentially making the users unfit for reproduction. Similarly, the use of finasteride for treating androgenic alopecia (male pattern baldness) is discussed as it can improve hair coverage and potentially increase sex appeal, but it also has side effects including sexual dysfunction, reported by 4.2% of men in pivotal trials compared to 2.2% in the placebo group, and can lead to infertility. The sale of finasteride in Denmark among men aged 18-44 has more than doubled over a 19-year period, indicating a rising demand for this treatment. The authors emphasize the importance of patients being informed about the serious adverse effects of treatments like finasteride, as what is gained in terms of appearance may be lost in reproductive capability, presenting a Catch-22 situation akin to the Mossman-Pacey paradox.