More young men are taking drugs to prevent hair loss, raising concerns that oral medications may be associated with rare but potentially long-term side effects.
An Epic Research report commissioned by NBC News found that the number of men prescribed finasteride in the United States has increased nearly 200% over the past seven years.
“In my clinic, it’s like water,” says Dr. Jerry Shapiro, a dermatologist at NYU Langone Health. “I always prescribe it.”
While Epic’s report targets men 25 and older, doctors like Shapiro say an increasing number of younger men are also seeking treatment at an earlier age, some before hair loss begins or worsens. He said some people in their late teens are trying to stop hair loss.
Dr. Maria Colavincenzo, associate professor of dermatology at Northwestern Feinberg School of Medicine, said part of the increase in prescriptions is related to telemedicine companies such as Hims, Keeps and Row, which promote the drug on billboards and in online ads. He said there may be. 10 years actually.
Social media influencers promote finasteride by posting videos about hair loss and regrowth while taking finasteride. Finasteride is also heavily promoted on a popular website called Tressless, which is also an active community on Reddit.
“People are interested in treating a little younger than what I’ve seen before,” Colavincenzo said.
Doctors say the daily pill is safe, but once you start taking it, you need to keep taking it for as long as you want to avoid hair loss. And the drug is controversial because erectile dysfunction can persist even after the medication is stopped.
What is finasteride? Is it effective?
Originally developed to treat enlarged prostates, finasteride, also known by the brand name Propecia, has been approved by the Food and Drug Administration for hair loss for nearly 30 years.
This is a medication taken daily that slows the progression of androgenetic alopecia, commonly referred to as androgenetic alopecia. Approximately half of men will suffer from this type of hair loss by the age of 50.
There is no conclusive evidence that men who start taking the drug before their hair starts to fall out will not go bald, but doctors say the risk appears to be low.
In this form of hair removal, characterized by a receding hairline and thinning at the back of the head, two main changes occur in the hair follicles, Colavincenzo said.
This includes miniaturizing, or shrinking, the hair follicle and slowing down the hair growth cycle, both of which lead to a decrease in hair thickness.
Finasteride blocks the 5-alpha reductase enzyme, preventing the conversion of testosterone to dihydrotestosterone (DHT) and lowering DHT levels in the body. DHT is the main hormone responsible for facial and body hair. Conversely, high levels of DHT are thought to shrink hair follicles on the scalp, shorten hair growth cycles, and cause hair loss.
“If you block the signals that tell you to curl your hair, your hair may stop curling and maybe even shrink a little bit,” she says. “This is what finasteride does.”
The reason why some people have high DHT levels but don’t go bald comes down to genetics, she says, and it’s an active area of research today.
Fortunately, the majority of men who take finasteride seem to be successful in slowing hair loss.
Shapiro said studies have shown that the drug has about an 80 to 90 percent chance of preventing further hair loss, adding that the drug is effective at preventing further hair loss, so the sooner it is started, the better. . However, once you start taking it, it becomes a lifelong drug.
“Most medical treatments are lifelong,” said Shapiro, who is also a medical consultant for Keeps, which sells the drug online. “If you have high cholesterol, you have to take medicine forever; if you have high blood pressure, you have to take medicine forever.”
Dr. Carolyn Goh, a dermatologist at UCLA Health, said that although long-term data on the drug’s effectiveness is limited, the data shows the drug’s benefits are maintained over time. A recent study by South Korean researchers published in the Journal of Dermatology found that after five years of follow-up, nearly 100% of men had the same or more hair than they had before taking the drug. .
“It’s very effective,” she said. “It might just prevent hair from getting worse rather than necessarily growing hair, but it’s very effective.”
Another study by Italian researchers followed more than 100 patients taking finasteride for 10 years and found that 86% of men saw no change in their hair.
Although finasteride is very effective at preventing further hair loss, it is not as good at regrowing hair that has already been lost. For this reason, it is often used in conjunction with minoxidil, a topical medication applied directly to the scalp to stimulate hair growth.
Colavincenzo said some patients he has been following for about 10 years have had success with the drug, but he doesn’t necessarily know if the drug is working.
“The difficult thing is that we often don’t know how well it’s working,” she said. “Even if your hair doesn’t get worse, it’s still a success.”
Because male pattern baldness is considered a cosmetic disease, finasteride is usually not covered by insurance. It has been available as a generic drug since 2006 and typically costs less than $100 per month.
What are the side effects of finasteride?
In 2022, after patient advocacy groups asked the FDA to take the drug off the market, the agency required prescription labels to warn about the potential for suicidal behavior in men who take the drug.
Most recently, a 2023 article published in the International Journal of Impotence Research sparked online discussion about the phenomenon known as post-finasteride syndrome. This syndrome is associated with decreased sexual desire, erectile dysfunction, and even cognitive impairment.
The most commonly reported side effects of finasteride include decreased sexual desire, difficulty maintaining an erection, and decreased semen volume. These harmful sexual side effects are usually seen in less than 5% of men taking this drug.
There are also links to mental health effects such as depression. However, it is unclear how common they are and whether the drugs themselves are the cause.
“Certainly, the vast majority of my patients don’t have those side effects and are doing well and doing pretty well,” Colavincenzo says.
Colavincenzo warns against using the drug if men are already dealing with sexual problems.
“If someone told me they were having problems with their sexual function, I would be very wary,” she says. “I usually say I don’t think this is a good idea and I don’t recommend it to them.”
Shapiro says the risk of permanent side effects is “very rare.”
“I’ve never seen a patient develop symptoms like this. I’ve treated thousands of patients,” Shapiro said.
Correction: (June 10, 2024, 8:10 PM ET) A previous version of this article incorrectly identified the website Tressless. I’m active on Reddit, but I’m not part of the Reddit community.
