Imagine a feature article, in one of America’s largest and most influential newspapers, about cigarette smoking, but without a single mention of lung cancer. Impossible? Yet the article about finasteride (“My So-Bald Life...) is absent of any reference to post-finasteride syndrome (PFS).
The article reports in near-glowing terms on a crop of telemed startups that allow millennial males to obtain the prescription medication with ease via mobile phones. Meanwhile, we get an average of 45 new PFS patients a month banging on our digital door from across the globe...
DHT is the culprit behind hereditary hair loss in both men and women, although men have a whole lot more of the stuff. And so by interfering with the production of DHT, pharmacists discovered they could halt baldness in men, and in some cases actually regrow it, which is how finasteride came about.
If the millions of men who used Propecia became impotent, we'd have a serious crisis on our hands. But until stronger evidence is in, it's important to remember that stress can accelerate hair loss. So, worrying too much about this small report may just make things worse.
Drugs designed to treat baldness and an enlarged prostate may have long-lasting effects on men’s reproductive health, but more research will be needed.
Finasteride can also be used as a treatment for female pattern hair loss, hirsutism (excessive hair growth in women), and polycystic ovarian syndrome. However, these are all off-label applications for this drug. (1) Finasteride is currently only FDA-approved for men..
Propecia is actually the same drug, albeit in a different dosage, as Merck's Proscar, a treatment for enlarged prostate glands. Although proved to be safe, Proscar was criticized last summer in a respected clinical study whose lead researcher likened it to "an expensive placebo" for most patients.
There are no predictive factors for the risk of development of PFS. Nevertheless, it has been suggested that a patient history of preexisting mental health disorder, particularly depression, may put patients at an increased risk.
The benefits are clear: men who start taking daily finasteride at the first signs of hair loss will not go bald. Plus there are no interactions with other drugs.
But there is a small risk of sexual side effects such as such as erectile dysfunction, ejaculatory problems and reduced libido, which require careful management by an experienced doctor.
An added bonus is that finasteride reduces a man’s future chance of developing of prostate cancer.
Is the wave of new companies selling products for hair loss providing a much-needed service – or simply cashing in on men’s insecurities?
Even those who suffer from what patients have deemed "post-finasteride syndrome" admit that the vast majority of men take the drug without incident. Plenty of doctors consider it to be safe enough to prescribe.
The drug is better at stopping hair loss than at bringing back what’s already gone.
But there’s one drug in Trump’s reported regimen that I would never touch — a medication to prevent premature baldness called Propecia. Never mind that my hair is thinning faster than the South American rain forest. You still couldn’t pay me to take Propecia. Here’s why...
An ever-growing number of these patients inform us that they were prescribed finasteride, virtually, by Hims, Keeps or Roman. And virtually without warning of PFS.
The Post-Finasteride Syndrome Foundation’s primary mission is to facilitate research on the characterization, underlying biologic mechanisms, and potential treatments of post-finasteride syndrome (PFS). Other goals include generating public awareness of PFS, and providing support for patients suffering from the condition.