More young men are taking medications to prevent hair loss, raising concerns about an oral drug that has been linked to rare but potentially long-lasting side effects.
A report by Epic Research, at the request of NBC News, found that the number of men with prescriptions for finasteride has increased 200% in the United States in the last seven years.
“It's like water in my clinic,” said NYU Langone Health dermatologist Jerry Shapiro. “I'm prescribing it all the time.”
Although Epic's report focused on men 25 and older, Shapiro and other doctors say they are also seeing younger men seeking the treatment, including some in their late teens who want to prevent hair loss before it occurs. start or get worse.
The increase in prescriptions could be linked to telemedicine companies like Hims, Keeps and Ro that promote the drug on billboards or online ads, said Dr. Maria Colavincenzo, a professor of dermatology at Northwestern Feinberg School of Medicine who has been practicing for a decade. your profession.
Also they influencers On social media they promote finasteride with videos about their hair loss and how it grew back after taking the drug. It is also heavily promoted on the popular Reddit platform community called tressless.
“People are now interested in treating (alopecia) much earlier,” said Colavincenzo.
Doctors say the daily pill is safe, although when someone starts the treatment they should take it for as long as they want to prevent hair loss. And there is some controversy about the drug, because of the possibility of impotence that could last even after stopping the medication.
What is finasteride? Works?
Initially developed to treat an enlarged prostate, finasteride, also known by the trade name Propecia, has been approved to treat hair loss by the Food and Drug Administration (FDA) for almost 30 years.
It is a daily pill that stops androgenetic alopecia, commonly known as male pattern baldness. Almost half of men suffer from this type of hair loss by the age of 50.
Although there is no definitive proof that men who start taking it before they start losing their hair will not go bald, doctors say the risk appears to be lower.
In this form of hair loss, characterized by a receding hairline and thinning at the back of the head, two main changes occur in the hair follicle, according to Colavincenzo.
It involves the miniaturization, or shrinking, of the hair follicles, and the slowing down of the hair growth cycle, which leads to a decrease in hair thickness.
Finasteride blocks the enzyme 5-alpha reductase, which prevents the conversion of testosterone to dihydrotestosterone (DHT) and reduces the body's levels of DHT, the main hormone for facial and body hair. On the other hand, it is believed that high levels of DHT shrink the hair follicles on the scalp and shorten the hair growth cycle, causing hair loss.
“If the signal that tells the hair to shrink is blocked, the hair does not shrink, and may even shrink a little,” he explains. “This is how finasteride works.”
Why some people have high levels of DHT but will never go bald comes down to genetics, he said, and is a still active area of research.
Fortunately, it seems that the majority of men who take finasteride manage to stop hair loss.
Studies have shown that the drug has an 80% to 90% chance of preventing hair loss, according to Shapiro, who added that since the drug works best at prevention, the sooner you start, the better. However, once taken, it becomes a lifelong treatment.
“Most things in medicine are for life,” said Shapiro, who is also a medical advisor to Keeps, which sells the drug online. “If you have high cholesterol or high blood pressure, you have to take medication forever.”
Although long-term data on the drug's effectiveness is limited, Dr. Carolyn Goh, a dermatologist at UCLA Health, says the benefits are maintained over time. A recent study by Korean researchers, published in the Journal of Dermatology, revealed that almost 100% of men had as much or more hair than before taking the drug after a five-year follow-up.
“It's very effective,” he says. “Although the answer may just be to prevent hair loss from getting worse, rather than making it grow more, it works quite well.”
Another study by Italian researchers followed more than 100 patients taking finasteride for 10 years and found that 86% had not experienced any change in their hair.
Although finasteride is effective in preventing hair loss, it is not so effective in regrowing hair that has already been lost, which is why it is usually combined with minoxidil, a topical drug that is applied directly to the scalp to stimulate hair growth. .
Colavincenzo said some patients he has followed for nearly a decade have had success with the drug, although they can't always tell if it is working.
“The hard part is that you usually don't know how well it works,” he said. “Even having your hair not get worse is an achievement.”
Because male pattern baldness is considered a cosmetic disorder, finasteride is not usually covered by health insurance. It has been available as a generic drug since 2006 and costs less than $100 a month.
What are the side effects?
The FDA required in 2022 that the drug's labels warn of possible suicidal behavior in men taking it, after a group of patient activists urged the agency to remove it from the market.
In 2023, an article published in the International Journal of Impotence Research fueled online debate about a phenomenon known as post-finasteride syndrome, related to a decrease in sexual desire, erectile dysfunction or even cognitive difficulties.
The most common side effects of finasteride are decreased sexual appetite, difficulties maintaining an erection, and a decreased amount of semen. These effects are usually seen in less than 5% of men taking the drug.
There is also a link to other mental health effects, such as depression, but it is unclear how common these are and whether the drug is to blame.
“Certainly the vast majority of my patients do not have these side effects and are fine,” Colavincenzo said.
If men are already struggling with sexual difficulties, it is not recommended to use the drug. “I'm very cautious if someone tells me they're having problems with sexual functions,” she said, “I usually tell them that I don't think it's a good idea and that I don't recommend it.”
For Shapiro, the risk of permanent side effects is “very, very rare.” “I have never seen it in a patient and I have treated thousands of patients,” Shapiro said.
