Last Updated on January 4, 2023 by Robert Price
You’ve visited the hair loss forums. And you’ve heard the horror stories about Propecia. Now, you’re scared and I don’t blame you! You want to keep your hair, but not if it costs you your manhood.
In this post, I’ll review the facts about Propecia/finasteride, while attempting to separate the truth from the fiction. I’ll also:
- Review some of the key studies on Propecia, in plain English with no medical jargon.
- Describe the basic facts about the drug, its effectiveness, and how it works.
- Discuss the possible side effects of Propecia.
- Examine the controversy behind this medication — again, striving to rely only on facts.
- Review what prominent doctors and hair loss experts think about Propecia.
- Explain the Nocebo Effect, which may be one of the reasons why self-reported side effects are on the rise.
- Go over the alternatives to Propecia, along with supplementary treatment options.
- Give my take on finasteride after spending hundreds of hours reviewing the research and data.
- Tell you whether or not I chose to use the medication after realizing I was losing my hair.
- Summarize the drug’s risks and benefits at the end of the article — and much more.
I cite my sources throughout this post, and I encourage you to review some of the data for yourself.
Disclaimer: I’m not a doctor. If you’re suffering from hair loss and wish to do something about it, I suggest you seek treatment from a qualified professional. Let’s get started.
Propecia for Hair Loss – The Basics
What is Propecia?
Propecia, along with its generic equivalent finasteride, is the only medication available that effectively targets the root cause of male pattern baldness, a hormone called DHT.
It was originally formulated as a treatment for BPH (an enlarged prostate). Researchers noticed that patients on the drug also regrew hair; Propecia was officially approved by the FDA as a hair loss treatment in 1997.
Finasteride before and after photos from a Japanese study. The bottom photos were taken 10 years later!
How it Works
Propecia blocks the conversion of testosterone to DHT. It reduces DHT levels in the body by about 70% and can dramatically slow, stop, and even partially reverse hair loss in some men. DHT is essential to male development during puberty, but it’s generally thought not to yield many tangible benefits after puberty. Some disagree, of course. More on that later.
Who It’s For
Propecia is FDA-approved to treat hair loss in men only, though it is sometimes prescribed to women for “off-label” use. See my article on female hair loss for more info.
How Effective is Propecia?
It’s very effective. According to the American Academy of Dermatology, Propecia or generic finasteride slows hair loss in 88% of men. It stimulates regrowth in about 66% of men as well (1). So there’s an excellent chance Propecia can, at the very least, help you maintain the hair you have.
Long-Term Propecia Studies
The initial studies on Propecia found that the drug was safe and effective. Side effects were rare, reported in about 2% of patients. Now, I’ll go over two of the most pertinent long-term studies on Propecia, in plain English! No jargon or convoluted, hard-to-follow sentences.
Five Year Propecia Study
This was perhaps the most significant long-term study on Propecia. It was double-blinded, placebo-controlled, and involved 1,553 men. Hair counts, before-and-after photos, patient self-evaluations, and investigator assessments were all conducted as part of the study. The results were as follows:
- By the end of the fifth year, in a one-inch diameter area of the scalp, men on Propecia had an average 277 more hairs than the placebo group.
- 65% of the patients on Propecia either improved or maintained their hair counts compared to their counts at the start of the study.
- In their photo analyses, dermatologists found that 90% of the men on Propecia showed no further, visible hair loss at the study’s conclusion, compared to 25% in the placebo group.
- Overall satisfaction ratings were much higher in the treatment group than the placebo group — 63% to 20%, respectively. Men were treated with Propecia reported higher satisfaction with their hair’s appearance on their vertexes (59% vs. 13% on the placebo) and on their frontal hairlines (48% vs. 7%). Men in the Propecia group were also more likely to notice shrinking bald spots (61% vs. 20%), increased hair growth (75% vs. 40%) and a slower rate of hair loss (90% vs. 67%).
- Physician investigators found that 77% of patients on Propecia had increases in scalp hair, compared to 15% of patients in the placebo group (2).
- Side effects were rare. A few of the most common ones included less desire for sex (1.8% vs. 1.3% on the placebo), difficulty in achieving an erection (1.3% vs. 0.7% on the placebo), and a decrease in semen upon ejaculation (.8% vs .4%).
- All sexual side effects reportedly went away in men who discontinued treatment.
Before-after results from one of Propecia’s clinical trials.
This Italian study is the longest Propecia study I’m aware of. It tracked 118 men on Propecia for 10 years. The patients were evaluated at baseline and then after 1, 2, 5, and 10 years of treatment. Although this wasn’t a double-blinded or placebo-controlled study, the results were still quite impressive.
- After 10 years, only 14% patients experienced further hair loss.
- 86% of patients benefited from the treatment, and its effectiveness was not found to diminish significantly over time.
- About 48% of the patients saw improvements over time.
- 7 subjects (5.9%) experienced side effects, and some of those patients stayed in the study because of the benefits they reported.
Prostate Cancer Prevention Trial (17,000+ Participants)
Finasteride is believed to lower the risk of certain types of prostate cancer, especially in older men. This 7-year study included over 17,000 participants. It was double-blinded and placebo-controlled. Researchers used the study as an opportunity to evaluate the sexual side effects of finasteride. They utilized a comprehensive Sexual Activity Scale, ranging from 1 to 100; higher numbers indicated a higher degree of sexual dysfunction.
Keep in mind, finasteride is typically prescribed at a much higher dosage for prostate cancer prevention (5 milligrams vs. only 1 milligram for hair loss).
In the study, researchers found:
- Finasteride increased sexual dysfunction only slightly in the control group, and that its effects diminished over time.
- The average Sexual Activity Scale score in the finasteride group was 3.21 points higher than the placebo group at the first assessment; it was only 2.11 points higher (again, on a 100 point scale) at the study’s conclusion.
- The researchers concluded that finasteride’s impact on sexual function is minimal in most men.
In a 2014 article, Meena K. Singh, MD and Marc Avram, MD state that this particular Prostate Cancer Prevention Study was “the most informative trial specifically analyzing the effect of finasteride and sexual functioning” (3). They conclude that based on the data of hundreds of controlled, randomized trials, finasteride should still be regarded as a safe and well-tolerated medication.
Trusted by Doctors and Leading Hair Loss Organizations
There are doctors who have prescribed Propecia for going on 20 years, to thousands of patients, who assert that it’s safe and have no issues prescribing it to themselves or members of their immediate families. Dr. Alan Bauman, a prominent Florida hair restoration surgeon, had prescribed it to 8,000 patients as of 2011 and says it’s safe (4).
Dr.’s Rassman and Pak of Balding Blog have both taken Propecia, as have members of their families, with no side effects (5). Dr. Julian Mackay-Wiggan, a dermatologist at Columbia University, has her husband on Propecia (6).
The American Hair Loss Association, one of the world’s leading hair loss organizations, recommends Propecia as the best first-line of attack against androgenic alopecia, or male pattern baldness.
Propecia works. And, that’s undoubtedly one of the top 10 reasons you MAY want to give Propecia a chance.
About the Risks and Sexual Side Effects of Finasteride
There are (at least) several studies and surveys that Propecia skeptics claim call into question the drug’s safety profile. None of these studies were nearly as large or exhaustive as the initial FDA studies. But they’re worth looking at, nevertheless.
2015 Northwestern University Study
This study was essentially a review of 34 finasteride trials. It concluded that not one of those 34 published finasteride trials “provided adequate information about the severity, frequency or reversibility of sexually adverse effects.” Researchers found that adverse effects were not sufficiently graded in terms of their toxicity. According to the study’s lead author Dr. Steven Belknap, “People who take or prescribe the drug assume it’s safe, but there is insufficient information to make that judgment.”
Potential Problem with this Study – The lead researchers received direct funding from the Post-Finasteride Syndrome Association.
2011 Journal of Sexual Medicine Survey
This study essentially went viral in 2011 and really put Propecia’s safety profile into question.
It’s very controversial, primarily because the study’s lead researcher, Dr. Michael Irwig of George Washington University, recruited his subjects from an online Propecia support group.
In other words, the overwhelming majority of men involved in his survey were already having serious issues with the drug (or perhaps other psychological problems). So while the statistics are somewhat shocking at face value, they’re really not all that surprising. Irwig found that:
- 94% of patients suffered from a low libido.
- 92% of them experienced erectile dysfunction.
- 92% had decreased sexual arousal.
- 69% developed problems with orgasm.
- Side effects lasted an average of 40 months after treatment had been discontinued
This study compared the safety of finasteride to tamsulosin; tamsulosin, like finasteride, is used to treat BPH and is a 5α-reductase inhibitor. The researchers in this study concluded that long-term finasteride use lowered testosterone levels and resulted in the worsening of ED symptoms. They also stated that ED symptoms did not worsen among patients who took tamsulosin.
Finasteride and Depression
Mental side effects, primarily depression, have also been reported. This 2006 study involving 128 men found that finasteride might induce depressive symptoms; it should be noted that in the study, those symptoms resolved after the medication was discontinued. The possibility of mental side effects, by the way, is one of the 10 things I personally hate about Propecia.
Dr. Michael Irwig also conducted a study, comparing the rates of depression among former finasteride users to balding, non-finasteride users. He concluded that the rate of depressive symptoms was considerably higher in the finasteride group — 75% vs. 10% among non-finasteride users (7).
Researchers have noted their concerns with Irwig’s findings, citing the implicit biases among the participants in his study. Again, many of them were recruited from an online support group for men suffering from long-term side effects as a result of using finasteride. In their 2014 article, Dr.’s Meena K. Singh and Marc Avram state that based on Irwig’s studies, “We cannot conclude that finasteride is definitively linked to persistent sexual dysfunction and depression” (8).
Other Finasteride Side Effects
As is the case with any prescription medication, Propecia has many potential side effects. Some of the serious side effects include chills, cold sweats, confusion, dizziness, and lightheartedness. Allergic reactions have also been reported, including rashes, hives, and swelling of the lips and face. Sexual side effects, as discussed above in detail, are also possible. If you’re looking for an exhaustive list of Propecia’s possible side effects, you can review this drugs.com medication profile.
Propecia and Prostate Cancer
In the aforementioned Prostate Cancer Prevention study, researchers found that finasteride reduced the overall risk of prostate cancer by 25%; however, it increased the risk of high-grade prostate cancers (more serious cancers) among the participants by 27%. Finasteride itself wasn’t the reason for the uptick in high-grade cancer diagnoses, according to the researchers.
The drug is known to shrink the prostate. And, according to Dr. Otis Brawley, chief medical officer for the American Cancer Society, doctors are more likely to diagnose prostate cancer in men with smaller prostates. He states, “This drug wasn’t causing more prostate cancer. It’s causing more prostate cancer to be diagnosed” (9).
Finasteride and Infertility
This is another somewhat touchy/unresolved subject. From what I’ve gathered, most doctors contend that there isn’t a direct link between Propecia and fertility (or infertility). That said, according to a 2013 paper, which reviewed the effects of finasteride on fertility in 4,400 men, the drug can reduce sperm counts significantly, even at small doses. Upon discontinuing the medication, average sperm counts increased fourfold. So in other words, the effects on infertility, if applicable, are generally reversible (10).
The Belagravia Centre of England advises their patients to discontinue Propecia a week before attempting to conceive (11).
Dr. William Rassman says that using Propecia while trying to have a baby is generally safe, but he still typically advises his patients to stop taking the drug for a 2-week cycle while attempting to conceive. He notes Propecia’s short half life, the fact that the drug is out of the bloodstream within 24 hours, and that it’s out of the tissue within a few days (12),
A Changing Tide?
I don’t think there’s any question that opinions are starting to shift on Propecia, primarily among hair loss sufferers and, to a much lesser extent, in the medical community. It used to be a no-brainer almost: when someone noticed they were losing their hair and wanted to fight it, they got on the drug and that was that. People believed the statistics, that only about 2% of men experienced side effects.
Now, it appears that the rate of side effects may have been under-reported in the studies, and a very small percentage of men do experience serious, long-term side effects after they stop using the drug. Nevertheless, the majority of hair loss experts stand behind the drug and continue to prescribe it.
On The “Nocebo” Effect
In recent years, there’s definitely been an uptick in men reporting sexually adverse effects from Propecia. Some people attribute the increase in perceived side effects to the so-called “nocebo” effect. When patients expect negative results or side effects from any medication, those side effects often noticed — hence the name.
Here’s an interesting New York Times article on the Nocebo effect, which mentions finasteride. It cites a study in which finasteride was administered to two groups of men to relieve the symptoms of prostate enlargement. The first group was informed that finasteride could cause erectile dysfunction, and the second group wasn’t told about that particular side effect.
In the informed group, 44% of the patients reported experiencing erectile dysfunction, compared to only 15% in the uninformed group. It should be noted that patients who take finasteride for prostate enlargement generally take it at higher does than men who use the drug to treat male pattern baldness, and that could be the reason for the high rate of side effects in this study.
“My Biggest Regret is not Starting on Propecia Sooner”
I’ve heard this refrain from regretful men countless times. Their stories usually go something like this:
First, they become paralyzed by fear after reading the Propecia horror stories online. So they decide not to take it. Then, eventually as their hair loss worsens — and it almost always worsens — they start taking the drug, almost out of desperation. They don’t have any side effects, and their hair loss stops. A significant percentage of them report noticeable regrowth, too. But they still have considerable hair loss, which may have been prevented to some degree had they started on the medication sooner.
I’m not saying using Propecia doesn’t come with risks. It certainly does. There are risks and benefits to practically every medication. But the amount of fear mongering and misinformation being passed around with regard to Propecia is troubling, to say the least. People on YouTube, who have never taken the drug and frankly know nothing about it, are making anti-Propecia propaganda videos — and they’re generating thousands upon thousands of views.
My Take on Propecia
In this op-ed, I state the reasons why I personally wouldn’t use Propecia without trying alternatives first. So no, I’m not a shill for the pharmaceutical companies.
I believe the research indicates it’s safe and well-tolerated by the vast majority of its users. In my opinion, the nocebo effect is real, and it’s likely a major reason why self-reported side effects appear to be on the rise. I see little compelling evidence to suggest that a significant percentage of men experience long-term side effects after stopping Propecia.
Still, I also believe opinions are starting to shift on the drug to some degree. Some doctors are more cautious about prescribing it, and patients are exponentially more hesitant to take it today than they were 10 or even 5 years ago. Better, safer medications will hopefully be available in the not-too-far distant future.
When I realized I was losing my hair in 2021, five years after starting this site, I opted to use minoxidil instead of finasteride.
A Vocal Minority
The Propecia critics are a loud and dominant group. I don’t want to criticize them, because I know some of them are genuinely suffering. All that said, I believe the relatively silent majority of men on Propecia tolerate the drug without any major issues.
Most Effective Option for Aggressive Hair Loss
Time is of the essence in cases of early, aggressive hair loss. The sooner you start treatment, the better your prognosis will be. And Propecia is the only treatment option that has been proven, time and time again, to effectively treat and even partially reverse cases of aggressive, early onset hair loss.
If you’re a balding young man with an extensive family history of hair loss, Propecia is likely going to be, by far, the most potent treatment option for you. Whether or not it’s worth the risk is entirely your call.
Supplementary Treatments and Finasteride Alternatives
Propecia is most frequently used in conjunction with minoxidil. They seem to have a synergistic effect when used together, as they effectively treat hair loss both internally and externally. Propecia, minxoidl, and Nizoral shampoo collectively form the “Big 3” hair loss treatment cocktail. Nizoral has its skeptics, but evidence does seem to suggest that it can help prevent androgens from attaching to hair follicles.
As far as Propecia alternatives go, many young men look to natural remedies such as Saw Palmetto and Pumpkin Seed Oil, both of which show promise as reasonably effective natural treatments for hair loss.
Do these natural remedies work as well as Propecia? No, certainly not. But the early research shows some potential.
Pumpkin Seed Oil Study – Before-After Photos
Copyright © 2014 Young Hye Cho et al. Click to view the original. You can read my full pumpkin seed oil review here.
PRP and laser therapy for hair loss are also options, both of which are among the top 7 hair loss treatments available at this time.
Topical Finasteride & RU58841
Since I first wrote the initial draft of this post a few years ago, topical finasteride has become a more popular treatment option. In 2015, Swiss researchers found that the topical version of the medication reduced DHT levels by about 25%. Comparatively, oral finasteride reduced DHT by around 75%, leading the team to speculate that topical finasteride may yield less side effects.
They also concluded that the topical treatment was more effective overall (13). It was a small study with only 18 participants, but other research has indicated that topical finasteride may be a viable alternative to the pill.
As far as new and trendy hair loss treatments go, RU58841, the “for-research” only topical, seems to be gaining traction. In animal studies, RU58841 targeted DHT locally without reducing serum (blood) DHT levels. It has a questionable safety profile. Nevertheless, some RU users have reported exceptional results anecdotally.
Low-Dose Finasteride
Since my initial draft of this article, low-dose finasteride has become increasingly popular. When you see these stats I’m about cite, you’ll likely understand why:
- A .5 milligram dose of finasteride — half the standard dose — is about 80% as effective as the standard dose.
- .25 milligrams of finasteride — a quarter dose — delivers half the DHT-lowering benefit as the 1 mg capsule.
In theory, the lower your dose, the lower your risk of side effects will be.
But before you jump on the low-dose finasteride bandwagon, consider the following:
- No significant studies have been done to test the long-term effectiveness (or safety) of low-dose finasteride.
- Just because you take 50% less finasteride doesn’t necessarily mean you’ll have a 50% reduced chance of experiencing side effects. The numbers don’t correlate directly.
- 1 MG is the standard dose that’s been proven to help effectively treat hair loss in 9 out 10 guys.
- Most doctors still prefer to prescribe the standard dose, at least as a starting point. If a patient develops side effects, they can adjust the dose accordingly.
Which version of finasteride should you take? That’s coming up in the next section.
Propecia vs. Generic Finasteride
Most men opt to take the generic finasteride, as it can be purchased for around $10 per month. Propecia typically costs $50-$60 per month. Insurance will not cover these medications.
The men who choose to spend extra money on Propecia usually do it for one reason and one reason only: consistency. You know exactly what you’re getting with Propecia every time, as it’s manufactured to the same standards without deviation.
On the other hand, there are many different generic versions of finasteride available, which are manufactured throughout the world.
The active ingredient is the same, of course. And it’s unlikely, in my view, that your results will be dramatically different, whether you go with the generic or the name-brand Propecia.
But if you do use a generic and have positive results, it would probably be wise to stick with the same version of that generic medication for as long as possible to ensure consistency. Consult with your doctor and/or pharmacist about this if you have any questions or concerns.
Tips for Using Propecia Safely
First off, you should talk to a dermatologist or hair loss specialist. Obviously. Aside from doing that, there are a number of things you can do to minimize your risks if you’re considering using Propecia.
Get a medical evaluation before starting treatment.
You could have a medical issue you aren’t aware of, which could jeopardize your safety while on the drug. Getting a full check-up could be a wise move on your part, including some blood and hormonal tests, if possible.
Dr. Jeffrey Rapaport, MD likes to test prostate-specific antigen (PSA) levels in his patients before prescribing Propecia (14). Dr. William Rassman of BaldingBlog offers optional DHT testing to all of his patients prior to going on finasteride — and if they have low DHT levels, he may not recommend the drug to that person (15).
Proceed with caution if you have a mental health issue.
Patients with certain mental health problems may be more likely to notice side effects. Before you begin treatment, if you’re having a mental health issue, you may want to talk to a counselor or therapist, along with your doctor.
Stay positive and have an open mind.
If you expect negative side effects, there’s a good chance you’ll have negative side effects.
Propecia Positives
1. Best First-Line of Attack – The American Hair Loss Association recommends Propecia as the first-line treatment option for male pattern hair loss. It can dramatically slow and partially reverse hair loss for a high percentage of men.
2. Generally Well-Tolerated – Propecia has been used as a hair loss treatment since 1997. It’s FDA approved and considered safe by the two of the world’s leading hair loss organizations, the International Society of Hair Restoration Surgeons and the American Hair Loss Association.
3. Trusted by Doctors – Based on my research, it appears that the overwhelming majority of hair loss specialists and dermatologists believe Propecia is, by and large, a safe and highly effective treatment for androgenic alopecia.
4. Can Work for Years, Even Decades – Propecia is the most effective long-term hair loss treatment option on the market today.
5. Easy to Use as Directed – Taking a pill every day is no big deal for most people. On the other hand, compliance may be an issue with a hair loss treatment like minoxidil, where the solution must be rubbed into the scalp twice daily.
6. Affordable – Generic finasteride especially is a budget-friendly hair loss treatment and can often be purchased for $100 or less per year.
The Risks and Downsides
1. The side Effects may be more common than we realized.
2. There’s a very small risk you’ll develop persistent sexual side effects and/or post-finasteride syndrome.
3. If you stop taking it, you’ll lose any hair you kept or regrew with the drug within about 12 months.
4. The unknown is another downside, given that Propecia is still a relatively new medication. The general consensus in the medical community is that it’s a safe and well-tolerated medication for the most part, but that could change in the future.
Propecia for Hair Loss – Closing Thoughts
So do the benefits outweigh the risks? That’s entirely up to you. Propecia is a proven, highly effective treatment for male pattern hair loss, approved by the FDA and trusted, by and large, by the medical community. It stops hair loss in many men, and can promote some regrowth in up to two-thirds of its users.
Men are becoming more hesitant to use it for a variety of reasons — but primarily due to the risk of long-term sexual side effects. Again, the side effects went away in all men who experienced them in the large FDA trials, but newer studies and reviews appear have put Propecia’s safety profile into question, at least to some degree. Some men look to alternatives like minoxidil, laser therapy, pumpkin seed oil, PRP, and saw palmetto; but none of those treatments are likely to yield better results than Propecia, either in the short-term or the long-term. Topical finasteride perhaps is the one exception to the rule.
If you have any questions or comments or a personal experience with Propecia/finasteride, feel free to leave a comment.
Robert Price is a writer, consumer advocate, and hair loss researcher with thousands of hours of experience in the field. His goal is to keep you out of the hair loss rabbit hole, underworld, or whatever you want to call it. He founded Hair Loss Daily, the unbiased hair loss blog, in 2016. You can learn more about Robert in the my story section of this website.
I think you should explore the finasteride cancer link a bit more thoroughly.
You’re right, I added a section exploring the link further. If you see anything I missed, let me know. Thanks!
Great Article! I am in early twenties and still in the stage where I am thinking of staring Finasteride(I have been using Rogaine regularly for two years now). My question – are you taking it? If yes, since when? and have you noticed anything personally – both mental and physical side affects? If you wouldn’t mind, please answer, thanks!
Hi Arjun,
Thanks for your comments. No, I am not on finasteride, and it’s not something I’d personally consider unless I were truly going bald. For more information, see this article.
I’d love to know if they’ll ever make a medication that works the same as how Latisse works for eyelash growth for the scalp? I’d be pretty interested to see that as an alternative to finasteride! Am i right? Also which this stuff was cheaper.
Hi Blaine,
Yes, I’ve been meaning to do a write-up on Latisse. I imagine a similar product for the scalp will be available at some point, and I’d also guess that it will indeed be expensive. Cheers.
Thanks for your reply, Robert. Yeah, it’s a bummer that big pharma takes advantage of people like that. I’m looking forward to the option though. Have a great week.
I just want to say that i dont think taking propecia is worth the risk. It have really Destroyed my life
I think we should stay away from these DHT blockers; unless we are over 70.
I took less strong anti-baldness pills called STIMULAIR which main ingredient is SAW PALMETTO; when I turned 33. Within 2 months; I lost my erections . Took me 7 more months to Google causes of impotence & found DHT-blocking pills as one of culprits. Threw my supplies; cancelled my monthly orders & complained to STIMULAIR & they of course maintained their pills are natural & safe. I still have their receipts from 2012.
Took me 6 more depressing months to finally feel again my erections luckily. Unbelievable feeling to get them back.
I think a safer permanent alternative to hair loss is hair transplant. Save up or take a loan. Or just shave your head bald; life will go on.
You’re certainly not alone in believing men shouldn’t try to alter their DHT levels. Even activities like long-distance running can reduce DHT though, as can certain foods, but yeah, you’re talking about potent DHT blockers and those could certainly be considered “extreme” when compared to other hair loss treatments.
I agree that hair transplantation is safer option, however, most men who go severely (or even moderately) bald don’t have enough donor supply to achieve full coverage via hair transplants alone. And as they go bald, their transplants often start to look unnatural if they don’t use some kind of treatment, whether it’s fin, minoxidil, or whatever. Glad you recovered from that treatment, and thanks for sharing your story! Life goes on, indeed.
Very good Article Robert, I been on Fin for almost 10 years now. I was losing my hair when I turned 17 and over the years was more concerned. I got a minor hair transplant to my hair line due to make it thick. It was so minor that my own brother didn’t notice it until I told him after couple of years. Long story short my doctor put on Fin in 2009 when I got the transplant. I am 46 now and have thinned but maintained good set of hair. I did have some ED issues when I started taking FIN but they went away after few months. I have normal sex life now. One side effect was definitely depression that I noticed in the last couple of years. Luckily my HT doctor is also a therapist who helped me get through some tough times. I am not sure if FIN caused the depression or other things that were going on in my life. People always say that only young people worry more about their hair, i think it could be any age. You could be 40 and start losing your hair and worry about it. Over all I would say that I am still going to keep taking it until I am 55, that’s when I retire and maybe then I can think about just giving up everything.
As far as future treatments, I only believe in possibility of hair cloning, that can be transplanted back. There are few companies that are working on it, one company is REPLICEL in Canada. I hope they can come up with something concrete in next couple of years.
Thanks
Thanks for sharing your story here, Jack. I agree with you – hair loss can have a negative effect on a man’s confidence/self esteem regardless of his age. As someone who has a depressive personality, I can certainly relate to your concerns about fin’s mental side effects.
Did you have any depression issues prior to taking the drug, out of curiosity? I’ve read that some doctors now advise against fin for men with histories of mental-health issues, as they seem to be most prone to developing depression; they’re also more likely to experience the “nocebo” effect as well, of course. Glad you’re tolerating the drug reasonably well and maintaining your hair! All the best.
Yes. I have never ever met a single guy in my life that was not at any point concerned or cared about going bald. Not one. I think every single guy worries about it, but some just decide the treatments carry some significant risks not worth it. I dont think that is wrong thinking, but just because someone chooses to not treat it does not mean they dont care.
Caring about what you look like is a fundamental part of being human.
Would you say there is any minimum age for taking finasteride? Would the risk of adverse effect possibly be higher in a twenty year old, who would possibly still be developing?
Hi Joe,
Good question. Most 20 year olds aren’t “developing” really. Sure, some may hit one final growth spurt of some kind, but the male “equipment” is all fully formed for most men by that point, and DHT mainly plays a role in the hormonal transition from boy to man, which should be complete by the age of 20 (likely much sooner). Accordingly, finasteride is FDA approved in men age 18 and over. Nevertheless, taking finasteride at such a young age, for an extended time, could potentially increase a man’s risk of having side effects down the road, I suppose.
Hello. I need some advice here as I’m getting anxiety from my hair loss situation.
I’m a 26 year old and last year I went through some extremely stressful months. I had seborrheic dermatitis and experienced a sudden hair loss on the temples and hairline for few months and now I can see miniaturization on these areas.
I had blood tests and found that I was extremely Vitamin D deficient, had mild hypothyroidism and high cortisol level (stress). Apparently I have androgenic alopecia and that event caused a sudden acceleration of shedding (my maternal grandfather was bald/my dad and his dad did not go bald but at 69 years old my dad’s hair have evenly thinned which I guess is normal for that age).
Thankfully I have thick hair so the hair thinning on the hairline is not obvious yet. I was advised by a dermatologist to start 5% minoxidil and advised against taking oral finasteride. Another dermatologist advised me to continue 5% minoxidil, get PRP treatments and also gave me a topical finasteride gel which she said doesn’t cause side effects (she was also against the oral finasteride).
I did some research online and I found some people saying that you might get sides from the topical finasteride… I have yet to start applying the topical finasteride as I’m scared of side effects. However I want to save my hair while it hasn’t gone bad yet. My question here is: does anyone know anything about topical finasteride ? Do your think it will give me side effects ? Should I try it ? Any further advise on my situation will be greatly appreciated.
Here’s my detailed post on topical finasteride.
Can females use propecia & get same results?
Hi Sandy,
Propecia is only FDA-approved for males. However, some doctors do prescribe the medication to women “off label.” Female hair loss is much more complex than male hair loss, which is caused primarily by DHT (and genetics, of course). In cases where female hair loss is linked to DHT, Propecia/finasteride may be beneficial to women, though probably not to the degree that it’s beneficial to men. I’ve read that it can effectively slow hair loss in post-menopausal women, in particular, when combined with oral contraceptives containing drospirenone. It can lead to birth defects as well and is a Category-X drug, so it’s usually a a treatment that is contraindicated for women still of child-bearing age.
See this article for more info: 12 Things All Women Should Know Before Using Finasteride.
I’ve been taking finasteride for just over a week now (1mg a day) and since taking them have started feeling noticeable depressive thoughts and increased anxiety. I cant be 100% sure that finasteride caused it but its certainly a big coincidence if it hasnt.
I am very concerned about studies that say negative side effects will continue even after discontinuing taking them. How long are they talking when they say long term? I hope it doesnt mean its flicked a switch in my brain which leaves me with these depressive thoughts indefinitely.
Hi Rhys,
Sorry to hear about your issues with finasteride. Keep in mind you could be dealing with the so-called “nocebo” effect I mention in my article — so in other words, these side effects could be of the temporary variety. Did you have depression/anxiety issues before you began using the drug? A week certainly doesn’t indicate “long term” use and you’ll probably be fine. If I were you, I’d speak with the Dr. who prescribed the medication to you ASAP.
IDK the riskiest thing to me is not any of the sexual stuff everyone constantly talks about. Its the neurosteroids in the brain that change that we know next to nothing about.
This is what causes the depression, and anxiety some people get. Personally I would just quit if I got this kind of side effect screw hair. Your health and well being is worth more than hair.
The potential for mental side effects, whether real or “imagined,” is likely my biggest concern as well.
I just started taking FInasteride about 6 weeks ago….5 mg for enlarged prostate…i just went to the doc today for a checkup….i have to take it for at least 3 months for it to reduce the prostate…but he said after that…i can try and cut the dosage in half and see if it effects my prostate…he said that might work…cause i do not want to have erectile dysfunctional problems…i’ve already experienced the ejaculation semen part or at the very least a small amount that is clear…very weird and actually sort of depressing….that is why after 3 months i will try and cut down the dosage or ask another doctor if there is something else..I’m already on Terazosin as well…to help keep my prostate a normal size or go for the surgery which clears out part of the prostate.
That’s interesting, Jack. I didn’t think finasteride was necessarily a “first-line” treatment option for an enlarged prostate, though I know it is used to treat the condition. Sorry to hear about the side effects. Definitely follow up with your doc and I’m sure it’ll turn out fine. Cheers.
Hello Robert.
First of all ty for putting together this review it really does help.
So im 19 years old and im starting to lose hair from the hair line and i think im also losing a bit from the crown, not sure about that.
Any way i went to a doctor and he gave me minoxi 5%, ketozol shampoo and propecia.
I have a few concerns and questions that i would love you to answer if you can.
1. im a short and small guy but 2 out of my 4 cousins got a real big boost to thier hight around my age (20~), so i still have this hope inside me i will become taller, anyway, will taking propecia interrupt with that? By small i mean i weigh 110pound nad im 5.6 feet tall, should i be taking a smaller dose?
2.Since im not really losing alot of hair, all tho it is getting worse over time, is it really smart to just jump stright into taking propecia? perhaps i should be just changing my lifestyle and just using minoxi?
TY.
Hey Matty,
Sorry about the delayed reply here. Obviously, I’ll preface this comment by stating that you should direct your concerns about hair growth as it relates to human growth to your doctor. If I were you I might wait just a bit longer before I hopped on Propecia, especially if your hair loss doesn’t seem to be of the “aggressive” variety. From what I’ve read, while nothing has been proven, limiting DHT may also, theoretically, limit growth in adolescent males. A smaller dose could also be an option. Hope that helps.
If 34 trials are not enough or done well enough to conclude whether its safe from a sexual sides stand point what would it take? 50 years to get a new drug approved to get to that safety standard?
I mean it has an awful lot of studies on it already, and tons of people on it for 25 years now. That is a loong time.
Is it worth it? It is if you don’t want to go bald! Every medical professional recommends it because nothing else works. Risk it or lose it
I wouldn’t say every medical professional recommends it. Doctors are actually considerably less likely to prescribe Propecia/finasteride today than they were in the recent past — I’m talking 5-10 years ago. There are a variety of reasons for this, granted. And while there are other, somewhat effective treatments available, I agree that Propecia is likely the only viable, long-term option in cases of aggressive hair loss.
I’ve been taking Finasteride for 8 years now. If I decide to stop taking it what is the best way? Stop cold turkey after 8 years or is there a better way to do it?
I’m just worried about the long term cognitive side effects of Dementia or Alzheimer’s which run in my family.
Speak with your doctor, they might want to wean you off the medication rather than have you stop abruptly.
I’ve been on Finasteride for 8 years straight with no break in use. If I decide to stop taking it what is the best way to stop….cold turkey or is there another way? Are there side effects documented when one stops after taking it for this long? Does your body go back to the pre finasteride production of hormones?
I wonder how fast I will lose my hair once I get off of it.?
I’m concerned about the long term cognitive effects of Dementia and Alzheimer’s which both run in my family.
Hi Jon,
I will look into this further for you. First off, of course, you should speak with your doctor before stopping finasteride use. I believe weaning off it gradually would be the preferred approach but I’ll explore this more and perhaps write a more in-depth post on it. Thanks for your comment.
I just started it today at 1/4 the dose. I wish there was an alternative, but I looked in the mirror and realized how much hair I have lost over the last few years. I have to do something. Minox just isnt practical for hair loss all over your entire head.
GL to anyone facing hair loss. Odds are you will be
I tend to concur with you, Joe. If you have diffuse thinning throughout the entire scalp, minoxidil probably isn’t going to be a sufficient long-term treatment option. I’m sure there are exceptions to the rule but can’t imagine they’re very common.
I’ve been taking propecia for about 6 years after a friend recommended it.
Having an identical twin brother, I felt I had the perfect lab rat to really see how if it works.
I noticed very quickly that I soon stopped getting that itchy feeling where another hair follicle had died and my hairdresser was soon commenting on the thickness of my hair. But the real winner was comparing myself to my twin brother and now after 6 years, people think I have had a hair transplant due to the difference in us.
I can honestly say I’ve not had one side effect from taking propecia…sex life has been fine and no depression, but I have always been a very positive person and so I think anyone planning on taking this, needs to give it some thought before they do.
I’m aware that there could be problems coming off it and I am already planning on reducing the dosage to eventually come of completely, ready for when the soon to be wife wants a family…she accepts that children will mean having a bald husband 🙂
Thanks for this awesome comment, Steve! That’s amazing that people think you’ve had a hair transplant, just based on the disparity of your hair density vs. your brother’s. Yes, I believe most doctors do recommend stopping Propecia before starting a family, but once you’re satisfied with your family size, there’s no reason you couldn’t continue the medication, based on what you’re telling me anyway. I’m obviously no doctor. Or you could be the bald husband, that could be fun too! Either way. Have a good one.
My hairloss was found to start eight years ago, when I was 26, I was worried, but wasn’t very depressed. Over the years, the hairloss is becoming worsen, I once took the medicine, Finasteride, and then stopped, and after some years I took again and then stopped again, I always started the medicine again because of depression about my hair loss, and then stopped after a few months because of worries about possible side effects which may be permanent, and I often got frightened by the online comments and advice suggesting that Finasteride is dangerous and we should stop taking it. I remember there was one very convincing comment for me, I forget where I saw it, but it’s said – You can easily find a doctor in hospital who is bald or suffering hair loss, if it’s safe, I can’t see any reason for the doctor to hate their hair. – It was very convincing to me and then I stopped the medicine, and after some good length of time I will become worried again, when I see that I am losing more hair. I don’t know, I understand there are always risks for any medicine, it’s all about probabilities. However, I would take the risk if it’s going to treat a fatal condition because that’s my life. However, hair loss is not fatal, and not even a disease in my opinion. In short, over the years, it’s a mix of worries and depression. I am worried that the medicine will ruin my sex life some time or some years later which no one
can guarantee, however, at the same time, I am depressed that as I see I am going to be bald…. I understand that a bald man could be a manly man, but I just, feel it difficult to accept to be bald personally….
any advice that can help me make the decision on whether I should take the medicine again? or just
simply give up?
Sounds like you’re very conflicted, and I don’t blame you. Whether to fight or accept hair loss is a personal decision. Some doctors advise against taking it if you’re prone to depression or other mental-health issues.
It doesn’t sound like you ever actually had side effects while taking the drug? If that’s the case, then chances are you’ll tolerate it fine and I highly doubt you’ll end up being in the small minority of patients who suffer irreversible side effects. The anti-Propecia crowd is vocal for sure and they can make you question your own sanity, but I think you just need to kind of weigh the risks and benefits of the drug for yourself and make a decision. Then stick to it.
IF you’re gonna let it go, let it go. If you’re gonna use propecia, just see a doctor and start using it. Forget the forums and youtube channels and all of that. Make a decision one way or another and then start living again. That’d be my advice. Best of luck my friend.
I’ve set up an doctors appointment for next wednesday to get Propecia. What’s you suggestion on the best routine for using it. I’ve been leaning towards either every other day or monday, Wednesday and friday. I heard of one guy who doing it twice a week which is interesting.
I’m one of those few men you see on YouTube that begin to go bald when they’re only 14.
I began to hear the constant bickering and joking of being “bald” when I was in the 7th grade. When I was only 13 years old, I was 5’9, considerably 5’10, and it was obvious that I had went through puberty before my peers. All my life I’ve been that one kid in the group that gets picked on a little more than others, so when my friends joked around about them seeing my scalp or my giant forehead, it didn’t bother me. All my life, I had always had a high hairline and thin, dirty blonde hair.
In summertime and early 2018, I had several people comment on the thinness and unnatural look of my hair. It became immensely blonde, and bangs that hung over my forehead became more notably see-through. I was blonde/thin on top, and dark brown/thicker on the bottom. My hair turned brown as I matured, but crept it’s way back to blonde in high school.
Being only 15, I never worried about my “receding hairline”, no matter what the hairdresser said. “No way could a 15 year old be facing male pattern baldness” I thought to myself. I denied it and assumed the newly formed widow’s peak was always there.
Spending the summer in Northern Germany, I became extremely self-conscious about my thin hair. The best style I could make my hair was similar to Trump’s weave. I complained to my parents, (Dad who started balding in his mid-30’s and no early people balding on either side, although every male has lost hair to an extent), and he brushed it off. A year before my concerns I was on a 9-month spree of Accutane, and they said my hair was thin because of one of the side effects from that skin medication.
But as more and more questions about my odd hair came up, the more and more paranoid I got.
I ended up constantly looking in the mirror, doing countless online research, and stresses out if people knew I was bald. I convinced my mom to buy me Rogaine in October, but I knew the only way I could keep what I had was Finasteride. After being looked at by my doctor and a blood test – which came back with the bitter sweet answer: Male Pattern Baldness. I then was able to convince my dermatologist to proscribe me Finasteride in early November, and I continue to take it months later, now in May.
I have notable differences. I feel I was only a 2.5 (or three, depending on who you ask: it is obvious I’m recessed, only to what degree on a natural large forehead) when I started, but thinning was everywhere. My hair is still pretty thin and wispy, but my top hair is completely dark brown now like my donor region – which I get a lot of comments from people who haven’t seen me within 4 months. I hope this means that the miniaturization of my follicles has decreased, although my hair is still thin. The major thinning in the crown has decreased drastically, and in only seven months time saved me from having a bald spot. Hairline hasn’t really improved from the Norwood 2.5-3, and it is still something I’m extremely insecure about, but I don’t think many people notice it as much as before. I also have a short hairstyle than the poor attempt at the Bieber look I had before.
My hair overall on both has become thicker than before as well. And I’m happier and feel better about it. Only being on Finasteside & Rogaine for seven months, I’m hoping for even more of a product.
I just turned 17 in the beginning of April, I was wondering if taking this drug will have any problems with my development? Going back to what I said before, I’ve only grown an inch or two since 7th grade, and I have a good amount of body hair, so I’m pretty sure I’m done with puberty. The only side effect I have noticed is a little less sperm count, but I’m not sure if that’s the Nocebo effect you were talking about.
I consider myself an outgoing, semi-athletic, decent looking guy that hasn’t traditionally had it hard finding girls’ attention. I don’t want to hinder my confidence or looks even more than it already did, so taking the drug, at only 16, was worth the risk for me. I also use dry shampoo almost every day – could that cause me to lose my hair even faster? And how long can I expect Finasteride to work for me? If I could go the rest of high school, and four years of college with a good amount of unnoticeable hairloss (like it is right now), I’ll be satisfied and happy. That’s approximately 5 years total, added on the 7 months. I’d prefer not being that one frat dude who never takes off his hat. What is realistic for me and my situation with my such strong aggressive hairloss? Also, what effects do you think Accutane had with my baldness?
Hi Payton. Sorry you’re in this situation, I’m sure it’s been a nightmare to deal with hair loss at such an early age. From what I’ve read, finasteride is typically not recommended until after the age of 18, but there are cases where exceptions are made. As long as you’ve already transitioned from boy to man, i.e. finished puberty as most men have by the age of 17, then I imagine you’ll be okay. This is something you’ll want to discuss with a doctor, obviously, and given that you seem like a thoughtful young man, I’m sure you’ve done this.
While I can’t predict your future, I think the chances of you hanging onto your hair for the five years you mentioned as a goal are likely high and realistic. Very possible you hang onto it for longer than that, should you continue to use the drug. But yeah, the aggressiveness of your hair loss is the wildcard and the effects will wane over time almost certainly. But on the bright side, it zounds like you’ve been responding well, so there’s a good chance the drug will keep working for you and help you maintain your youthful looks for the foreseeable future.
I used Accutane also in high school too — a gnarly but highly effective medication, for sure. I imagine there’s a chance it accelerated your hair loss, temporarily, to some degree. Hope this helps. I would maybe cut out the dry shampoo as I’ve read that that can cause temporary hair loss when used too frequently, and it’s probably just not worth it in your case. Sincere apologies for the extended delay and I hope you’re doing well.
Great article
Propecia is a form of medication which is used to prevent male pattern baldness. Because of the evolution of propecia, living with recognizable hair loss is no longer inevitable. The success of a hair loss treatment depends on the early intervention. Propecia is a hormone-altering drug. It has numerous potential side effects. So, it will definitely make sense to ask an expert prior to using propecia for balding.
would you consider topical finasteride as an alternative? I’m using 82 F?? your thoughts?
Topical finasteride may be an alternative, though the jury is still out on its long-term effectiveness and its unlikely to work as well as oral finasteride. Sorry about the delay, have had a variety of crises to contend with. Cheers.
I’ve been taking finastride for 2 years now, 1mg a day with minoxidil 2 times some days but reducing usually to 1 time a day because of busy schedule. I didn’t observe any side effect from it though there was a time when I stopped my medication for 1-2 months because I got all my hair back and guess what? Yep I lost my hair again. I again started it and now been continuously sticking to it, got a lot of hair back but there’s a point on my temples beyond that I am unable to regrow hair. Might have to go for a transplant there but guys be positive about it and you have to be because you can’t get anything without losing something.
Started taking Propecia at 50, 17 years ago. Could not be happier. Lots of regrowth. Stopped cutting hair 5 years ago and now its shoulder length and thick. No long term side effects. BTW, my brother, who is just a year older and always had similar hair, is a cue ball now.
Very interesting, Gary, appreciate you sharing that! Wow, 50, that’s quite a bit later than most people. I know the medication diminishes in effectiveness somewhat with age, but that’s fascinating that you’ve been able to retain your hair while your brother is bald. Obviously it’s working well for you!
I started on Propecia at 19, around 3.5 years ago. Lots of hair loss in my family, with my dad and his brothers starting in their early 20s, so I’ve been teased about its inevitability my whole life. My hairline has also always been really high, so I knew that as soon as I started receding the game would already be over – this led to obsession throughout ages 17/18 and I eventually decided to get on Propecia just to end the stress.
I was aware of the potential side effects, but thought that if I made it through the first few weeks without them, then I wasn’t part of the unlucky group and wouldn’t ever have a problem. I haven’t experienced any side effects, but I regret starting because I did so without ever experiencing any clear hair loss – I took it just to end the obsession that was stressing me out and taking over my life. Now I’m not really sure what to do; on the one hand, I’m tempted to just continue with it forever as I may well have been heavily balding by this point anyway.
On the other hand, I’m concerned that staying on it for decades (potentially unnecessarily) could increase my chances of PFS when I eventually quit. I’ve considered stopping temporarily to see if I experience any hair loss, but have also read PFS stories where people think it has been caused by stopping and starting Propecia. So I’m kind of in limbo; I’m probably being ridiculous about a very low probability event and should just be grateful that I’ve had no side effects or hair loss – which is obviously the position that everyone wants to be in! Anyway, this was a fantastic, even-handed article that really put a lot of my paranoia to rest, so thanks a lot
Thanks for sharing your story, Jack. Very interesting. Were you ever diagnosed with genetic hair loss out curiosity? It sounds like you’re tolerating the drug without issue so that’s good. It’s unlikely you’ll have any significant side effects going forward. You could certainly consider stopping the medication — especially if you aren’t sure if you have genetic hair loss in the first place! But I’d definitely suggest seeing a doctor first. Sounds like you need a more thorough evaluation than you had the last time around. Best of luck and thanks again for commenting!