Last Updated on May 19, 2020 by Robert Price
When I first started evaluating hair loss treatments, Propecia/finasteride seemed like the most promising option.
It can stop hair loss in 90% of guys and lead to regrowth.
Plus, all the studies seemed to indicate it was safe. Countless doctors and pharmacists alike also say it’s safe, many of whom have been prescribing or administering it for nearly two decades.
So who the hell am I to be questioning the safety of Propecia?
That’s the question. Well, I’m an average dude, who used to be obsessed with hair loss, and now I’m just fascinated by it.
As I’ve said before, on my start here page, when I was in the early stages of my hair loss obsession, I researched male pattern baldness like Tom Hanks researched AIDS in the 1993 movie Philadelphia. Yeah, yeah, offensive…maybe.
I’m not anti big pharma, either. So let’s get that out of the way. I believe advances in the pharmaceutical industry are one of the main reasons we’re now living to 80 instead of 65. Before going further, I should disclose that I’m not a doctor, and if you’re looking for medical advise or considering a particular treatment for hair loss, please talk to a professional!
My Opinion Today, as of 5/1/2020
Before I thought Propecia/Finasteride was perfectly fine and safe. Now I’m not 100% convinced of that. From what I’ve gathered, I believe it’s safe to say that the vast majority of men take the drug without any major issues, namely sexual side effects. With that disclaimer out of the way, here are three primary reasons why I’ve changed my position on Propecia:
1. The Risk of Side Effects Could Be Higher Than The Studies Claim
I believe it’s likely that the percentage of men who experience side effects while on this drug is higher than I thought — and higher than some of the experts and studies claim, too.
1-2%. That’s the unlucky percentage of guys who develop sexual side effects from the medication, per the trials. Are those figures really accurate though?
Given that everyone’s aware of the side effects now, I think it’s safe to say that more than 1-2% of men are developing sexual side effects. The nocebo effect — which basically means a side effect that occurs when someone is hyper aware of it before beginning a treatment — could be a factor here obviously.
In a 10 year Italian study, side effects were reported in 5.9% of users, not 1%.
In 2015, Northwestern University conducted a review of 34 finasteride studies.They concluded that “Not one of the 34 published clinical trial reports provided adequate information about the severity, frequency or reversibility of sexual adverse effects.”
Potential issue: Northwestern received funding from the post-finasteride syndrome foundation. A conflict of interest? Perhaps.
I’ve also spent some time reviewing post-finasteride syndrome. To be honest, I still have no idea whether or not it’s real. Do some men experience lingering side effects after they discontinue the drug? Yes. Have non-finasteride users also reported developing similar symptoms? Yes.
PFS sounds horrible. Whether or not it’s a real or (mostly) psychological condition remains unknown in my view.
2. I’m not sure if blocking DHT is a fantastic idea
A 5-alpha reductase inhibitor, finasteride works by blocking the conversion of testosterone to dihydrotestosterone or DHT. Is that a good thing? Generally, doctors (especially hair loss doctors) seem to think so.
DHT offers few substantial benefits to men after the completion of puberty — that seems to be the argument. DHT is one of the primary reasons your voice and your balls dropped. It aided in the development of your penis too. And those were all good things, right?
DHT is also five times more potent than testosterone (source). So not surprisingly, many elite athletes and body builders would much rather go bald than use a DHT blocker like Propecia. Some even take supplements to boost their DHT levels.
But testosterone is superior to DHT — more stable, for grown men anyway, that’s what all the experts seem to believe.
Some take it a step further and say DHT is just a do-nothing death hormone that causes prostate cancer and kills your hair follicles. I’m being a bit facetious there obviously, but many people in the medical community do claim that DHT offers few if any substantial benefits. I’m just not convinced yet.
DHT is fundamentally a developmental hormone, but it may yield benefits after puberty that aren’t fully understood. That’s my opinion, anyway. I’m not an endocrinologist, but I don’t particularly like the idea of lowering my DHT levels by 70% over the course of multiple decades. And I’m sure I’m not alone.
3. I’m also skeptical because of my own experiences on prescription meds.
I’ve been on two major medications in my lifetime: antidepressants for about 5 years and accutate for 7-8 months, I believe. I still have lingering side effects from both of those medications — and I was informed of none of these effects prior to treatment.
For example I was never a much of a sweater before the antidepressants. Now, to this very day, I sweat like former NBA player and prolific sweater Patrick Ewing after even the lightest of workouts — and I’ve been off the happy pills for almost 7 years.
I got fat by my standards on the antidepressants also, and once I finally got off them, it took me about 5 years to burn off the weight I gained. Nobody told me I might get fat, until it was too late.
Here’s Patrick Ewing, arguably the sweatiest athlete of all time. I look like a lighter version of this after a light workout, courtesy of the good folks at Pfizer.
Thanks to the accutane, I have to apply chap stick at least once per hour during the day. Parts of my skin are dryer than the Sahara desert. They told me the side effects would cease after I stopped taking the medication, but they did not. None of these effects are life-altering, necessarily. But do I enjoy them? No.
And if you take any kind of medication long-term, there’s a chance you’re going to have some persistent side effects, which will likely be of the relatively minor but annoying variety. Or you could get very unlucky, I suppose. So yeah, #3 is anecdotal clearly, but most people who’ve been on prescription medications for extended periods of time will understand where I’m coming from, I think.
The Bottom Line
Propecia wouldn’t be my first choice to treat hair loss. Take that for what it’s worth, and again, I’m no doctor and I’m not even balding yet as far as I know.
If I were a 20-something young man and I were balding fast, then yeah, I might be more inclined to try it. Now I’m 35 and still a 2 at worst on the Norwood scale, so the odds of me becoming a very bald man are starting to diminish, hopefully (my maternal grandfather was a norwood 6, a fact that still gives me nightmares on occasion).
And as I told you, I do believe that the overwhelming majority of men on Propecia, finasteride, etc. take their medications with no major issues. But the stakes are high here, and I make it a priority to keep my penis out of harms way whenever possible. That means no tighty whiteys or relations with transgender prostitutes (Higher risk of venereal diseases, don’t be so politically correct). No Propecia if I can help it, either.
That said, I have no interest in going bald. Like ever, so I’m certainly not against treating hair loss. Unlike Bruce Willis, I know for sure I would NOT look good bald. I know that about myself. Sure, I’d get over it (balding) eventually and accept my genetic fate, but you better believe I’d fight it for as long as I could. Once my luck runs out and my follicles start failing on me, PRP, laser therapy, and minoxidil are the three options I’ll consider first. And I will aim to take action as quickly as possible.
What Should You Do?
Of course that’s entirely up to you. It’s a tough call for many men, I realize. The nocebo effect is real, in my opinion, and likely one of the reasons for the uptick in reported side effects.
So what’s your Propecia position? If all else failed, I still might give it try. Low-dose Finasteride, that may be the way to go, for me. Supposedly taking .5 milligrams of Propecia daily is roughly 80% as effective as taking 1 mg daily. That seems like a decent option.
I also like topical finasteride — in theory, blocking DHT locally would be my preferred course in fighting hair loss.
RU58841 is too experimental for my tastes, but I know some users are having great success with it.
I honestly wrote this post in a hurry after many hours of research when I was just building the site. It needed an update, so I went through and made some revisions here in March, 2020. My opinion hasn’t changed too much. I hate the concept of finasteride, but at the same time, I still realize that it’s a well-tolerated drug. And it’s been a miracle for many people. I’m still conflicted about the drug, four years after my initial research dive.
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.