Doctors & Researchers Speaking Out

Using finasteride for hair loss is like shooting at sparrows with cannons.

 

Using finasteride for hair loss is like shooting at sparrows with cannons. The drug.…blocks not only the super hormone but also other hormones that affect thinking and psyche, mood and emotions. Discontinuation of the drug should actually make the hormones work again.…but apparently, something breaks down in some men, in the prostate, in the brain, in the whole organism.

I Didn’t Want to Go Bald. A Pill the Doctor Gave Me Destroyed My Life (English translation): Die Zeit, Feb. 22, 2018

Michael Zitzmann, MD, Andrology Professor
University of Munster, Germany

Blocking 5alpha-reductase by finasteride treatment may have broad consequences for the nervous system.

[W]e have evaluated in male rats the effects of a subchronic treatment with low doses of finasteride.…and the consequences of its withdrawal.…on neuroactive steroid levels…. Interestingly, at the withdrawal, some of these effects persisted, and different changes in neuroactive steroid levels, and in the expression of receptors, were also detected. Altogether these findings suggest that the block of the enzyme 5alpha-reductase by finasteride treatment may have broad consequences for the nervous system.

Effect of Finasteride, an Inhibitor of the Enzyme 5alpha-Reductase, in the Nervous System: The Journal of Steroid Biochemistry and Molecular Biology, July 2017

Roberto Melcangi, PhD, Head of Neuroendocrinology, Department of Pharmacological and Biomolecular Sciences
University of Milano

We wouldn’t recommend that any man take [finasteride], especially not young men.

We are certainly very cautious, because we see the side effects. We wouldn’t recommend that any man take [finasteride], especially not young men. The longer they take it, the greater the risk of experiencing persistent side effects, including after they’ve stopped.

Do Anti-Baldness Remedies Make You Impotent? Puls, SRF-TV, May 7, 2018

Doris Mannhard, MD, Urologist
University Hospital Zürich

Propecia should not have been authorized in the first place, and its approval should be revoked as soon as possible.

Propecia was approved in 1997 as a solution to slow male pattern baldness. Finasteride is not only poorly effective, but it can lead to infertility. As we stated in 2006, we advise against a cosmetic product with potential endocrine side effects. Propecia should have never been approved, and its authorization should be revoked as soon as possible.

Finasteride-induced Infertility (English translation): Der Arzneimittelbrief (The Drug Letter), November 2013

Dietrich von Herrath, MD, Chief Physician
St. Joseph Hospital, Berlin

Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

Available toxicity information from clinical trials of finasteride in men with [androgenic alopecia] is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride: PeerJ, March 9, 2017

Steven M. Belknap, MD, Research Assistant Professor of Dermatology and Medicine
Northwestern University Feinberg School of Medicine

Patients with this condition should not be stereotyped or stigmatized.

The medical community has an obligation not to turn a blind eye on [PFS] in young men. Patients with this condition should not be stereotyped or stigmatized by untrained and unprepared clinicians, due to lack of awareness…. Greater awareness and education is needed among the medical and scientific communities in order to develop better approaches for managing men with PFS. It is paramount…to promote educational and training programs to increase awareness and improve management of this condition.

The Post-finasteride Syndrome: Clinical Manifestation of Drug-Induced Epigenetics Due to Endocrine Disruption: Current Sexual Health Reports, September 2018

Abdulmaged M. Traish, PhD, Professor of Biochemistry and Urology
Boston University School of Medicine

The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent.

The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent. I think it’s important to be educated about the potential side effects.

Donald Trump’s hair loss drug tied to anger, depression, and self-harm in new medical study: The Daily Mail, March 21, 2017

Landon W. Trost, MD, Head of Andrology
The Mayo Clinic

Persistent side effects from finasteride are real.

Symptomatic finasteride users had “significantly lower International Index of Erectile Function composite score” and “significantly lower scores for each of its domains of erectile function, sexual desire, orgasmic function, intercourse satisfaction, and overall satisfaction.”…There exists “a significant positive correlation between a subset of Beck Depression Inventory scores related to negative attitude and blood oxygen level dependent activity.

Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss: The Journal of Clinical Endocrinology & Metabolism, July 2018

Shalendar Bhasin, MD, Professor of Medicine
Boston University School of Medicine

Their only crime in life is to take an FDA-approved drug.

I have hundreds of [PFS] patients. They have low libido. They have flat emotions. They see a woman, they say intellectually, ‘I know I am supposed to be interested in you. But I am actually not interested in you’. They have muted orgasms, reduced volume of ejaculate, reduced penile sensation… If it is 1.4 percent [of finasteride patients who experience persistent sexual dysfunction] and there are several million people on this product, you’re looking at 300,000 men rendered impotent by a hair-loss drug. Their only crime in life is to take an FDA-approved drug.

Hair Loss Drug Propecia Carries Risk of Losing Something Else: NBC News, March 10, 2017

Irwin Goldstein, MD, Clinical Professor of Surgery, University of California at San Diego
Editor-in-Chief, The Journal of Sexual Medicine

We propose that the Dermatologist Society remove from their guidelines ‘the utilization of finasteride for male pattern hair loss.’

Persistent adverse effects development from finasteride in young men include erectile dysfunction, low libido, lack of orgasm and depression. Finasteride use in young males is a potential risk for their sexual health. Physicians treating male pattern hair loss should discuss with patients the potential risk of adverse events with finasteride. We propose that the Dermatologist Society remove from their guidelines “the utilization of finasteride for male pattern hair loss.”

Sexual and Nonsexual Problems after Finasteride Used for Hair Loss in Young Men: American Society for Men’s Health, 2014

Kim M. Drasa, MD, Professor of Urology
Central Polyclinic, Tirana, Albania

Some of the effects of androgen inhibition cannot be reversed once local androgen levels are re-established.

Treatment of young subjects is of increasing concern due to accumulating evidence that daily use of oral finasteride has several severe adverse effects.…Since finasteride inhibits T conversion into DHT, which is responsible for most androgen activity, it is plausible that prolonged finasteride use in predisposed individuals could simulate the effects of aging in young men. Since some of the effects of androgen inhibition cannot be reversed once local androgen levels are re-established, it is temping to speculate that patients could still suffer from adverse sexual effects several months or even permanently after finasteride discontinuation.

Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia: PLOS ONE, June 24, 2014

Carla Di Loreto, PhD, Experimental and Clinical Medical Sciences
University of Udine, Italy

I would not feel comfortable recommending Propecia to a young, sexually active man.

My yardstick for treating any patient is, what would I do if this were my own son? Ten years ago, I would have answered differently. But now I would not feel comfortable recommending Propecia to a young, sexually active man.

Are Hair-Loss Drugs Safe? Men’s Journal: September 2015

Nelson Novick, MD, Clinical Professor of Dermatology
Mount Sinai School of Medicine

I will not be against the prohibition of Propecia.

Gynecomastia in men taking this drug is proven. I will not be against the prohibition of Propecia. If it were me, I wouldn’t take it.

Propecia, Prescribed to 30,000 Men to Combat Hair Loss, Is on the Hot Seat (English translation): Le Parisien, Nov. 8, 2017

François Desgrandchamps, MD, PhD, Chief of Urology
St. Louis Hospital, Paris

With a greater concentration of receptors, the [penis] becomes more sensitive to testosterone and at a certain point, paradoxically, that sensitivity may shut down.

A group of Italian researchers gave finasteride to rats and noticed that the number of androgen receptors in their brains went up. Moreover, the effects persisted long after the drug had been discontinued.…[T]hey then called in men with PFS, took skin from the penis and found that the density of androgen receptors in men with PFS was about twice that of those without. Now, remember the idea of the testosterone bell curve and damping effects (little testosterone, little growth, more testosterone, more growth, even more testosterone, reduced growth)? I think this is what we are seeing here. With a greater concentration of receptors, the organ becomes more sensitive to testosterone and at a certain point, paradoxically, that sensitivity may shut down.

The Virility Paradox: The Vast Influence of Testosterone on Our Bodies, Minds, and the World We Live In: February 2018

Charles J. Ryan, MD, Distinguished Professor of Clinical Medicine and Urology
University of California, San Francisco

I don’t think it’s very responsible for dermatologists to use [finasteride] to combat hair loss.

I don’t think it’s very responsible for dermatologists to use [finasteride] to combat hair loss. You must know that this molecule, finasteride, has been the subject of more than 2,600 scientific articles found in trustworthy databases. And they all say, You may be able to reduce baldness, but it comes with a serious risk of impotence, ejaculation problems, testicular pain and, just as bad, a risk of breast cancer.

The Wonderhair Pill, May 2006. VRT-TV, Belgium

Jan Tytgat, PhD, Professor of Toxicology and Pharmacology
KU Leuven University, Belgium

This research should cause us to think more carefully about this commonly encountered medication.

A review of 17 randomized controlled trials (including more than 17,000 patients) demonstrated a nearly twofold increase in sexual, ejaculatory and orgasmic dysfunction in young men using Propecia for male pattern hair loss. At the same time, a recent study demonstrated changes in the levels of certain steroids in cerebrospinal fluid of men taking finasteride for hair loss. These steroids have been shown to influence brain function, and their presence may help explain the profound psychological changes such as depression and suicidality that have been associated with finasteride use. This research should cause us to think more carefully about this commonly encountered medication.

Potential side effects of the drug Trump reportedly takes for hair loss: The Washington Post, Feb. 3, 2017

Daniel Marchalik, MD, Urologist
MedStar Washington Hospital Center

Sexual dysfunction and suicidal ideation that appears to result from [finasteride] are important adverse effects.

Sexual dysfunction and suicidal ideation that appears to result from [finasteride] are important adverse effects. Patients should be informed of these risks, so that they can weigh the benefits of harms against treatment.

Finasteride 1 mg in Alopecia: Sexual Dysfunction, Suicidal Ideation: Prescrire, October 2016

Bruno Toussaint, MD, Editorial Director
Prescrire

Finasteride treatment may have broad consequences for brain function.

The effects in the brain of finasteride…have been poorly explored. Therefore, the effects of a subchronic treatment of finasteride.…have been evaluated in male rats.… One month after the last treatment.…changes in neuroactive steroid levels, steroid receptors…and GABA-A receptor subunits…were detected. These findings suggest that finasteride treatment may have broad consequences for brain function.

Effects of Subchronic Finasteride Treatment and Withdrawal on Neuroactive Steroid Levels and Their Receptors in the Male Rat Brain: Neuroendocrinology, Dec. 9, 2015

Silvia Giatti, PhD, Pharmacological and Biomolecular Sciences
University of Milano

Does stopping finasteride treatment mean the physiological mechanism of testosterone secretion is reset?

[Finasteride therapy] is a modification of the hormonal mechanism, which raises the question of reversibility. Does stopping treatment mean the physiological mechanism of testosterone secretion is reset? I can’t answer. We probably don’t have the precise data we’d need to answer that.

Santé report on the suicide of PFS patient Romain Mathieu: France 5 News, Nov. 24, 2016

François Haab, MD, Urologic Surgeon
Tenon Hospital, Paris

Further studies are necessary to investigate the pathophysiological and biochemical pathways leading to post-finasteride syndrome.

Concern regarding adverse effects of finasteride is increasing. We aimed to determine the type and frequency of symptoms in men having long-term sexual and non-sexual side effects after finasteride treatment.…The most frequent sexual symptoms…were loss of penis sensitivity (87.3%), decreased ejaculatory force (82.3%), and low penile temperature (78.5%). The most frequent non-sexual symptoms were reduced feeling of life pleasure or emotions (75.9%), lack of mental concentration (72.2%) and loss of muscle tone/mass (51.9%)…Further studies are necessary to investigate the pathophysiological and biochemical pathways leading to the post-finasteride syndrome.

An observational retrospective evaluation of 79 young men with long‐term adverse effects after use of finasteride against androgenetic alopecia: Androlog, Jan. 13, 2016

Carlo Trombetta, MD, Head of Department of Urology
University of Trieste, Italy

[Finasteride] treatment affected the expression of a number of accumbal proteins.

[O]ur results showed that [finasteride] treatment affected the expression of a number of accumbal proteins involved in key functional processes, such as regulation of GABAergic neurotransmission, as well as steroid and pyrimidine metabolism. These findings may prove crucial to understanding the neurochemical mechanisms of FIN’s neuropsychiatric side effects.

Exploring the neural mechanisms of finasteride: a proteomic analysis in the nucleus accumbens, Psychoneuroendocrinology, October 2016

Alessio Soggiu, PhD
University of Milano

It’s awful when a patient…takes a medication for a specific purpose, but then develops side effects that may be more damaging than its positive effects.

It’s awful when a patient doesn’t know what’s happening, and takes a medication for a specific purpose, but then develops side effects that may be more damaging than its positive effects. The patient needs to know that, and to be able to say, I’m stopping now. That’s the responsibility of the doctor who prescribes the medication, or the pharmacist who supplies it.

The Wonderhair Pill: VRT-TV, May 2016

Dirk Michielsen, MD, Professor of Urology
Ziekenhuis University, Brussels

[Finasteride] is associated with adverse side effects that could become persistent after therapy discontinuation.

Finasteride is a steroid 5-alpha-reductase inhibitor, approved for the treatment of androgenetic alopecia and benign prostate hyperplasia. In some patients the treatment is associated with adverse side effects that could become persistent after therapy discontinuation, resulting in the so-called post-finasteride syndrome (PFS).

A pharmacogenetic survey of androgen receptor (CAG)n and (GGN)n polymorphisms in patients experiencing long term side effects after finasteride discontinuation: International Journal of Biological Markers, Dec. 9, 2014

Erika Cecchin, PhD, Researcher in Clinical and Experimental Pharmacology
National Cancer Institute, Milan

Persistent sexual side effects as well as anxious/depressive symptomatology reported even after discontinuation of finasteride.

Observations performed in a subset of patients treated for male pattern hair loss indicate that persistent sexual side effects as well as anxious/depressive symptomatology have been reported even after discontinuation of finasteride treatment.

Patients treated for male pattern hair with finasteride show, after discontinuation of the drug, altered levels of neuroactive steroids in cerebrospinal fluid and plasma: Journal of Steroid Biochemistry and Molecular Biology, February 2015

Donatella Caruso, PhD, Professor of Pharmacology and Biology
University of Milano

Refrain from prescribing oral finasteride to a patient with a personal history of depression, sexual dysfunction, or fertility problems.

To date there are no predictive factors for the risk of development of post-finasteride syndrome and no known treatment for the disorder. For the time being, as a general rule: Refrain from prescribing oral finasteride to a patient with a personal history of depression, sexual dysfunction, or fertility problems.

The Difficult Hair Loss Patient: Guide to Successful Management of Alopecia and Related Conditions: August 2015

Ralph M Trüeb, MD, Proefssor of Dermatology
Center for Dermatology and Hair Diseases, Zürich

(CAG)n and (GGN)n repeats had different frequencies according to symptoms reported by patients with PFS, likely reflecting the vast array of genes modulated.

Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS). Aim: To determine whether (CAG)n-rs4045402 and (GGN)n-rs3138869 polymorphisms in the androgen receptor (AR) gene are implicated in PFS. Conclusion: This study showed that short and/or long (CAG)n and (GGN)n repeats had different frequencies according to symptoms reported by patients with PFS, likely reflecting the vast array of genes modulated by the AR [and] a U-curvilinear profile of (CAG)n repeats for skin dryness symptoms, where the two extremes exhibited a worse condition than medium repeats.

Androgen Receptor (AR) Gene (CAG)n and (GGN)n Length Polymorphisms and Symptoms in Young Males With Long-Lasting Adverse Effects After Finasteride Use Against Androgenic Alopecia: Journal of Sexual Medicine, November 2016

Sabina Cauci, PhD, Medical and Biological Sciences
University of Udine, Italy

Adverse effects persisted…indicating the possible presence of a ‘post-finasteride syndrome.’

In this pilot study, we sought to characterize sexual and nonsexual adverse effects that men reported experiencing at least 3 months after stopping the medication.…Responses from 131 generally healthy men (mean age, 24 years) who had taken finasteride for male pattern hair loss was included in the analysis. The most notable finding was that adverse effects persisted in each of the domains, indicating the possible presence of a “post-finasteride syndrome.”

Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride: American Journal of Men’s Health, June 13, 2014

Christine A Ganzer, PhD, Assistant Professor
City University of New York

One study has found lower levels of several neurosteroids in men with persistent adverse effects of finasteride.

Persistent adverse effects of finasteride in younger men include erectile dysfunction, low libido, lack of orgasms, depression, and decreased alcohol consumption. One study has found lower levels of several neurosteroids in this population. Out of the various persistent side effects, erectile dysfunction and decreased alcohol consumption have been the most studied in animal models. Further research is needed on who is susceptible to the persistent adverse side effects of finasteride and on the underlying mechanisms of the medication.

Persistent Sexual and Nonsexual Adverse Effects of Finasteride in Younger Men: Sexual Medicine Reviews, Dec. 17, 2013

Michael S. Irwig, MD, Associate Professor of Medicine
George Washington University

Further research is needed on who is susceptible to the persistent, adverse side-effects of finasteride.

Post-finasteride syndrome is now a recognized condition, affecting as many as 20 per cent of those taking finasteride.…The persistent sexual side-effects of finasteride may manifest after varying periods of taking the drug, or not until the drug is discontinued. It is not known why some men are susceptible to the potential adverse effects of finasteride, while others—the majority—are not affected.…Further research is needed on who is susceptible to the persistent, adverse side-effects of finasteride and on the underlying mechanisms of the medication.

A Clinical Overview of Finasteride and Its Potential Causative Links to Long-term Side-effects: The Medical Independent, Jan. 22, 2015

Andrew Rynne, MD
Clane General Hospital, Kildare, Ireland

Men suffering from PFS are plagued with many physical, mental, and emotional symptoms that have led to long-term depression, marital problems and divorce, and now several reported cases of suicide.

Post-finasteride syndrome is a serious state of permanent sexual, mental and physical side effects which do not resolve after quitting the drug… It is also surmised by the few specialists in the medical field that a type of receptor or “brain damage” has occurred.…Men suffering from PFS are plagued with many physical, mental, and emotional symptoms that have led to long-term depression, marital problems and divorce, and now several reported cases of suicide.

Post-Finasteride Syndrome Therapy, MatthewBruhin.com, 2015

Matthew Bruhin, PhD
Bruhin & Associates Psychotherapists, San Diego, California