An increasing number of young men are taking a medication to prevent hair loss, raising concerns about rare but potentially long-lasting side effects. According to a report by Epic Research for NBC News, the number of men in the U.S. with finasteride prescriptions has surged nearly 200% over the past seven years.
“It’s like water in my clinic,” said Dr. Jerry Shapiro, a dermatologist at NYU Langone Health. “I’m prescribing it all the time.”
Younger Men Seeking Treatment to Prevent Hair Loss
Although the Epic report focused on men aged 25 and older, Shapiro and other doctors have noticed more young men, including some in their late teens, seeking treatment early to prevent hair loss.
The rise in prescriptions is partly attributed to telemedicine companies like Hims, Keeps, and Ro, which heavily advertise the drug, noted Dr. Maria Colavincenzo, an associate professor of dermatology at Northwestern Feinberg School of Medicine.
Promoted by Social Media Influencers
Social media influencers also promote finasteride, sharing their hair loss and regrowth journeys. A popular Reddit community called tressless frequently discusses the drug.
“People are interested in treating it a little bit younger than what I saw before,” said Colavincenzo.
Potential Long-Term Impotence
Doctors affirm that the daily pill is safe but emphasize that it must be taken continuously to maintain its effects. Controversy surrounds the drug due to the potential for long-term impotence even after discontinuation.
Finasteride, originally developed for treating an enlarged prostate and known by the brand name Propecia, has been FDA-approved for hair loss for nearly 30 years. It is a daily pill that slows androgenetic alopecia, or male-pattern baldness, which affects about half of men by age 50.
It May Lower Risk of Early Balding
Though no conclusive evidence guarantees that starting the drug early prevents baldness, doctors suggest it lowers the risk. Finasteride works by blocking the 5-alpha reductase enzyme, preventing testosterone from converting to dihydrotestosterone (DHT), which is believed to shrink scalp hair follicles and shorten the hair growth cycle, leading to hair loss.
“If you block that signal telling the hair to shrink, then the hair doesn’t shrink, and it might even unshrink a little bit,” Colavincenzo explained.
Determined by Genetics
Genetics largely determine why some men with high DHT levels don’t go bald, a subject of ongoing research.
Most men taking finasteride successfully slow their hair loss.
Drug is More Effective at Prevention
Studies indicate the drug has an 80% to 90% success rate in preventing further hair loss, according to Shapiro. Starting early is key, as the drug works better at prevention and becomes a lifelong commitment.
“Most things in medicine are lifelong,” said Shapiro, who also advises Keeps, a company selling the drug online. “If you have high cholesterol you have to be on medication forever, or if you have high blood pressure you have to be on medication forever.”
Dermatologist Says Drug is “Very Effective”
Dr. Carolyn Goh, a dermatologist at UCLA Health, noted that while long-term data on finasteride’s efficacy is limited, existing data shows its benefits are maintained over time. A recent Korean study published in the Journal of Dermatology found that nearly 100% of men retained the same or more hair after five years on the drug.
“It’s very effective,” she said. “Although the response may be just keeping the hair from getting worse rather than necessarily growing hair, it works quite well.”
Less Successful at Regrowing Hair
Another study from Italy, which followed over 100 patients on finasteride for 10 years, found that 86% experienced no change in hair loss.
Despite its effectiveness in preventing hair loss, finasteride is less successful at regrowing lost hair. It is often combined with minoxidil, a topical drug that stimulates hair growth.
Hard to Gauge Effectiveness
Colavincenzo noted that patients using finasteride for about a decade have had success, though it’s difficult to gauge the drug’s effectiveness. “The hard thing is you often don’t know how well it’s working,” she said. “Even if your hair is just not getting worse it’s a success.”
Since male-pattern baldness is considered a cosmetic issue, finasteride is typically not covered by insurance. Available as a generic since 2006, it usually costs less than $100 per month.
Possible Suicidal Behavior
In 2022, the FDA required prescription labels to warn of possible suicidal behavior in men taking finasteride, following advocacy by a patient group. A 2023 article in the International Journal of Impotence Research sparked online debate over post-finasteride syndrome, linked to decreased libido, erectile dysfunction, and cognitive difficulties.
Common side effects include reduced sex drive, difficulty maintaining erections, and decreased semen production, affecting fewer than 5% of men. There’s also a possible link to mental health issues, such as depression, though it’s unclear if the drug is the direct cause.
Proceed with Caution
“Certainly the vast majority of my patients have no such side effects and are fine and do pretty well with it,” said Colavincenzo. For men already experiencing sexual issues, Colavincenzo advises against finasteride.
“I’m very cautious if a person tells me they’re having issues with sexual function,” she said. “I usually say I don’t think this is a good idea and I wouldn’t recommend it for them.” Shapiro emphasized that the risk of permanent side effects is “so, so rare. I’ve never seen it in a patient, and I’ve treated thousands of patients,” he said.
