Last week, President Trump’s doctor disclosed that the president takes finasteride, a drug marketed as Propecia, to treat male pattern baldness. While it is tempting to make jokes about Trump’s hair, and even the sexual side effects that accompany the drug, it also has many disturbing side effects that neither the president—nor any other man—should risk.
In the 19 years since Propecia was approved to treat hair loss from male pattern baldness, side effects have been so concerning that the term post-finasteride syndrome (PFS) has been coined and hundreds of lawsuits have been brought. In addition to its sexual side effects, the drug’s effects on cognition, mood and mental states have been documented in the scientific literature.
A 2013 study in Journal of Sexual Medicine noted “changes related to the urogenital system in terms of semen quality and decreased ejaculate volume, reduction in penis size, penile curvature or reduced sensation, fewer spontaneous erections, decreased testicular size, testicular pain, and prostatitis.” Many subjects also noted a “disconnection between the mental and physical aspects of sexual function,” and changes in mental abilities, sleeping patterns, and/or depressive symptoms.
A 2014 study in the Journal of Steroid Biochemistry and Molecular Biology finds that “altered levels of neuroactive steroids, associated with depression symptoms, are present in androgenic alopecia patients even after discontinuation of the finasteride treatment.” In 2010, depression was added to labels as a side effect. In 2011, a woman told CBS news she blamed her 22-year-old son’s suicide on Propecia and Men’s Journal ran a report called “The (Not So Hard) Truth About Hair Loss Drugs.”
Sexual side effects, but a full head of hair
Finasteride inhibits a steroid responsible for converting testosterone into 5α-dihydrotestosterone (DHT), the hormone that tells hair follicles on the scalp to stop producing hair. Years before Propecia was approved to grow hair, finasteride was being used in drugs like Proscar, Avodart and Jalyn to treat an enlarged prostate gland (benign prostatic hyperplasia).
Since Propecia was approved, its label has warned about sexual side effects, but termed them temporary. “A small number of men experienced certain sexual side effects, such as less desire for sex, difficulty in achieving an erection, or a decrease in the amount of semen,” said the label in 2014. “Each of these side effects occurred in less than 2 percent of men and went away in men who stopped taking Propecia because of them.”
But increasingly, users and some doctors say the symptoms sometimes do not go away when men stop taking Propecia and that their lives can be changed permanently. They report impotence, lack of sexual desire, depression and suicidal thoughts and even a reduction in the size of their penis or testicles after using the drug.
In 2011, the Propecia label conceded that sexual dysfunction could continue “after stopping the medication” and that finasteride could pose a “risk of high-grade prostate cancer.” In 2012, a warning was added that “other urological conditions” should be considered before taking finasteride. Soon, “male breast cancer” was added under “postmarketing experience.” Then the side effect of angioedema was added.
Propecia was not just sold in the U.S. Overseas ads compared twins who did and did not use the product. In the UK, the drugstore chain Boots aggressively marketed Propecia at its 300 stores and still does. One estimate says Propecia was marketed in 120 countries. In 1999 alone, Merck spent $100 million marketing Propecia directly to consumers, when direct-to-consumer advertising was just beginning on TV.
This is not a great drug for anyone—especially the president of the United States.
Martha Rosenberg is a nationally recognized investigative health reporter whose food and drug expose, “Born with a Junk Food Deficiency,” won an American Society of Journalists and Authors honorable mention. Rosenberg has appeared on CSPAN, National Public Radio and lectured at the medical school and university levels.