For many men, it is a panacea that has helped stop their baldness.
However, others claim it has had a devastating effect on their lives, with all sorts of paralyzing side effects such as impotence, infertility, insomnia, anxiety, depression and, in some cases, suicidal thoughts – even years after they stopped.
The drug is finasteride, sold under the brand name Propecia, which is used to treat male pattern baldness. Donald Trump and Wayne Rooney are said to be two of the millions who have used it hoping to reverse a receding hairline or bald spot.
Worldwide, the market for hair loss treatments is valued at an extraordinary £ 5.6 billion, with male pattern baldness being 90% of that and finasteride the most used treatment.
And finasteride works for male pattern baldness, and improves hair growth within a few months, according to multiple studies. The effects last as long as the man continues to take the medicine.
Worth the effort? Although finasteride is successful in stopping hair loss, some men say it has had a devastating effect on their lives, leading to a series of crippling side effects including impotence, infertility, insomnia, anxiety, depression and, in some cases, suicidal thoughts
In simple terms, hair loss stops by reducing the conversion of the male hormone testosterone to dihydrotestosterone (DHT). High DHT values cause hair follicles to shrink on the scalp, leading to hair loss. Finasteride not only prevents this, it has also been shown to stimulate regrowth.
In the UK, the drug is only available on prescription – from doctors since 1999 and since 2014 and on prescription at a pharmacist.
However, it is available on NHSprescription under the brand name Proscar – and at a higher dose: 5 mg compared to 1 mg for hair loss – to treat an enlarged prostate, a common condition that affects many men with age, causing problems with the urine flow.
This is because lowering DHT levels can also help reduce prostate size and prevent it from pressing on the bladder and urethra.
Finasteride is, in whatever way, a hugely popular drug, with more than 3.3 million prescriptions for prostate problems in England and Wales alone in 2017, double that of just ten years earlier.
But there is another side to this apparent success story – the potential side effects of the drug.
DHT affects other male characteristics and interfering with its production can lead to sexual dysfunction, including problems getting an erection, decreased desire, and decreased sperm.
Risk: in simple terms, hair loss stops by reducing the conversion of the male hormone testosterone to dihydrotestosterone (DHT). High DHT values cause hair follicles to shrink on the scalp, leading to hair loss
Less frequent problems may include infertility, testicular pain, and anxiety.
And since 2017, following a decision by the European Medicines Agency, Finasteride patient information sheets must now also contain warnings about the risk of depression and, in rare cases, suicidal thoughts.
Merck, producer of Propecia, says that only one in 100 people is affected by sexual dysfunction, although it now recognizes in patient information leaflets that this may persist after it has come out of the pills.
In the United States, Merck paid out more than £ 3 million to hundreds of men who claimed that the side effects continued after they stopped taking Propecia.
Meanwhile, more and more British men say they have been affected by persistent side effects – one of them is Ryan Clark, 52, an operations manager from North Tyneside, who says the drug has shed his libido and caused him to suffer from reduced fertility and depression.
After taking finasteride on and off for 18 years, he says he is still plagued by side effects, despite being stopped two years ago.
& # 39; I FASTLY LOST ALL INTERESTS IN SEX & # 39;
Ryan started taking finasteride after he noticed a small bald spot on his crown. & # 39; I was only 31 and did not want to get bald at such a young age & # 39 ;, he says. He had read about Propecia and thought it sounded like & # 39; a panacea & # 39 ;. Ryan & # 39; s doctor prescribed the drug privately and he started paying £ 30 a month for the daily pill.
& # 39; Regarding the treatment of my hair loss, the drug worked beautifully and the holes in my crown filled in within three months, & # 39; he says. & # 39; However, within a few weeks I lost interest in sex and my libido did not return. I did not connect it to finasteride because this side effect was never mentioned.
& # 39; Within three months I started feeling anxious and getting insomnia. I had always been confident, happy and positive, but suddenly I was withdrawn and irritable. & # 39;
Destroyed: Ryan Clark, 52, an operations manager from North Tyneside, who says the drug has shed his libido and left him with impaired fertility and depression
Ryan, who married Lyndsey in 2010, 42, went & # 39; several times & # 39; back to his doctor about his various health problems. & # 39; They have all handled them separately, & # 39; he says. & # 39; I was offered medication for sleep and depression, but I refused. & # 39;
His list of symptoms continued to grow. & # 39; I developed dry skin, painful red eyes and palpitations, muscle loss and weight loss. & # 39;
In 2010, tests showed that he had poor quality semen with low motility and was told that he and Lyndsey were unlikely to become pregnant naturally. Their son, Joshua, now six, was conceived by IVF.
During all this, Ryan continued to experience symptoms. & # 39; I felt that people thought I was a hypochondriac & # 39 ;, he says. & # 39; I would see my doctor, but the only thing I got was a roll of the eyes. What I wanted, I had never been so in vain to lose my hair. & # 39;
SIDE EFFECTS THAT RIGHT AND TOUCH
Two years ago, a desperate Ryan searched for his symptoms online and encountered Post-Finasteride Syndrome (PFS) – a collection of symptoms that include sexual dysfunction, infertility, anxiety, and depression that persist long after finasteride has stopped.
The side effects may be due to changes in hormone receptors in the body, suggests Professor David Healy, a psychiatrist at Bangor University and founder of RxISK, a pressure group campaigning to emphasize side effects of drugs.
& # 39; Finasteride not only works on hair growth and reduces prostate but has effects throughout the body & he says.
& # 39; I felt that people thought I was a hypochondriac & # 39 ;, he says. & # 39; I would see my doctor, but the only thing I got was a roll of the eyes. What I wanted, I had never been so in vain to lose my hair. & # 39;
& # 39; As with a host of other drugs, such as SSRI antidepressants and the acne drug Roaccutane, we don't know why these effects persist in some people. & # 39;
When Ryan read about PFS, & suddenly everything clicked into place, I had listed almost all the symptoms and they all started after I started Propecia, he says.
& # 39; There were 5,000 men, many of them from the UK, like me on a website, all describing how their lives had gone with the medicine.
Gestopt I stopped taking the pills, but none of the symptoms disappeared in the two years that followed. In fact, I have also developed neuropathy (causing nerve damage, pins and needles) in my hands and feet.
& # 39; Yes, the patient information leaflet mentions sexual dysfunction, but does not emphasize how serious and long-lasting the problems can be. & # 39;
YOUNGER MEN WITH A GREATER RISK
The threat posed by finasteride to fertility must be emphasized for younger men, suggests Allan Pacey, a professor of andrology at the University of Sheffield.
& # 39; I ran an andrology laboratory in Sheffield for 25 years, and I regularly ran into men with poor or no sperm & # 39 ;, he says. & # 39; They would reluctantly admit that they were using anabolic steroids – which was obvious anyway because of their appearance – or finasteride names. & # 39;
Professor Pacey explains that the effect on sperm is because both finasteride and anabolic steroids lead to the closure of the crucial hormone produced by the brain and tells the testicles to produce sperm.
The body is fooled into thinking that the testicles work harder than they actually are, because the testosterone level in the blood is increased.
& # 39; The data seems to show that when a man stops (taking the medication), he recovers the ability to produce sperm, but it can take many months. & # 39;
DANGEROUS MUST BE STRESSED
Dr. David Edwards, a doctor at Chipping Norton and former president of the British Society for Sexual Medicine, agrees that the potential side effects, and the fact that they can be long-lasting, should be made clearer to patients.
& # 39; If you asked the average practice nurse, pharmacist or doctor about this, I don't think they would know what the risk is of side effects, such as sex problems and depression, & # 39; he says. & # 39; More information must be given about the risks & # 39; s. & # 39;
Tom, 45, a former Cheshire teacher who spoke on condition of anonymity, could no longer agree.
OTHER DRUGS ASSOCIATED WITH MALE INFREQUENCY
Finasteride is not the only drug that is reported to cause sexual dysfunction.
Research published in the International Journal of Risk & Safety in Medicine in 2018 identified 13 other medications associated with sexual problems such as & # 39; a pleasant or weak orgasm, loss of libido and impotence & # 39 ;.
The drugs listed include antidepressants known as selective serotonin reuptake inhibitors (SSRIs), isotretinoin (the active ingredient in the Roaccutane acne medication) and 5-alpha reductase inhibitors for hair loss and prostate problems, a class of drugs that are also known as finasteride – including dutasteride (brand name Avodart).
Researchers who studied 300 reports of sexual disorders noticed that there was an overlap in some of the symptoms reported from the drugs. Common characteristics were genital numbness, orgasmic problems, loss of libido, and impotence. These problems had domino effects, including loss of relationships and reduced quality of life.
Researchers called for more work to determine why these drugs can cause such a wide range of sexual problems.
He took Propecia eight years ago for just three months, but says that he has lost his career and relationship and now lives with his parents and works part-time in the retail trade.
& # 39; My relationship collapsed under the pressure of sexual problems and I have not had another relationship since then & he says. & # 39; I had to give up the doctrine due to memory and fatigue problems.
& # 39; It is not the life that I had imagined that I would live. And I only took the pills after a few guys that I knew had taken the mickey from a bald spot that I had developed. & # 39;
His doctor agreed to write a private prescription for Propecia. & # 39; He said that impotence can be a side effect, but since I am young, I don't think I fully understood what this meant.
& # 39; In the third month my libido just disappeared and I started getting erection problems. I felt incredibly tired and had memory problems.
& # 39; I stopped taking the pills and hoped it would all stop – but that didn't happen. & # 39;
Tom & # 39; s doctor said the symptoms were not associated with the drug and said he had prescribed a higher dose of finasteride to patients with an enlarged prostate without adverse effects.
& # 39; I later saw an NHS endocrinologist who said the same thing, just like two others I paid to see privately. They told me that I had a depression that I thought was wrong.
& # 39; Four months ago I got new neurological symptoms, including increased anxiety, head pressure – as if I had concrete in my head – headache, total impotence, and terrible insomnia. & # 39; Those involved say that the refusal of the medical profession to recognize that finasteride can cause such side effects are particularly difficult to take.
Ryan says: & # 39; I have seen two endocrinologists say my hormone levels are normal and my symptoms are not associated with finasteride. & # 39;
PEOPLE TAKE THEIR OWN LIFE
The online support group Propecia Help says it has 5,000 members and that men participate at a rate of 100 a month from around the world. It reports that 59 suicides worldwide are associated with the drug.
& # 39; People should be specifically warned of these side effects so that they can weigh the risk and benefits & # 39 ;, a spokesperson told Good Health.
& # 39; A man who loses a little hair cannot be expected to risk a horrible condition that goes beyond the current medical understanding, when neither the prescriber nor the package leaflet sufficiently emphasizes the risks. & # 39;
Professor Healy also emphasizes the need for more recognition of the risks.
& # 39; People kill themselves after taking this medicine & # 39 ;, he says. & # 39; I had a colleague who led his own life 15 years ago, so I know it happens – and so many people with the same symptoms can't be wrong.
& # 39; People take their own lives because of the effects of the drug, but also because they cannot reach anyone and they are not believed. & # 39;
For men who take the drug in larger doses for an enlarged prostate, it is believed that the benefits outweigh the risks.
Professor Roger Kirby, a prostate surgeon and president of the Royal Society of Medicine, says that Proscar is a good treatment for older men with enlarged prostate who are not too concerned about possible effects on their sex life.
& # 39; But I tend not to prescribe finasteride to younger men with benign prostatic disease due to sexual side effects. There are alternative treatments that can be prescribed for younger men.
& # 39; I think younger men who are worried about hair loss are better off with a hair transplant. & # 39;
Merck, however, emphatically defends Propecia's safety record. & # 39; Propecia (finasteride) has been prescribed to millions of men worldwide since its approval and has been the subject of extensive clinical trials reported to regulatory authorities around the world, & # 39; says a spokesperson.
& # 39; The safety and efficacy of our products are paramount.
& # 39; We continuously review the safety profile and update the safety information included in both the summary of product characteristics (intended to inform health professionals) and the package leaflet (or & # 39; packet insert & # 39 ;, intended for patients) .
& # 39; The potential for erectile dysfunction and depression may occur as a side effect in finasteride treatment, although it sometimes occurs, is documented both in the Summary of Product Characteristics and in the patient information leaflet.
& # 39; Anxiety is another potential side effect that is mentioned. & # 39;
For more information, visit propeciahelp.com
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