There’s a lot of misinformation out there about oral finasteride. That’s a shame because of how powerful this medication can be.

If you’re just beginning to experience hair loss, chances are you’ve heard a lot about finasteride and its close cousin dutasteride. Before you let fear over side effects scare you off, make sure you understand the real risks (and very real benefits) of taking this affordable hair loss medication before you do. Image by drobotdean for Freepik. 

If you’re a young man (or man of any age) noticing the first signs of hair loss, chances are you’ve spent some time researching online what to do about it, and come across a lot of forums, self-declared experts, and purported ‘studies’, all claiming to know the risks of finasteride and its close cousin dutasteride (Propecia). A Google search on hair loss medication is possibly even how you ended up following my channel or subscribing to my newsletter. 

Chances are after your research binge, you’ve come away with a sense of foreboding about those side effects and are seriously reconsidering whether you want anything to do with medical hair loss therapy. 

And that’s a real shame. 

 

What Are the Real Risks of Finasteride? 

If you’re a man considering (or on) oral finasteride or its cousin dutasteride, you’re probably here to find out about the sexual side effects: decreased libido, erectile dysfunction, and reduction of ejaculatory volume. With all the fearmongering out there, how could you not be worried? 

The reality is that finasteride is a very safe and effective drug. While there is a potential for sexual side effects, the chance of these occurring are incredibly low, around 2-3% on the standard dose of 1mg/daily, taken as a pill. I also want to point out that the incidence of sexual side effects in those taking a placebo (a water pill) is 1%. Simply taking a pill that could be a medication is enough to cause 1 out of 100 men to experience a sexual side effect. 

The side effects are also not subtle – if it happens, you’ll know. Of those men that fall into that 2-3%, most will experience the side effects almost immediately, within the first few weeks of starting the drug. 

If you are in that 2-3%? The good news is that this side effect is almost always reversible and dose dependent. When a patient experiences this, I stop their medication, wait until things resolve, then try at a lower dose. If a lower dose of oral finasteride doesn’t help? We can try a topical preparation. 

 

What About Other Side Effects With Finasteride?

There are other, less known and discussed potential side effects with finasteride. These occur with much less frequency than the more well known sexual side effects. 

• gynecomastia (breast enlargement and tenderness)* 
• male breast cancer* 
• prostate cancer, though this has recently been contested in larger trials. It’s now thought that finasteride leads to an increased rate of discovery of prostate cancer cases. 
• brain fog 

*The incidence of these two side effects is incredibly close to the placebo group – those who are not taking the medication. 

There are also some patients who cannot take finasteride. Those who are suspected to be allergic, have varicose veins (can lead to testicular pain), or liver conditions (since finasteride is processed by the liver) are not candidates for this medication. Finasteride and dutasteride are also not appropriate for women, as they can cause birth defects in male fetuses. That’s also why we recommend men who are planning to conceive with their partners cease finasteride for 3 months prior to trying and then resuming (3 months usually won’t affect your hair loss). 

That brings up another point. A lot of men out there are switching to topical finasteride because of fear over sexual side effects. While topical finasteride is less likely to trigger those side effects, it can still happen. Also, you need to practice chemical safety with topical finasteride, particularly if you spend time around women who are/might be pregnant, because of those potential birth defects. That’s also why if you’re taking finasteride, you can’t give blood. 

By far the biggest concern for men considering taking finasteride is sexual dysfunction. Yes, it can happen, it’s incredibly rare, and the good news is we have ways to manage it. Image by wayhomestudio for Freepik.  

Why Does Finasteride Affect Men’s Sexual Health?

The reason finasteride and dutasteride can affect men’s sexual health has to do with how it works to stop hair loss, by blocking the formation of dihydrotestosterone (DHT) through the inhibition of 5 alpha reductase, the enzyme that converts testosterone into DHT. 

For men who have androgenic alopecia, hair follicles in the DHT sensitive zone are susceptible to miniaturization and eventual loss by high levels of DHT.  By blocking the formation of DHT by targeting the enzyme that makes it with finasteride, we can preserve hair. 

It’s plausible that a lack of DHT or another hormone that’s a target of 5 alpha reductase leads to erectile dysfunction. It’s also possible that finasteride leads to more testosterone being converted into estradiol (since it’s sitting around, no longer being converted to DHT), and too much estradiol can cause sexual side effects in men. 

Again, when finasteride is stopped, these side effects go away and in the vast majority of cases, they’re dose dependent, meaning your doctor decreases the dose and the side effect stops. 

A Note About Post Finasteride Syndrome 

Post finasteride syndrome, where side effects of erectile dysfunction, anxiety, insomnia, and feelings of isolation are experienced even after medication is ceased, is incredibly rare. Because of the rarity, studies on the subject have yet to show a clear cause or mechanism – meaning we don’t know who is susceptible or why finasteride triggers this condition. I’ve yet to see it in my own practice, and the other hair loss doctors I speak with regularly have also yet to see a case. That’s not to discredit or contradict people who have experienced this or minimize what they’ve experienced. My point here is that clinically, it’s so rare that the chance of you getting it from taking this medication is close to negligible. There are many things that can contribute to sexual dysfunction: smoking, a sedentary lifestyle, poor health, endocrine and cardiac issues – just to name a few. Sometimes, it can be hard to track down an exact cause, but a pill is easy to blame.

Inexpensive Prescription Hair Loss Medication Delivered To Your Door.

If you’re interested in trying finasteride or dutasteride, fear of this side effect shouldn’t be holding you back. 

Think of it this way – do you take paracetamol/acetaminophen for a cold or headache? 1-2% of acetaminophen users experience acute liver toxicity (the risk going up with increased doses). That doesn’t mean we don’t take it, but we make sure we understand what the potential risks are in case they do happen. 

If you’re interested in understanding more about the syndrome from a reliable source, you can read about medically studied cases in this journal article. 

 

That 2-3% Still Gives me Anxiety. Can’t I Just Use Minoxidil? 

It’s tempting to want to try something that doesn’t carry to risk of sexual side effects, and many men wonder if they can just address their hair loss with minoxidil and skip the finasteride all together. The problem is that hair loss will likely continue. Image by stocking for Freepik.

Some people think that because minoxidil is effective for hair loss, it’s a replacement for finasteride. That couldn’t be further from the truth, because they work very differently. 

Whereas finasteride (and dutasteride) addresses the root cause of androgenic alopecia by blocking DHT and stopping further DHT sensitive hairs from being miniaturized and lost, minoxidil works by encouraging miniaturized hairs to mature back into thicker hair strands. 

Minoxidil can help make hair look fuller, but without a 5 alpha reductase inhibitor, your hair loss will continue. 

Now, there are other things, such as microneedling, red light therapy, and some natural supplements like saw palmetto, pumpkin seed oil, and caffeine, that can help with growth and hair loss, but they should really be thought of as supplementary support, not treatment. They aren’t a substitute or replacement for medical therapy. 

Hair transplants aren’t to be used in replacement of medical therapy either. Most hair surgeons, including myself, like to use medical therapy (including finasteride) to stabilize hair before going ahead with a transplant. Why? Because a hair transplant without stabilized hair loss might look nice in the short term but will set you up for failure long term when hair loss continues. 

 

Final Thoughts

If you are experiencing hair loss and care about preserving your hair, then you’d be doing a disservice not exploring finasteride. I always want my patients to be educated about side effects, but a lot of the discussion out there boils down to fearmongering. Any medicine that can do good will come with potential side effects, even at a standard dose, there’s no such thing as ‘risk free’.  

I think we obsess about the side effects of hair loss medication because of our culture. We consider things like plastic surgery or hair loss as vanity, not health. That’s a shame, because making sure you have the confidence to feel good about yourself as you go about your day is absolutely healthy. 

And, if all this discussion of side effects hasn’t frightened you away from exploring hair loss medication for yourself? Visit us at Feelconfident.com to see if medical hair loss therapy is right for you. 

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.