Hair loss your biggest problem? Try finasteride and you may have a worse problem

Believe it or not, there's something worse than male pattern baldness. It's depression, plunging libido and shrinking genitals. Those are the symptoms doctors say are caused by finasteride, a popular hair-loss treatment heavily promoted by "telehealth" companies like Hims.com. The drug is sold commercially as Propecia and Proscar.

In a Wall Street Journal report, Dr. Justin Houman, a urologist at Cedars-Sinai Medical Center in Los Angeles, said the unpleasant side effects of finasteride are "very very common" and cautioned that young men should avoid it.

Finasteride is, it should be noted, a legitimate treatment for prostate enlargement, where the beneficial effects may outweigh the possible side effects. 

Risks of finasteride

One of the most widely reported risks of finasteride is sexual dysfunction, which includes:

• Reduced libido (low sex drive)
• Erectile dysfunction (ED)
• Decreased semen volume and fertility issues
• Delayed ejaculation

It also has serious mental health effects, including depression, anxiety and thoughts of suicide and possible cancer risks, according to the Mayo Clinic.

While finasteride can shrink the prostate and reduce the risk of low-grade prostate cancer, studies suggest it may slightly increase the risk of aggressive, high-grade prostate cancer in some men. The reason is unclear but may be due to delayed detection of cancerous cells.

Other studies, including one by the University of Illinois, suggest it may cut the risk of heart disease. 

Carnival barker tonics

Hair-loss cures are an old standby in the carnival barker school of health care and have most likely been around since the first human male started losing hair. But lately, they and other unproven and unregulated tonics have gained a certain air of respectability because of clever marketing by "cool" telehealth sites.

Telehealth products have expand the loophole long used by dietary supplements, which relieve consumers of millions of dollars per year for unproven substances that may not only be ineffective but also dangerous.

Since they're not legally drugs, supplements and many cosmetics aren't subject to regulation by the U.S. Food and Drug Administration and their safety and effectiveness are not guaranteed.

But finasteride is a prescription drug and is not approved for over-the-counter sale, so how are men buying it online? That's where telehealth companies come in. It's another miracle of technology that the old-fashioned carnival barker has been replaced by companies like Hims, which last year enjoyed $1.5 billion in revenue from more than 2 million customers. 

How they work

Many telehealth platforms offer finasteride through online consultations. These companies typically:

• Require you to fill out a medical questionnaire.
• Some may offer a brief video consultation with a doctor.
• If approved, they ship the medication directly to you (often as a subscription).

These services operate legally by connecting customers with licensed doctors or healthcare providers who write prescriptions, even though they have not seen the patient in person. 

Online pharmacies also sell finasteride and other prescription medications. The patient simply forward their physician's prescription. Compounding pharmacies can also brew up a custom version of a prescription drug under certain cicumstances. 

But a large network of shady sites, many operating overseas, also sell prescription medicines and may not screen patients effectively or at all. 

In the case of finasteride, it's important to take the drug only under a doctor's supervision. In many cases, it may be best to avoid it as a hair-loss treatment.

Why avoid it? Very simply, it is effective only as long as you take it. Stop taking the drug and your hair starts falling out again but the unpleasant side effects remain.