A spike in men presenting to GPs with unexpected depression and erectile dysfunction after taking hair loss medication has prompted doctors to issue a warning about slick social media advertisements and speedy telehealth appointments.
The recommendation to consult a doctor face-to-face and use additional safeguards – such as pre-medication blood tests – comes as Gen Zs and Millennials increasingly turn to digital subscription services for hair, skin and mental health medications shipped to their door.
Mosh and Pilot are among several Australian companies selling hair loss treatment plans via online consultations with a doctor.
Both businesses offer subscriptions that can include finasteride, an oral prescription medication that can treat male pattern hair loss by blocking the production of a certain hormone. Doctors have also used the drug for decades to treat enlarged prostates.
Between January 1, 2015 and December 31, 2020, there were 18 reported issues and zero suspected deaths linked to finasteride, according to the federal government’s database of adverse event notifications.
But the number of reported side effects has doubled in the past five years. There were also five reported deaths with suspected links to the medicine since 2020.
The most common issue reported was erectile dysfunction, followed by loss of libido, depression and suicidal ideation. A handful of people told doctors they had insomnia and brain fog after taking the medication.
Inclusion in the database is not confirmation that an adverse event has occurred, or that it was caused by a particular medicine or vaccine – only that a report was made.
Melbourne man Anthony, who didn’t want his surname published for privacy reasons, started taking finasteride in 2019 after realising his hairline was receding. But he stopped using the medication after just two weeks.
“Within a day or two, I started noticing side effects – mainly a disconnect from reality,” Anthony said. “I remember leaving my workplace and feeling just out of it. The feelings of happiness and sadness and anger, all those emotions don’t exist as they did previously.
‘If I could go back in time and talk to myself, I’d say, cop the hair loss – it’s no big deal.’
Anthony, who suffers mental ill health years after taking finasteride
“I’ve never [previously] had any mental health issues. It’s a really shocking and weird situation.”
The 36-year-old, who was prescribed finasteride after a short consultation at a bulk-billing GP, says his ill mental health symptoms persist to this day, despite going to therapy and also trying two kinds of mental health medications.
There are also sexual side effects that continue to “hit pretty hard” almost six years later, to the point where he has given up going on dates.
“I have zero libido and changes to sensitivity down there,” Anthony said. “It’s not low libido – it’s complete disconnect. Nothing, zero.
“I haven’t really told my family or friends because it’s really embarrassing. If I could go back in time and talk to myself, I’d say, cop the hair loss – it’s no big deal.”
A Sydney businessman, also speaking on the condition of anonymity, said he took finasteride in 2020 after an online consultation. The drug “completely eradicated” his libido, he said.
“It took me about six months to get back to normal,” the Sydney man said. “They definitely downplay this side effect. They say it’s only a small percentage of people, but I hazard a guess that it’s way, way higher.”
Dr Emmanuel Anthony, the Victorian deputy chair of the Royal Australian College of General Practitioners, said he had heard from colleagues that there was an uptick in men seeking medical advice after taking finasteride.
“We are seeing more patients who are getting these side effects that they consider unexpected,” Dr Anthony said.
“The impression I’m getting is they weren’t properly counselled that these risks could happen. In a lot of cases, they’re patients who’ve received these medications from online services and might not have received the same counselling they would have gotten if they’d seen their GP.”
Dr Anthony said the patient cohort typically waited two to three months before seeking help for side effects.
“There are so many things that can impact a person’s libido.”
The GP said a doctor prescribing finasteride should take a thorough medical history from a patient and, ideally, order a blood test to check the patient’s prostate cancer risk.
‘We are seeing more patients who are getting these side effects that they consider unexpected.’
Dr Emmanuel Anthony on men seeking medical advice after taking finasteride
“It’s really important because finasteride is one of these medications that can mask prostate cancer – it can reduce PSA [prostate-specific antigen] levels by up to 50 per cent. Elevated PSA is our most useful early market for prostate cancer. This way, they have more certainty and reassurance.”
Dr Anthony said while a small cohort of patients experienced ongoing symptoms, it was important not to panic.
“These side effects are usually fully reversible. The next emotion to consider is – don’t feel ashamed. As GPs, we’re used to discussing these fairly sensitive issues. I want to assure someone who has used an online provider, or not gone through their regular GP, that we’re not going to shame you.”
Professor Eric Chung, a past leader of the Urological Society of Australia and New Zealand’s andrology advisory group, also urged men to speak to a qualified doctor. Andrology is the study of men’s reproductive and urological health.
He said the exact adverse effect of hair loss drugs on sexual function was likely dependent on various factors such as duration and dosage, the patient’s baseline sexual function, age, medical comorbidities and lifestyle factors such as stress.
Melbourne-based clinical psychologist Dr Marcus Squirrell said he would typically check whether a client was using finasteride if they were seeking therapeutic help for erectile dysfunction or loss of libido.
“Whenever I am assessing and treating clients with concerns relating to a loss of libido or erectile dysfunction, I typically ask about their use of that medication,” Squirrell said.
“Some clients have reduced their dosage and noticed an improvement in their sexual functioning. I think it’s something that psychologists, sex therapists and medical doctors need to be aware of as part of their screening questions for sexual difficulties.”
Mosh’s chief medical officer Dr Kieran Dang said while standard video call appointments were scheduled for 15 minutes, a practitioner would spend longer with a patient if required.
“Men are informed of potential side effects through written information and during their practitioner consultation,” he said.
“Our medical questionnaire screens for any history of mental illness or suicidality. Where patients may be at increased risk of side effects, our doctors provide tailored advice, including alternative options to finasteride or adjusted dosing.”
Dang said patients could speak to a practitioner at any time should they experience any side effects at no extra cost.
Pilot was also contacted for comment. The Age asked the company how long its average telehealth consults were for men seeking hair loss treatments and what safeguards it had put in place.
Melbourne man Mitch Sabine runs a support network for men whose side effects continue long after they stop taking finasteride.
Post-Finasteride Syndrome Network is also a charity that has raised more than $700,000 for research into finasteride side effects. This research primarily takes place in Finland and Germany.
“The first objective we’re working towards at the moment is really understanding the mechanisms driving the disease. The ultimate objective is to either find some sort of therapeutic – whether it’s a treatment or cure,” Sabine said.
While post-finasteride syndrome is not a disease formally recognised by the medical community, Sabine is hopeful that will one day change.
“Five years ago, these scientific networks didn’t exist. There was basically zero research taking place. Once someone reports a case of PFS, please take them seriously.”
If you or someone you know needs mental health support contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.
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Broede Carmody is a health reporter for The Age. Previously, he was a state political reporter for The Age and the national news blogger for The Age and The Sydney Morning Herald.Connect via Twitter or email.
