Is it worth the risk to try propria (finasteride)?

Question

I've been thinking about trying propecia, however the horror stories (ED, brain fog, etc..) scare me away. What are your personal experience with patients taking it? Thank you

Jason Emer, MD · Answer

I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options and any concerns you may have about side effects. There are great non-invasive options like prp/progesterone which work well with finasteride. See an expert. Best, Dr. Emer

David Deutsch, MD · Answer

The reported incidence of sexual and other side effects from Finasteride is 1-2%.We have tens of thousands of men who take Finasteride daily and do fine.I would suggest consulting with a Dermatologist or experienced Hair Restoration Surgeon to see if Finasteride is appropriate for you.

Carrie Houssock, MD · Answer

Finasteride is the single best oral medication in terms of its efficacy for hair loss.  It is the only oral medication known to not only stop hair loss but IMPROVE hair over time.  However it does come with risk of side effects include ED and decreased libido.  While these side effects are rare, they are possible.  I find most of my patients in their 30s and 40s do not have an issue while taking it.  I will not suggest it to my older patients for their risk of ED increases with age.  In addition, in the rare circumstances where a patient has had side effects, they resolve once the medication is stopped.  It is best to attempt the medication under the guidance of a reputable hair restoration specialist.

Craig L. Ziering, DO · Answer

Propecia is a very good FDA approved treatment for hair loss for the appropriate male patient. It blocks DHT and prevents or reverses the miniaturization of hairs in thinning and balding areas. Its important to note that side effects can occur in approximately 2% of the patients that take the medication. The most common side effect is decreased sex drive. In most instances this side effect is reversible with discontinuation of the medicine, although there has been some reports of patients claiming persistent side effects. Before starting any prescription medication the patient should have a full evaluation by a listening physician, as well as a complete understanding of what the medication does. This would include any contraindications and side effects.

Melvin L. Mayer, MD · Answer

My patients have used finasteride since the late nineties, almost 20 years. It has been certainly the most effective and reliable medical treatment available during this time. However, I have had the predictable 2% who have sexual dysfunction, usually decreased labido who upon stopping the drug reversed in 1-4 weeks back to "normal". In my opinion it is very rare to experience "permanent" sexual side effects as mentioned in the FDA label. I personally took it for 10+ years with no side effects and still prescribe it if patients are willing to accept a small amount of risk.

Sahar Nadimi, MD · Answer

Androgenetic Alopecia (AGA), or hereditary hair thinning, is the most common form of hair loss in humans. This condition is also known as male-pattern hair loss or as female-pattern hair thinning. The cause of hereditary hair thinning is a gradual shrinkage of the hair follicle which occurs under the influence of androgen hormones. Basically, the 5-alpha reductase enzyme converts testosterone to dihydrotestosterone (DHT) in scalp hair follicles. In genetically susceptible scalp hair follicles, DHT causes the gradual transformation of large hair follicles to a finer and shorter hair (this process is called “miniaturization”). Finasteride (Propecia) is a medication that decreases levels of DHT by blocking the  5-alpha reductase enzyme.  It is a very safe and effective treatment of androgenetic alopecia in men. The risk of sexual side effects is about 5%, but upon discontinuation of the medication, the side effects go away. The decision to use Propecia is wise for patients with androgenetic alopecia as the medication has the potential to slow the thinning process. In order to determine if this medication is a good treatment option for you, a proper scalp exam is necessary. I recommend an in-person evaluation by a hair transplant specialist

Ilhan Serdaroglu, MD · Answer

You may have Post-finasteride syndrome, occurs in men who’ve taken finasteride to treat hair loss by a chance of %4-5. That may causes some symptoms include: loss of libido, erectile dysfunction, depression, suicidal ideation, anxiety, panic attacks, Peyronie’s disease, penile shrinkage, gynecomastia, muscle atrophy, cognitive impairment, insomnia, severely dry skin and tinnitus. The condition often has a life-altering impact on victims and their families, such as job loss and the breakup of marriages and romantic relationships..

William Yates, MD · Answer

Dear friend
The risk of any of those symptoms is very small.  If you have any side effects just discontinue. The medication is metabolized in the liver and out of your system in a short period of time.  I have used Propecia for 13 years without any issues.  I have also been in this industry for 15 years and I feel 2% is high.  However, if you have a mental block because of everything that you have researched, you will fall into that category.
I will advise you to give it a try. If this doesn’t convince you, you can try doing PRP. 
PRP (Platelet Rich Plasma) is one great option to take care of your hair. This procedure consists on getting some of your blood and putting it in a machine that will separate the different ingredients that are in the blood. From those ingredients we take the growth factors and inject them in your scalp. These growth factors will start working in your follicles enhancing your hair and reducing (and even stopping) the rate of your hair loss. If your follicles have not been dormant for too long the hair can regrow. This applies as well to baby  (miniaturized) hairs.
Best of lucks!

Sean Behnam, MD · Answer

In general I believe it's worth the risk. Ultimately it comes down to personal preference, but keep in mind that less than 5% of patients that take Finasteride even report side effects at all, and even then only a small group of them feel the side effects that are significant enough to stop taking it. And, of the small amount that do need to stop taking it, for the vast majority all side effects disappear within a few weeks of stopping Finasteride. Obviously there's always a risk with any medication, and whether that risk is too great is up to each patient.

William Rassman, MD (retired) · Answer

The risks of sexual side effects are about 3%. If you are one of the unfortunate 3%, then you can stop it. My son takes this drug and found an increased sex drive on it

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