By Adam Hurly.
Earlier this year, the web was atwitter about claims that Donald Trump was taking hair regrowth drug Propecia. It’s a drug that decreases the conversion of testosterone to dihydrotestosterone, which in turns prevents hair from falling out (since dihydrotestosterone is a big culprit behind balding). It wouldn't be surprising if Trump takes Propecia; that wispy, discolored mop looks anything but natural. Or perhaps, like Samson the Israelite, Trump's power is somehow linked to his flowing locks. It makes total sense that he would do whatever possible to prevent balding. (Hey, anything to make sense of the guy.)
This bit of gossip aside, it's a big question for guys in their late twenties and early- to mid-thirties: How far will you go to prevent hair loss? Are you going to move to Nova Scotia because you read somewhere that pollution causes male pattern baldness? Or will you embrace it and shave your hair as closely as possible?
Hormone-altering drugs like Propecia have numerous potential side effects. Many of the outlets blogging about this Trump item pointed out that Propecia can cause mental confusion and impotence in rare cases—though most guys see no negative side effects at all. (Trump, obviously, has never been impotent.)
If you’re thinking about taking Propecia (aka Finasteride, its generic name), it’s imperative to educate yourself about your chances of a positive outcome and the potential harms. To help you sift through all the noise, we asked three dermatologists to tell us exactly what they tell their patients before prescribing anything.
1. Once you start taking it, you need to keep taking it “If Propecia is discontinued, all the hair retained in that period will fall out,” says Jane F. Kardashian, MD in Fresno, CA. So, you’re basically committing yourself to using this drug for life.
2. Finasteride is traditionally a medicine that treats enlarged prostates “Many men take this drug in much higher doses for enlarged prostate and we only use one fifth of that dose for hair loss,” says Lindsey Bordone, MD at New York Presbyterian and Assistant Professor of Dermatology at Columbia University. Your insurance may not cover a 1mg dose of Finasteride, since this is such a low dose that it’s clearly being used for cosmetic reasons. One workaround is that your insurance might actually cover the 5mg dose, used to treat enlarged prostates. Some guys cut these pills into fifths—good luck with that task. But seriously, do not take the whole pill. Because…
3. Especially high doses (like 5mg) can lead to breast cancer in men “One side effect can be breast enlargement, and other changes in breast tissue which might be a sign of male breast cancer,” says Kardashian. “A ten-year study published in the Journal of Urology found no link between Finasteride 1 mg and male breast cancer. However, studies of Proscar (Finasteride 5mg) used to treat benign prostatic hypertrophy (BPH), did show a rare increased rate of breast cancer of 1.5 out of 20,000 patients. So, this may be dose-related problem and warrants further investigation.”
4. Also, you might lose your sex drive… “Because many men want to keep their hair to attract a sexual partner, perhaps the most annoying side effect is sexual dysfunction,” says Kardashian. “3.8 percent of men reported one or more adverse sexual consequences, like loss of libido, impotence, or failure to ejaculate." So, small as the risk is, you're definitely rolling the dice when you take Propecia.
5. …And your libido might not come back for a while “Symptoms can persist for a longer period of time than what we previously believed, even after stopping the medication,” says Filamer Kabigting, MD, who also practices at New York Presbyterian, and is an Assistant Professor of Dermatology at Columbia University. Bordone adds that she has never had patients with this issue, and that anybody who does should see his urologist immediately.
6. Propecia might not be the best solution for your specific case “Before taking Propecia get a full hair evaluation by a knowledgeable healthcare provider to determine if the hair loss is caused by an underlying medical condition,” says Kardashian. “There are many causes of hair loss many of which are reversible and include fungal infections, autoimmune disorders, traction from tight braiding, and telogen effluvium (caused by fever, surgery, chronic illness). This diagnostic step is best carried out by a dermatologist who has spent time learning about hair structure, function, and diseases.”
7. The closest alternative is Rogaine “Rogaine, or minoxidil 5%, is the most common first-line treatment,” says Kabigting. “It’s simple to use and proven to work, but you have to use it regularly, twice daily, to maintain its effect. Mild scalp irritation can develop in some, but this can largely be avoided by minoxidil foam rather liquid. Like Propecia, it can take while to see results—up to six months—so be patient. It is otherwise well tolerated, and affordable: as cheap as $10 per month.”
8. Men who are trying to conceive might want to temporarily discontinue “There is a risk of decreased ejaculation volume,” says Bordone. “I mention this to men who are trying to conceive and explain that if there is any delay beyond several months in their partner becoming pregnant, to consider taking a break from the medication.”
9. It actually works in preserving and regrowing your hair “In studies, 80 percent of men taking Finasteride 1mg preserved their original hair follicle counts and 64 percent experienced some regrowth after two years of continued use,” says Kardashian. “Additional studies at one, two, and five years respectively showed hair loss at a rate of 58, 72, and 100 percent in groups of men receiving placebo, versus 14, 17, and 35 percent hair loss in men taking Propecia.”
10. Scare tactics aside, negative side effects are fairly rare “Overall I have no less than 300 men on this medication, and in the last few years have not had a single patient tell me that he is discontinuing the medication due to side effects,” says Bordone. Either way, pay close attention to your own body’s response, and speak with your dermatologist immediately at any indication of a change.
Bottom line: Losing your hair isn’t the worst thing in the world. Even power donuts can look good when worn with confidence. Should you want to avoid Propecia or Rogaine, though, there's always hair transplants or micropigmentation.
This story originally appeared on GQ.
More from GQ: