Propecia® (Finasteride 1mg) is an oral medication that was made available for hair loss prevention and hair regrowth in 1997. Propecia® is now available as a generic drug. Finasteride has been shown in multiple studies to be a very effective, if not the most effective medication in hair loss prevention. It works by interfering with DHT, the hormone involved in male or female pattern baldness.

Until a few years ago, I prescribed it to almost all of my surgical and non-surgical hair restoration patients. At that time, there were reported side effects, but the conventional wisdom was that upon cessation of Finasteride use, everything would return to normal. I have since changed my approach, and very few of my patients end up leaving my office with a prescription for Finasteride.

Over the past few years, a growing body of evidence is showing that Finasteride may be more harmful than we originally thought, and that, in fact, some of the issues that it causes my persist for months or years beyond cessation of use. In 2012, the FDA mandated that Finasteride included additional warnings on its label to warn consumers of several disorders that can “continue after the use of the drug.” This chronic condition has been named “Post-Finasteride Syndrome,” or PFS.

Here are a few of the potential side effects of Finasteride:

  • Impotence
  • Erectile Dysfunction
  • Decreased Libido
  • Infertility
  • Orgasm Disorders
  • High-grade prostate cancer
  • Gynecomastia (growing breasts)
  • Breast cancer

A growing body of doctors are also reporting other prolonged side effects of PFS, including, anxiety, depression, insomnia, and panic attacks.

So what’s my take on Finasteride?

I still think that it is one of the most effective treatments that I can offer to my patients suffering from hair loss. However, I think it is important that patients are fully aware of the potential long-term side effects, and that they are able to weigh these risks against the potential benefits.

ISHRS Hair Transplant Forum Volume 26, 1-6