Snippet from the article:

Men who take the hair-loss medication Propecia and develop sexual side effects may be at risk for severe depression and suicidal thoughts, a new study suggests.

In the study, 64 percent of men who developed long-lasting sexual side effects from the drug also reported experiencing moderate or severe symptoms of depression, and nearly 40 percent reported suicidal thoughts.

Low libido and erectile dysfunction have been reported in men taking Propecia, and in some, the side effects persist after the medication is stopped. It is not known how many men experience long-lasting sexual side effects from Propecia, but it is thought to be a small percentage.

Doctors and Propecia users should be aware of the potential serious risks of the medication, “especially as it is being used cosmetically, to alter a normal age-related process,” said study researcher Dr. Michael Irwig, an assistant professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C.

Read the rest — Hair-loss drug linked to severe depression in men

I’ve already received a couple dozen emails from readers sending me links to various articles written about this (and some links to press releases from law firms seeking out people looking to sue). I really am having difficulty here in that the report cited: “Irwig interviewed 61 young men whose average age was 25, who had previously used finasteride (the generic name for Propecia). All the men had experienced sexual side effects for at least three months after they stopped taking the medication. They had not experienced sexual problems before taking the medication, and did not have a history of mental illness.”

Reports that I have read from other countries don’t seem to report the severe sexual side effects or depression as reported in this article, so I am certainly confused. With 100% of those interviewed for this study reporting lasting sexual side effects, there appears to be a bias in the reporting and I have to wonder if these were among the same group of patients that were also interviewed from the Propecia complaint forums (like the last media blitz from Dr. Irwig’s interviews).

With that said, from my readings and from an occasional patient who reported mood alterations from Propecia, I have little doubt that in a subgroup of patients, the 5-alpha-reductase blocker does impact some brain function, perhaps enough to be a cause of depression. On those patients who had some alteration in mood, the symptoms went away in a few days after they stopped the drug.

Certainly, this latest wave of media coverage is alarmist. The article notes that “the findings are preliminary, and further research is needed to confirm them” but that isn’t going to stop the swarms of ambulance chasers looking to make a buck.

Hi Dr.,
You often mention how the half-life of finasteride is not so long. Why can’t you make it longer so that the dose is distributed over a week, rather than a day, and you could just take one pill per week? Many drugs are “extended release,” no?

I think taking a pill once a day is not too difficult for most people, but I don’t know if they’ve attempted making an extended-release pill.

For those who may not know how half life works, if you take a drug at 8am and the half life is 4 hours, at 12pm you will have 50% of the drug left in your blood stream, at 4pm you will have 25% left, at 8pm you will have 12.5% left, at 12 am you will have 6.25% left, at 4am you will have 3.125% left, at 8am (NEXT DAY 24 hours later) you will have about 1.5% left. Time to take another pill!

I am 43 years old and I have taken propecia for years with none of the scary sexual side effects but I have lost body hair on my arms and chest. In fact, I have gone off of propecia on a number of occasions (when my wife and I decided to start a family I thought it better to be off for a few months before we conceived). My body hair would reappear after a few weeks of being off propecia, and would then fall out again once I resumed propecia. Nobody can tell me loss of body hair is not connected to propecia. It doesn’t bother me seeing as I don’t have the other side effects.

A loss of body hair may be connected to Propecia (finasteride), but it is a rare side effect that I have seen only a handful of times. DHT (which Propecia targets at decreasing) is a cause of male pattern hair loss, but DHT is also responsible for secondary male characteristics such as arm, chest, back, pubic, nose, and ear hair GROWTH. I’ve also been asked about an increase in body hair after taking Propecia.

The majority of patients who take Propecia will not notice any change in their body hair. I’ve written about this before here, here, and here.

Dr,

Do you have any theories or ideas as to how prostogladin d2 (studies recently show bald men to have higher levels in the scalp) fits in with the factors which we know contribute to hair loss like genetics and DHT?

Is this something you discuss with your fellow professionals and do you think that this discovery of PGD2 will lead to less invasive ways to slow or stop hair loss any time soon?

I’m asking as somebody who can’t take propecia due to side effects who wishes there was another way!

Researchers have found that Prostaglandin D2 is present in bald scalp and not in a hairy scalp. The suggestion is that PGD2 is an inhibitor of hair growth in AGA and some researchers believe that the PGD2-GPR44 pathway is a potential target for treatment.

This is still in the research area and there is no drug that I am aware of that will be available clinically at this time. I’m always hopeful for new proven treatments, but whether this is one of them remains to be seen.

Hi i’ve currently been taking Proscar 5mg tablets cut into quarters I take it 6 times a week and have a 1 day break (so im intaking 7.5mg per week) I’ve been on the drug for close to 4 months. firstly is this acceptable or should I be looking to take it every single day?

Also my main question, I have alot of vellus like hairs some grow to a centimetre or so some are eternally lingering around 1mm, small and blonde my plan with finasteride is to revert these hairs back to the terminal stage, I’ve noticed my remaining terminal hairs look stronger right now but im wondering the rough timescale of when I should see my vellus hairs growing in stronger, I know everybody responds differently but if you could ball park the average for me and maybe explain what I should see process wise (does anything change to let me know etc) if the medication is working for me. Many thanks!

This should be discussed with the doctor that prescribed you the medication. In general, the recommended treatment for male pattern baldness is 1mg finasteride per day. Many patients break up the 5mg finasteride pill into four pieces and take 1.25 mg per day with no issues. The half life of finasteride (Propecia) is about 4 hours, so after 24 hours almost all of the medication is out of your blood stream (even if you took a 5mg dose or 1mg dose or 1.25mg dose). Thus, the medication is meant to be taken daily (without skipping) so that you maintain a consistent level in your blood stream. It is not a cumulative dose over a week. You cannot take a 7mg pill once every seven days and expect it to work the same as taking 1mg daily for 7 days.

Finally, without an examination I really do not have any way to know if the medication is working for you. Ideally, one would have a measurement done before you started the medication (such as a photograph, miniaturization study, or bulk measurements) and compare this with a follow-up measurement. Otherwise it is just a subjective guess.

The Propecia timeline for results can be found here.