The slogans, plastered over websites and social-media adverts, promise a ‘healthy, handsome and happy you’. In accompanying images, attractively tousled millennials and stylish, bearded middle-aged men with gorgeous girlfriends sip cups of coffee. It might look as if they’re selling designer furniture or espresso machines, but they are promoting companies that sell an £18-a-month hair loss medicine.
‘Hands want something to run through,’ reads one blurb. ‘The wind needs something to mess up. Graciously oblige by doing what you need to do to keep your hair on your head.’
Another says: ‘To have an issue isn’t weird. Not handling it – that’s weird.’
In the past, popping pills or using lotions to prevent balding was, if not unspoken, a fairly unglamorous option. But the message here is starkly different: Wanting to look good, and keep your hair, is nothing to be embarrassed about – so why not take a pill to help with that?
The companies behind these campaigns have taken a similar approach to marketing erectile-dysfunction drugs, with eye-catching billboard campaigns featuring similarly good-looking models. And they have been astonishingly successful.
One US firm, Hims, launched in 2017 and is now worth more than £2 billion – thanks, no doubt, to its quirky approach. Alongside the pictures of genetically blessed men on its website are trendy pug dogs sporting comedy wigs, and it recently ran a clever campaign featuring an array of boiled eggs, with shells carefully cracked to look like different hairdos.
Oxford-based brand Manual provide tablets in stylish, green-hued packaging reminiscent of grooming products, while London company Numan regularly advertises during football matches on Sky Sports, telling men to ‘do something’ about the ‘despair, despair, despair’ of thinning hair.
London company Numan regularly advertises during football matches on Sky Sports, telling men to ‘do something’ about the ‘despair, despair, despair’ of thinning hair
The drug they sell, called finasteride, has a decades-long track record of treating hair loss – and, for the vast majority of patients, it is safe and effective. In the US alone it’s thought there are more than one million men taking finasteride, including former president Donald Trump.
Yet there are concerns about the tablets. The Mail on Sunday has heard from scores of men who claim that taking finasteride has left their health in tatters. Impotence, depression, flaky, puffy skin, insomnia and drastic weight loss are among just some of the problems suffered by young men – with symptoms often lasting for years after stopping the medication.
One user said: ‘I haven’t been able to get an erection for months. I can’t have sex with my girlfriend any more. All for a hair-loss drug.’
Finasteride works by blocking the conversion of the male hormone testosterone into dihydrotestosterone, or DHT. High levels of DHT are believed to lead to hair loss by shrinking follicles on the scalp.
Finasteride was originally developed, and taken at higher doses, to treat enlarged prostate, a common condition affecting middle-aged men that causes problems with urinary flow.
But users began to see unexpected hair growth. When given in lower doses in studies, more than 80 per cent of men who take it stop losing their hair and 65 per cent see hair begin to grow back, often within months.
The effects last as long as the patient continues to take the drug. Customers buying it online have to fill out questionnaires and in-house clinicians review each request before authorising its sale.
All the companies mentioned state on their websites that possible side effects include depression and erectile dysfunction. But experts worry that some men buying finasteride may not be fully aware of the potential downsides.
Dr David Fenton, a consultant dermatologist at St John’s Institute of Dermatology in London, regularly prescribes finasteride. He says: ‘When we put patients on this drug, we monitor them closely.
‘I don’t think it’s a good idea to be able to access it without the support of a medical expert.’
One US firm, Hims, launched in 2017 and is now worth more than £2 billion – thanks, no doubt, to its quirky approach. Alongside the pictures of genetically blessed men on its website (left) are trendy pug dogs sporting comedy wigs, and it recently ran a clever campaign featuring an array of boiled eggs, with shells carefully cracked to look like different hairdos (right)
A number of recent studies have shown a link between regular use of finasteride and severe side effects.
In 2017, Canadian researchers found it increased the risk of mental health problems, including suicidal thoughts. That same year, a study in the US found some men taking the drug were left with erectile dysfunction for four years afterwards.
Merck & Co, the pharmaceutical company that created finasteride, has long denied any link between its medicine and serious long-term side effects – despite having paid out millions of dollars in the US to patients who claim to have been damaged by taking it.
Earlier this month, documents released in a New York court showed the drugs giant had been aware of reports of finasteride patients having suicidal thoughts since 2009.
Meanwhile, a paper published in June last year by Baylor University in the US examined the effect of finasteride on young men and found that nearly 70 per cent of study participants experienced abnormal ‘penis shrinkage’. Two subjects died by suicide – one during and one after the study.
Such is the scale of the problem that support groups have sprung up online and given a name to the wide-ranging collection of symptoms: post finasteride syndrome.
While blood tests and scans show nothing abnormal in the majority of people taking finasteride, medics agree the physical and mental health problems are all too real.
‘When doctors see these men who complain of sexual performance issues and depressive episodes, they automatically think it’s a mental illness,’ says Professor David Healy, a psychiatrist at McMaster University in Canada and founder of RxISK, a pressure group that campaigns to highlight drug side effects. ‘But I’ve seen at least 1,000 cases of post-finasteride syndrome in my time and the symptoms are clearly physical, too.
‘Flaking or bloated skin, a sudden loss of muscle mass, numbness in the genitals so severe I know a man who put chilli paste down there to see if he could feel anything.’
At present, experts don’t know why some men who take the drug suffer this way. To confuse matters, many say symptoms only worsen months after they stop taking it. As a result, many complain they have been brushed off by doctors and accused of being hypochondriacs.
One of them is James Dillon, who began seeking treatment for hair loss in January last year when he noticed he was ‘thinning on top’.
Looking back, James says he wasn’t sure he was even balding that badly but, like many men his age, the 29-year-old plumber from Staffordshire was image-conscious. ‘I’ve always tried to look my best,’ he says. ‘I go to the gym, I eat healthy, I play football. I just wanted to keep looking good.’
Searching for answers online, James came across multiple websites selling finasteride. He read up on the possible side effects and says he found them a bit shocking, but he reasoned that these were highly unlikely. ‘Even if I did get them, I’ll just come off it and it’ll be fine,’ he says.
Oxford-based brand Manual provide tablets in stylish, green-hued packaging reminiscent of grooming products
James didn’t buy the pills immediately. He took a few days to mull it over. But during those days he was badgered on his social media by targeted pop-ups ads from companies selling finasteride.
He says: ‘It seemed pretty easy-going, just a pill a day, not much risk involved. So I just decided to go for it.’
James logged on to an online pharmacy and requested the drug. He was instructed to fill out a questionnaire, which, among other things, checked that he was aware of the possible side effects. Ten minutes later, he was approved for a prescription.
A few weeks after starting the medication, during sex with his partner, he found he was unable to perform. ‘I just couldn’t,’ admits James.
‘I had no sexual response whatsoever.’ He immediately stopped taking finasteride, but the sexual problems got worse.
A visit to his doctor didn’t help. He says: ‘My GP said he prescribes finasteride a lot and now that I’d come off the drug, the symptoms would go away.’ But they worsened.
He adds: ‘I lost all sexual feeling. I started having horrible thoughts. Suicidal thoughts. I’d never had any mental health issues in the past before and suddenly I had this wave of depression over me.’
James is still suffering. ‘My girlfriend was really understanding but it’s definitely taken a toll on our relationship. We haven’t been able to have sex for a year. I’m lucky we’re still together.
‘I only took it for three weeks, now I’m a shell of myself.’
Another sufferer, Simon Breidert, a psychiatric worker from Berlin, began taking finasteride in 2015.
He says: ‘I was in my mid-20s and still single. I started losing my hair and I had a panic that I would be out of the dating game. It wasn’t even that much hair loss, I just wanted to get ahead of the problem.’
Simon went to a doctor for a second opinion who told him finasteride was safe and there was nothing to worry about.
He started taking the pills and was pleased with the results. He says: ‘My hair stopped falling out pretty quickly and then some of it began to grow back.’
But within a year he started experiencing strange symptoms. He says: ‘My skin got really dry and I started having trouble sleeping. I’d just moved house and I put it down to stress.’
Several months later the symptoms had not gone away and Simon decided to come off the drug – and his health began to deteriorate rapidly. ‘I lost almost two stone in six months,’ he says. ‘I got awful headaches, and I couldn’t focus at work.’
Simon Breidert, a psychiatric worker from Berlin, began taking finasteride in 2015 but then started experiencing strange symptoms
Concerned, he went back to his doctor and had a number of scans and blood tests. All of them came back normal. Yet his health worsened. He felt ’emotionless’ and adds: ‘My problems concentrating got so bad that I had to stop driving. It was the worst time of my life.’
Now 36, Simon claims things have improved in the past year and his insomnia has faded. He credits this change to regular exercise and a healthy diet, but is still shaken by the experience and the fact that no doctor could offer him any treatment.
Simon has now founded the PFS Research Association to campaign for official recognition of post-finasteride syndrome and raise funds for further research into the causes and a possible cure.
He says he was motivated not just by his own scarring experiences, but also because of the many others he has spoken to who have been through similar ordeals. During his illness, Simon turned to online support forums and says he was struck by the scores of men desperately looking for answers.
One forum, the Post-Finasteride Syndrome Foundation, has 2,500 members all suffering from long-term side effects they claim were brought on by the drug,
Founder Philip Roberts says he has seen an increase in sufferers who have purchased the drug from the slick new online companies.
He says: ‘On average, we are contacted by 45 new patients every month from across the globe. That’s up 462 per cent since 2018. An ever-growing number of these patients tell us they were prescribed finasteride virtually by telemedicine companies.
‘Long-term sexual dysfunction in men who have taken finasteride has been well documented for at least three years now.
‘And, in the past 18 months, an increasing number of studies have referenced depression and suicidal behaviour as being linked as well.
‘The fact that the drug is now being peddled in designer packaging doesn’t change its many inherent dangers to physical, sexual and mental health.’
Dr Fenton said for the majority of people, finasteride is completely safe.
‘In about five per cent of patients you might see side effects, such as temporary loss of libido or erectile dysfunction, but these almost always go away when the patient has stopped taking the drug.’
But he is quick to warn it is a ‘serious’ medication. He continues: ‘There is this risk of side effects, sometimes quite serious ones, with this drug.
‘For that reason patients need to be properly informed about the potential dangers of starting any drug of this kind.
‘They need to be told about a full range of treatment options. This drug definitely should not be given to patients as a first option. It should be for people who have exhausted their options.’
The Mail on Sunday contacted Hims, Manual and Numan for comment. All said that they offer ongoing clinical support to patients. They said they always assess for underlying risk factors before prescribing finasteride and provide patients with safety information.