His father and grandfather died with completely depleted heads. They started balding at an early age. With such background, Carlos ReruchaAlthough he was barely over 25 years old, he was beginning to worry about some areas of his scalp that had been “lightening” for some time. Family and friends told him about an effective solution to stop his incipient baldness: an “a priori harmless” alternative to the hair transplant. It was then, in 2021, when, on the recommendation of a dermatologist, this young man from Madrid began taking finasteride (marketed as Propecia), a medication that began to be prescribed in the 90s as a treatment for acne. Benign Prostate Hyperplasia (HBP) – increase in the size of this gland in elderly men – but over the years it has become an effective hair grower due to its proven action against hair loss.
He finasteride inhibits the enzyme 5-alpha-reductase, which transforms Testosterone (T) in Dihydrotestosterone (DHT), a hormone responsible for acne, prostate growth and also hair follicle recession. By inhibiting this enzyme, the medication also reduces circulating DHT levels – the more DHT that reaches the hair follicles, the greater the risk of baldness – and stops hair loss.
Currently indicated to combat both processes (enlarged prostate and baldness), finasteride is associated, in a small percentage of cases – about 2% – with a drop in libido, decreased ejaculate and erectile dysfunction. Some reliable scientific publications also relate it to the appearance of severe depression or suicidal ideations. In recent years, cases have also been reported in which the effects persist despite having stopped taking the pill, which is known as Post Finasteride Syndrome (SPF).
Last October, the European Medicines Agency (EMA) launched an investigation into the alleged links between therapy with this drug and suicidality. The procedure, led by the Pharmacovigilance Risk Assessment Committeeto (PRAC) of the EMA, will close in February 2025, when the Agency will issue a recommendation on whether the marketing authorizations for these medicines should be maintained, modified, suspended or withdrawn in the European Economic Area (EEA).
TO Carlos Reruchapresident of the Platform for People Affected by Finasterine (PAF), got the Chinese one. He suffers from Post Finasteride Syndrome. «The medicine stole my life. You are 29 years old and you don’t feel anything,” he says in statements to ABC. Insomnia, self-esteem problems, loss of libido, erectile dysfunction, depression and suicidal ideation These are some of the effects that caused this young man from Madrid to have to enter a psychiatric center twice after two years of treatment. «I didn’t want to live. “Just put an end to this nightmare,” says the affected person who still has not recovered normality in his sexual relations.
«Everything started to get out of control»
When Carlos went to a dermatologist looking for a solution for his alopecia, he promised him “obvious results,” and he did not lie to him. He also told him about the possible side effects of the medication, although he reduced them to a tiny percentage of patients and assured him that if he felt them he could reverse them by abandoning the treatment. There was a lack of truth.
There are at least 22,654 reported cases that link the intake of this drug with adverse reactions, which in some cases continue after stopping treatment, according to data from the Fundation Post-finasteride Syndrome (Likewise, a total of 56 countries have already warned about the existence of these persistent clinical symptoms. Carlos started with a 1 mg pill (the indicated dose of the drug to combat hair loss, in the indication as a medication against BPH is increased up to 5mg), combined with minoxidila vasodilator that improves blood flow to the hair follicles. A month after starting treatment, he began to notice changes in his sexual desire.
They lowered the dose and when he recovered they raised it again. Afterwards, he was prescribed 5 mg pills, which he cut himself to take his daily milligram. «That’s when everything started to get out of control. It was difficult to divide the doses exactly and one day I took a little and another a lot,” he admits. At the end of 2022, Carlos noticed changes in his mood for the first time. It was the prelude to “the fall into hell”he asserts.
“I had a feeling of castration”
In November 2022 “everything went wrong.” «I began to feel changes in my mood, hoarseness and erectile dysfunction problems. The drug was affecting me psychological level since it deregulates the synthesis of neurosteroids and neurotransmitters.” Although the ‘shock’ – as he defines it – came on December 23rd. «I had a feeling of castration, I suffered from insomnia, I had lost muscle mass, my anxiety was growing. All of this undermined my self-esteem. It was not an effect of my sexual problems, the drug was affecting me psychologically. Everything went to hell», acknowledges the patient.
He had lost control of his life and had not taken finasteride for months. The specialist recommended that he stop but it was too late. “Two years have passed and I still have the effects, although I have improved mentally somewhat with tough therapy sessions,” says Carlos, who in 2023 was admitted to a psychiatric clinic twice because he was determined to end his life. «Hair was the last of my worries. I had put my life at risk to have hair. I wanted to die, “No doctor believed me and I didn’t see a solution,” says the young man. His case is only one of the half a thousand registered on the Platform that he presides over.
Concern among andrologists
Andrologists and urologists consulted by ABC warn about the “abuse” that dermatologists make of this drug to combat alopecia and the possible “irreversible consequences” on the physical and mental health of those who consume them. They ask specialists to always inform patients about “the risks involved in the treatment.”
«They cannot deceive them by telling them that if they feel unwanted effects they can stop taking the pill. In most cases this is the case, but there are patients who stop the treatment and the symptoms continue,” the head of the Andrology Unit of the Urology Service of the Hospital Clínic of Barcelona tells ABC. Josep Torremade. The andrologist attests to the ‘boom’ of patients under 50 years of age and with alopecia problems who are using the treatment. “I see more and more men who come to my office with erectile dysfunction problems who take finasteride,” says Torremadé, who also recognizes the existence of SPF. Given the risks of the treatment, the specialist recommends “alternative hair therapies” and requires dermatologists to “inform patients about the risks associated with taking the drug.”
Ivan Schwartzmannassistant to the Urology Unit of the Puigvert Foundation in Barcelona, agrees with the Clínic expert that “the existence of side effects, in some cases persistent, should not be hidden from patients” and also advises dermatologists not to think about Finasteride “as a first option.” “It is clear, and it is even specified in the package insert, that finasteride can cause erectile dysfunction, loss of sexual appetite, anxiety and depression syndromes, suicidal ideations, etc.,” he says. For this reason, the urologist emphasizes the importance of “the doctor who prescribes it to inform the patient that it is not a harmless medication.”
From the Spanish Association of Andrology, Sexual and Reproductive Medicine, its president, Ignacio Moncadtois more cautious regarding the drug’s impact on sexual function. «Yes, it can influence libido but there is no clear pathophysiological mechanism that links it to erection problems. In this sense, I believe that there is more of a nocebo effect than a pharmacological effect,” says Moncada, head of the Urology Service at the Hospital de la Zarzuela in Madrid. He admits that “it is a topic under discussion and that there is clinical observation of the effects, although in some aspects there is no clear evidence of the pharmacological effect.” He admits that »there is clinical observation of the effects, although in some aspects there is no clear evidence of the pharmacological effect«.
Dermatologists consulted by this newspaper recognize the widespread indication of this medication in cases of androgenic alopecia and admit the possible side effects. «They appear in the drug’s technical sheet. Our duty is to inform patients that they exist and let them decide,” says the dermatologist at the Hospital de Sant Pau in Barcelona. Anna Lopez. Remember that adverse effects occur in a low number of patients, although the existence of Post Finasteride Syndrome is recognized. “Most dermatologists give all the information to their patients,” says López. However, many of those affected – the majority treated in clinics linked to aesthetic treatments – deny having been informed by their doctors about possible irreversible effects.
Carlos Reruchaat 31 years old, is still ill and considers his previous life lost. For those thinking about taking finasteride, he recommends that they “seek help to strengthen their self-esteem and not put their lives at risk.” “I wish I could turn back,” he concludes.
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