Should the Leader of the Free World Be Taking Propecia?

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In an interview with the New York Times today, President Donald Trump’s long-time physician, Dr. Harold N. Bornstein, noted that the leader’s PSA levels are low because he takes finasteride (also known as Propecia) to keep his locks long. The leader of the free world might want to think twice about continuing with this prescription.

As we reported last year, the FDA-approved pill has been called into question, with emerging research and a slew of lawsuits suggesting that finasteride may be more dangerous than previously believed. Users report that its side effects — inability to orgasm, painful erections, chronic depression, insomnia, brain fog, and suicidal thoughts — can last long after patients stop taking the pill.

That’s not to say it doesn’t do its primary job. Finasteride, which first came out in 1997, has been shown to thicken hair in 65 percent of those who take it. And more than 26 new generic versions, priced at less than a dollar a pill (versus $3 for Propecia), have made the drug even more attractive. While the packaging warns of a 1 to 2 percent chance of temporary sexual side effects, millions of men consider that a risk worth taking.

However, since 2011, approximately 1,245 lawsuits have been filed against Propecia's manufacturer, Merck, alleging that the company failed to warn users of a constellation of sexual and cognitive side effects — which patients and physicians now dub "post-finasteride syndrome" (PFS) because, they say, symptoms often persist after discontinuing the drug. Now the National Institutes of Health has added PFS to its rare-diseases database. Two years ago, a California woman filed the first wrongful death suit against Merck. Her husband, a 40-year-old IT executive and father of two with no history of mental illness, killed himself in March 2013. His family blames finasteride.

Knowing the drug's origins might prompt some to shy away from it. Finasteride has its roots in the 1970s, when scientists discovered a rare group of men in the Dominican Republic who were born with ambiguous genitalia and often mistakenly raised as girls. These men possessed other unique traits: They never lost their hair or had prostate problems. This was because they failed to produce an enzyme that converts testosterone to dihydrotestosterone, or DHT. DHT is critical for fetal development of male genitals, but in adults it impairs hair growth. Enter Merck, which unveiled a compound — finasteride — that slashes DHT levels 70 percent. As experts describe it, the drug works by mimicking the sex-steroid profile of pseudohermaphrodites. Some former male users equate this to "chemical castration." To this day, health officials warn women not to even touch finasteride pills, because doing so could cause genital malformations in an unborn boy.

Put party politics aside, and there’s obvious reason why a president taking a prescription that some experts believe may bring on permanent mental illness (not to mention sexual dysfunction) is worrisome. As many PFS patients have claimed, the side effects of taking finasteride can come on suddenly, and years after beginning to take the drug. President Trump should count himself lucky if he hasn’t experienced any of these potentially dangerous effects. But unfortunately, that doesn’t mean he won’t in the future.