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For a couple of years, Marc had been using Rogaine, a brand name for minoxidil, massaging one of the few clinically proven hair-loss medications into his scalp. He was meticulous about his appearance, clean-shaven and neatly dressed. And he took particular care of his hair, which was dark and thick and always carefully styled. But by the summer of 2020, he was shedding, in his estimation, over 200 strands a day. Marc panicked. He went to his doctor and was prescribed finasteride. His doctor warned him of the drug’s potential side effects, as Marc recounted in a blog post, but he was told that they should abate if treatment was stopped. Marc had also heard about something called Post-Finasteride Syndrome, or PFS—a constellation of sexual, physical and mental side effects that, according to the small number of finasteride users who describe experiencing them, stick around long after taking the drug. He figured that the risk was low. So, in September, he decided to take the medication anyway. At first, he felt waves of relief, as if he’d outrun fate, cheated his own genetic lottery. But a few weeks in, something was off. Marc’s mind felt foggy. A year earlier, in 2019, Canada began requiring finasteride manufacturers to include a warning about the risk of suicidal ideation on the product’s packaging. Depression was also among the potential side effects listed on the labels. But there was no mention of brain fog—there wouldn’t be, as it’s not an official medical term. Marc stopped the medication, then tried it again on a lower dose. “That’s when the horror story began,” Denise told me. A week later, while watching a film with a friend, he had a panic attack. Holding onto his hairline no longer felt worth it, and he quit finasteride the next day. Marc’s brain fog didn’t stop. Nor did the panic attacks. His genitals shrank. They lost sensation. His joints cracked loudly when he moved. Ringing blared persistently in his ears. He was jittery, constantly on edge, unable to sleep. To Denise’s knowledge, Marc wasn’t taking any medications other than finasteride. “I don’t know what’s going on with my body,” Denise says he told her. “It’s like I’m in a torture chamber and don’t know what the next thing is going to be.” In mid-February 2021, Marc moved back in with his parents. When he tried to sleep, he’d get brain zaps. Or his back would spasm, and he’d cry out to Denise in pain. “I’m getting nothing,” Marc would say when he tried to hug her, “I cannot feel comfort anywhere.” Unable to rest, he’d go on walks for hours and hours in the freezing cold, sometimes all night. Marc was raised Catholic, but had lost interest in religion when he was a teenager. Yet on these night-time walks, if he saw a church, he’d sit inside. Denise barely recognized him. Marc noticed that his hairline had stopped receding. “I wish I’d lose hair,” he told Denise. “I wish I was going bald now.” Hair growth and loss prevention is a big industry. Market intelligence agency Business Research Insights projected it to hit $5.9 billion globally by 2033 as hair loss remedies—a distinctly hypercapitalist endeavor—fly off the shelves. But the maintenance of a lush hairline isn’t a new concept. One Egyptian recipe, dated around 1500BC, details a curious hair loss antidote: mixing fats from a lion, a hippopotamus, a crocodile, a serpent and a cat. In ancient Greece, the medic Hippocrates is believed to have dabbled with a mixture of horseradish, cumin, nettles and pigeon droppings. Goat urine is said to have been Aristotle’s anti-balding remedy, while Cleopatra reportedly suggested that her lover Julius Caesar try a gritty fusion of ground-up mice, horse teeth and bear grease. Well into the 20th century, people with thinning hair were subject to snake oil salesmen who proposed contraptions like vacuum helmets and elixirs such as paraffin injections that left people with lumpy scalps. In 1938, the US Food and Drug Administration (FDA)—the government department responsible for ensuring the safety of drugs, food, medical devices and cosmetics— adopted a set of laws that attempted to regulate cosmetic products. Hair clinics (and questionable treatments) still proliferated. “Neither massage, mechanical devices, tonics, ultraviolet light, hormones, vitamins, or any other treatment will regenerate hair loss in ordinary baldness,” the American Medical Association’s Committee on Cosmetics found in a report in 1949. Hair specialists, the report said, “have no qualifications other than a full head of hair, a business brain, and an appetite for easy money.” In 1997, the first FDA-approved hair loss pill hit the market. For years, a drug called finasteride had been used to treat enlarged prostates—blocking an enzyme called 5-alpha reductase that turns testosterone into dihydrotestosterone (DHT), the primary hormone linked to prostate growth in adults. But finasteride has another effect, too. P Roy Vagelos, then chief of research at pharmaceutical giant Merck & Co, came across a paper that suggested that the drug might also be able to halt a receding hairline. Merck rolled out Propecia—a bronze octagon pill containing 1mg of finasteride—with a bold mantra: “Help make hair loss history.” Sales grew throughout the aughts, peaking at approximately $385 million in 2010. In the background, some patients were describing a disconcerting array of side effects. On propeciahelp.com, a forum that started on Yahoo Groups in 2003, they weighed in. Skin pigmentation changes. Curving penises. Saggy skin. Premature ejaculation. “Uncontrollable, racing thoughts,” wrote one user; “I spent three weeks in bed because I didn’t want to do anything else,” wrote another. In 2011, endocrinologists Michael S Irwig and Swapna Kolukula co-authored the first peer-reviewed study into long-term sexual dysfunction after taking finasteride—a symptom of what would become known among patients and researchers as PFS. Though some note that the study had potentially biased selection methods, it prompted more investigation into persistent side effects of the drug, including depression and suicidal thoughts. No studies have definitively proven that finasteride is the cause of these symptoms. But according to a 2021 Reuters inquiry, Merck & Co., the company that first distributed Propecia, was aware that some users had described experiencing them. Reuters reported that Merck & Co. knew about accounts of suicidal behavior in men taking Propecia, but decided not to add the warnings to the drug’s label when it was updated in 2011. At the time, Merck told Reuters that “the scientific evidence does not support a causal link between Propecia and suicide or suicidal ideation” and that those terms should therefore not be included on the label. Asked by GQ if Merck was aware of reports of suicidal behavior in 2011—and if it was, why did it not alert customers or update the label—Organon, the company that acquired Propecia in 2021, didn’t respond directly. A spokesperson emphasized that Organon “stands behind the safety and efficacy” of the drug, adding that regulatory agencies around the world have “thoroughly reviewed” it and it has been subject to a “rigorous, routine post-marketing surveillance process.” By 2018, over 1,000 lawsuits had been filed against Merck & Co., with plaintiffs claiming persistent sexual side effects from Propecia. The company paid out about $4.25 million to settle hundreds of these lawsuits. Since then, the hair loss industry has only continued to grow. The belief that balding is bad is, of course, culturally relative. Christian and Buddhist monks shave their heads as a sign of religious devotion, while in some African cultures, such as that of the Edo people of Nigeria, chiefs traditionally shave parts of their heads to indicate their position of leadership. But hair rejuvenation companies profit from a different idea: that hair loss is a problem that needs to be fixed. Analysis conducted in 2010 and 2011 by Kevin Harvey, an associate professor of sociolinguistics at the University of Nottingham, found that websites promoting Propecia characterized balding men as social outcasts, while men with hair were depicted as attractive, successful and happy. One 2010 campaign, for an anti-hair loss product by L’Oréal, went so far as to depict a suicidal hair follicle sitting on the edge of a building roof, holding out a hand to the product so as not to jump. Unsurprisingly, most guys I speak to are more than a little bit anxious about losing their hair. “If you’re not six feet six and super stacked, super wealthy, it’s like, ‘Hang on a minute. I want to keep my hair,’” says Robb Dixon, cofounder of SIDEfxHUB, a nonprofit dedicated to people who suffer from PFS and post-SSRI sexual dysfunction (a condition where people experience persistent sexual side effects after stopping use of a common antidepressant). Ten years ago, Dixon, then 23, was hitting new professional heights. He was a tour manager, traveling the world with platinum-selling musicians. “Life was phenomenally good,” he says. But after taking finasteride for hair loss, which was prescribed to him via a UK telehealth service, he began experiencing erectile dysfunction and decreased libido. He stopped the pills, then experienced what is known among PFS patients as a “crash.” “Everything just collapsed,” he says. “It felt like being tortured 24/7.” He wanted to kill himself. Now, he still struggles with suicidal ideation. Telehealth services can improve access to care and reduce costs, but the lack of in-person evaluation may pose ethical concerns. While many countries have actively updated their regulations to accommodate virtual care, “There is no standardized process or protocol in place that all of these direct-to-consumer tele-health companies need to follow,” says Ashwini Nagappan, a US health services researcher. “Because those services are not typically integrated in an individual’s existing medical records, there have been concerns raised about whether these companies have captured a detailed medical history of an individual.” This is particularly concerning when prescribing medication is central to a company’s profit margin, as is the case with businesses like Hims and Ro, which prescribe and sell their own branded treatments. “There is a conflict of interest that affects prescribing behavior,” says Reshma Ramachandran, a primary care physician, health services researcher and co-director of The Yale Collaboration for Regulatory Rigor, Integrity and Transparency (CRRIT). “It’s very difficult often for patients to know for sure if their prescriber is acting in their best interests or acting for the company’s bottom line.” The more insecure men feel—and the more they are convinced that hair loss is partially to blame—the more companies selling anti-balding products are likely to profit. “It was a five-minute process,” says Mark Millich, who was prescribed finasteride through Hims (now Hims & Hers Health Inc.) in the summer of 2020. He took a few photos of his scalp, uploaded them, filled in the questionnaire, then got the prescription—all without directly speaking to a doctor. “It was on my doorstep within two weeks,” he says. Millich, 32, tells me he went on to suffer from PFS, which he compared to being “lobotomized overnight.” He’s since launched a YouTube channel called Moral Medicine, featuring interviews with people who describe life-altering, medication-induced side effects. Hims & Hers told GQ the screening process for potential finasteride customers is conducted by independent, licensed healthcare practitioners and backed by “rigorous quality standards,” with each customer “clearly presented with essential information, including potential side effects, in multiple places before they begin treatment and throughout their care journey.” Before starting finasteride, banker turned gardener Marc Turner had watched a handful of YouTube videos about PFS, featuring apparent experts who said the condition wasn’t real. But weeks into taking the drug, he began to fret that he’d made a mistake. Convincing friends and family that he had PFS was another story. “It was so foreign and bizarre,” says Denise. At the beginning, she wondered whether her son’s symptoms could be psychosomatic, whether reading about the side effects was causing him to experience them. “Maybe you’re just anxious,” she’d suggest. “Do you think it’s possible that your brain is making these things happen?” Marc had already become isolated from numerous friends who couldn’t understand what he was going through. Over the course of several months, he visited a general practitioner, a urologist, a neuroendocrinologist, a sleep specialist and multiple psychologists and psychiatrists. He was prescribed pills and more pills. He met the head of urology at a Toronto hospital and left with a prescription to treat erectile dysfunction. He’d look his mum in the eye and plead for her to believe him. It sometimes felt like no one else did. For people suffering with PFS, the lack of support can feel as bad as the condition itself. Several men I spoke to described how they had been “ping-ponged” between experts, who told them that what they were experiencing could not be caused by the drug. Marko Cetinic was 36 and working as a gaming developer when he started taking finasteride. After just three pills, he noticed a bit of numbness in his penis. He stopped the drug immediately. At 10.30 a.m. the next day, he experienced a crash. His heart began pounding. His ears rang furiously. It felt like something had exploded inside him. Cetinic spoke to his doctor, his dermatologist and his therapist: none of them blamed finasteride, he says. It felt like the universe had been turned upside down. “It’s like 1984; two plus two is five,” he says. About two months after this incident, he admitted himself into a psychiatric facility. He stayed there for just over a month. “My dignity was taken away,” he says. While PFS patients describe side effects that amount to a relatively consistent set of symptoms, the condition is not medically recognized. There is also disagreement among the medical community about whether finasteride is actually causing the symptoms. One 2007 study published in The Journal of Sexual Medicine indicated that patients taking 5mg doses of the drug who were aware of its possible side effects were more likely to experience them (what is known as the “nocebo effect”). Then, in 2019, researchers posited that PFS may potentially be a “delusion disorder” and, possibly, a case of mass psychogenic illness—when multiple members of a community develop similar, often bizarre symptoms, without medical explanation. “The tenacity with which the patients hold on to their belief system, despite any rational argumentation against it, is indicative of at least a delusional aspect to their disorder,” the researchers wrote. Even when medical professionals do believe that finasteride may be the cause of patients’ symptoms, the condition remains a mystery. There is no known cure. This is partly because it is notoriously difficult to prove that a specific drug can cause a psychiatric condition. It’s hard to demonstrate causality—to show that a drug is directly responsible for an adverse effect. “It’s not like people are turning blue or they’re getting permanent liver damage, where you can just say, ‘Oh, wow, look, here is this physical lesion,’” said Josef Witt-Doerring, a psychiatrist who specializes in treating adverse psychiatric drug reactions. “We are talking about things that are less tangible.” PFS Network, a charity dedicated to understanding the condition and identifying potential treatments, is currently funding research into the genetic factors that might be involved. However, at present, there is no consensus about what causes PFS, how symptoms can worsen once the drug is stopped, and why some patients suffer adverse side effects while the vast majority of finasteride users do not. “From a pharmacological point of view, [PFS] is irrational,” says Roberto Cosimo Melcangi, an endocrinology professor at the University of Milan who is researching PFS. “In medicine, you have very few drugs that induce a persistent effect [years after the patient has stopped taking it]. There is no very real explanation.” Almost a year after first taking finasteride, Marc would spend the day crying, or trying to cry—he could no longer produce tears, which seemed to create an intense pressure in his head. The only moments his pain appeared to lift was when his five-year-old godson came over, and they would play cards. “You don’t feel like you’re part of the human race any more,” Denise explains. It felt like a switch had been turned off, the parts of him that made him feel like he was living. Marc told his mother that he couldn’t feel love any more, which she refused to believe. If he didn’t love her, why did he buy her a silver heart necklace on Mother’s Day? Why did he hug her and his sisters? “I’m trying to get it back,” he told her, “I do love you. I can’t feel it.” Marc tried ketamine therapy. He did three sessions and left “feeling even more agitated, deflated and traumatized,” he wrote in a blog post about his experience. Denise was forced to do the unthinkable: help her son look into assisted dying. He wasn’t eligible in Canada. At one point, Denise discovered a set of suicide notes in a drawer beside Marc’s bed, addressed to her, his dad and his sisters. “Every day, we lived with the fact of: When will this occur?” she told me. “I don’t even want to die. But I can’t live,” Marc said to his mother. He’d beg for her acceptance. “You have to let me go.” In May 2012, a 30-year-old former public health researcher called Kevin Malley staged a hunger strike outside Merck & Co.’s New Jersey headquarters. “I want Merck to see how their drug is destroying lives—and know that I’m just one of thousands of victims suffering across the globe,” Malley said in a press release, explaining that he’d suffered erectile dysfunction, severe memory loss and disorientation after stopping finasteride. The previous month, the FDA said that labels for Propecia would be expanded to include multiple persistent sexual side effects, following 59 reports between 1998 and 2011. But there are still so many unanswered questions—and with millions of men turning to finasteride to ward off balding—the potential damage should not be overlooked. Preliminary findings from as-yet-unpublished research funded by the PFS Network have indicated that people who take finasteride at a younger age may be more likely to develop the syndrome, but more research is needed. If this is true, it would be particularly worrying, given that Gen Z is the generation most exposed to social media and paid ads. A small minority of cases could turn into a not insignificant number as uptake increases; Hims & Hers Health, maybe the most recognized name in US direct-to-consumer telehealth for hair loss prevention, posted a net second-quarter income of $42.5 million this year, up from $13.3 million in 2024. The company now has over 2.4 million subscribers taking their array of medications, 31 per cent up on the previous year, and the average monthly online revenue per subscriber has jumped from $57 to $74. In spring 2022, Marc took his life in a hotel room. “I will go down as a suicide, but I was essentially murdered by Big Pharma,” Marc wrote in a note he left in the room. “The drug took everything from me, even my dignity.” In June that year, the FDA began requiring that US patients be notified about reports of suicidal behavior in men taking Propecia. This May, the safety committee of the European Medicines Agency confirmed that suicidal ideation is a potential side effect of finasteride. When I speak to Denise Turner over Zoom in June, she’s wearing the silver heart necklace that Marc bought her when he was ill. After he died, she planted a blue spruce tree in the park at the end of their street, in honor of the one he’d planted and nurtured in Lake Promenade. Sometimes, when she talks about what happened to her son, she feels as though people are skeptical, that they don’t believe that his suffering was caused by finasteride. She understands. “It’s a very hard thing to believe,” she tells me. But Denise is determined to prove that it was the reason why her son went through hell. “This did happen,” she believes. “This was the drug.” Illustrations By Micha Huigen This story originally appeared in British GQ.
