While the leader of the United States is not required to have an annual physical, President Trump recently had one and released the results to the public. He was reported to be in good mental health while also weighing 239 pounds.
Just one year ago, Trump’s private doctor, Dr. Harold Bornstein, revealed Trump uses finasteride, a drug that reduces the size of the prostate glands as well as stimulates hair growth. His use of finasteride is believed to be one of the reasons Trump has not advanced to the higher stage of hair loss. The drug also explains why his PSA (prostate specific antigen) was so low at 0.15.
Concerns about Side Effects
While many men across the country take the medication on a regular basis, there are concerns about side effects that go along with the drug. According to Dr. Parsa Mohebi, a Beverly Hills hair restoration surgeon, “The main side effect of finasteride that is documented is a decrease in sex drive. This happens in only 1% of the patients using it. There are more rare side effects such as testicular pain and breast enlargement. My observation in my office is in line with the results of those scientific studies. Finasteride is well tolerated by patients and they occasionally have side effects.”
Since there is concern about side effects caused by the continued use of finasteride, why do patients keep using the medication? Dr. William Rassman, of the New Hair Institute in Los Angeles, says “Men use finasteride because of its strong effect on hair growth. For the 97% who don't get the negative sexual side effects, or other side effects, they frequently either get to keep their hair or in some situations, regrow their hair.”
Depression and Suicidal Tendencies
According to a 2017 research paper by Western University in Ontario, evidence shows the mental health risks of using finasteride. The evidence points to an increase in the risk of depression as well as suicidal tendencies and anger on the part of patients.
During the same week the Western University research paper was released, a study by Northwestern University Feinberg School of Medicine found many of the participants in the study were impotent for four years after taking Propecia (the brand name for finasteride).
Finasteride belongs to a medication class, 5-alpha-reductase inhibitors (5ARIs), which have come under scrutiny by the United States and Canada because of their possible link to mental health issues. Researchers at Western University, led by Dr. Blayne Welk, examined finasteride and another 5ARI called dutasteride. Welk's team analyzed data from 93,197 men at least 66 years old when they received 5ARIs prescriptions between 2003 and 2013. They also studied another 93,197 men of a similar age who had never filled a prescription for a 5ARI.
The men using 5ARIs had an 88% higher risk of harming themselves during the first18 months of use. Men in the 5ARI group also had a 94% higher risk of depression in the first 18 months as opposed to the men not taking the drugs. After 18 months, the increased risk of depression fell to only 22%. The type of 5ARI did not appear to significantly alter the results.
Welk did note that the actual risk of depression and self-harm is very low. He added that, while the study wasn’t designed to prove if the drugs were causing the side effects, self-harm is less common than depression. However, it is a potential risk that patients need to be aware of before taking the medication.
Erectile Dysfunction Concerns
In addition to the risk of depression, a separate study spotlighted the concern of erectile dysfunction with the use of 5ARIs. Dr. Tina Kiguradze and Dr. William Temps of Northwestern University Feinberg School of Medicine in Chicago, along with their colleagues, found when erectile dysfunction occurred in men taking 5ARIs for at least 180 days, the dysfunction was still likely to continue at least 90 days after they stopped taking the medication. Plus, erectile dysfunction resolved faster in patients who took the medication for a shorter period of time.
While there is no outward indication that Trump is suffering from any of these side effects, the long term use of the medication is certainly a cause for concern among patients. When asked about sexual side effects associated with the use of finasteride, Dr. Alan J. Bauman of Boca Raton, Florida, said “About 2% of patients on finasteride will likely experience decreased libido or decreased sex drive, mild erectile dysfunction or difficulty maintaining a hard erection, or decreased ejactile volume.” He added that “it is important to realize that 98% of finasteride users report absolutely NO side effects and the drug has millions of man-years of success behind it around the world. Also, changing the quality, frequency, timing or amount of the dose of finasteride is a common method of reducing side effects while maintaining some hair-protective effects of the medication.”
Are There Other Options?
Are there other options for patients who desire a full head of hair? According to Dr. Rassman, “Finasteride is the best option. Alternative, less predictable options includes the use of topical minoxidil.” When asked the same question, Dr. Mohebi said, “We can use alternative treatments such as Rogaine (minoxidil) or Low Level Laser for hair loss when finasteride is not indicated. Hair transplant is the only permanent solution that can give most men a full head of hair. Hair transplants have advanced significantly within the last few years and can create undetectable results with minimal complications.” Dr. Bauman said that “even if patients undergo hair transplantation, which results in permanent hair growth, they still need to protect their non-transplanted hair which remains at risk. The most powerful and effective treatment stratagems typically include a multi-therapy approach and might include topical minoxidil, oral or topical finasteride, low level laser therapy cap devices, platelet-rich plasma (PRP), nutritional supplementation and appropriate hair care and scalp care regimens.”