A Quick Fix for Hair Loss Is Making Some Men Sick

The Journal | The Wall Street Journal & Gimlet
Release Date: April 14, 2025

Introduction

In the April 14, 2025 episode of The Journal, hosts Kate Linebaugh and Rolf Winkler explore the burgeoning issue of hair loss treatments, particularly focusing on the widespread use of finasteride through telehealth platforms like Hims. The episode delves into how these convenient, subscription-based services may be contributing to unforeseen health problems among men seeking quick solutions for hair loss.

The Rise of Telehealth and Finasteride

[00:05] Kate Linebaugh introduces the topic by mentioning her colleague, Rolf Winkler, who still maintains a full head of hair and frequently encounters marketing for hair loss medications from telehealth companies such as Hims.

[00:17] Rolf Winkler explains, "I'm hims.com and it gives you all these different options for medications that they'll sell you on subscription," highlighting the ease and accessibility these platforms offer.

The episode demonstrates the streamlined process of obtaining finasteride through Hims. [01:03] Kate notes, “in your case, how long did it take before you got approval? 60 seconds,” emphasizing the rapid approval process that bypasses traditional medical consultations.

Potential Risks of Finasteride

[03:07] Kate Linebaugh outlines the historical context of finasteride, approved by the FDA in 1997 for hair loss treatment. [03:16] Rolf Winkler adds, “there were a lot of controversies about the drug, chiefly the side effects associated with it,” pointing to sexual and cognitive side effects that some men experience.

Mark Milik, a 31-year-old veteran and construction health and safety manager, shares his initial decision to use finasteride without fully understanding the potential risks. [04:32] he recounts his first realization of hair loss at a family gathering, leading him to swiftly subscribe to Hims for treatment.

Personal Impact: Mark Milik’s Story

Mark’s experience with finasteride took a severe turn shortly after starting the medication. [11:13] He notes, “What I recall is that they talked about how side effects were rare. I think it was 1.2% was the statistic I had read.”

Approximately one to two weeks after beginning finasteride, Mark began noticing troubling symptoms. [11:50] He describes struggling with presentations, which was uncharacteristic of his professional performance. By June 2021, his condition deteriorated drastically, featuring symptoms like permanent slurred speech, anhedonia, cognitive fog, muscle twitching, significant weight loss, and joint issues. [12:10] Mark Milik explains, “I developed severe muscle twitching... my beard started to fall out... my cognitive impairment continued to get worse.”

Despite discontinuing the medication, Mark’s symptoms persisted and intensified. His attempts to seek medical help yielded unclear results, as tests like MRIs and EEGs returned benign. It wasn’t until he connected with others on Reddit that he realized the possible link between his symptoms and finasteride use. [14:18] Mark concludes, “I freaked out... let me just stop the medication just to see.”

Analysis of Clinical Trials and Side Effects

The podcast examines the reliability of finasteride’s clinical trials. [13:21] Kate Linebaugh mentions that many of Mark's symptoms were not identified during finasteride’s clinical trials and are absent from the drug's label. [17:22] Rolf Winkler underscores the scope of the issue by stating, “For a medication that is being prescribed to millions of people. I mean, that's a lot of men out there.”

An endocrinologist consulted by Rolf points out significant flaws in the clinical trials, including inadequate duration and oversight, which may have led to an underestimation of both the incidence and severity of side effects. This skepticism is echoed in the response from Organon, the company spun off by Merck, which defended the drug's safety and efficacy despite the concerns raised.

Regulatory responses have evolved over time. In 2011 and 2012, the FDA updated finasteride’s label to highlight sexual side effects. By 2022, the label was further revised to include risks of “suicidal ideation and behavior.” [16:25] These changes indicate ongoing scrutiny, though the latest statistics suggest the primary sexual side effects remain reported in less than 2% of users.

Telehealth Advertising and Regulatory Challenges

A significant portion of the episode critiques the advertising practices of telehealth companies like Hims. [07:02] Rolf Winkler observes that telehealth ads diverge from traditional drug commercials by often omitting detailed side effects, a strategy driven by marketing objectives to minimize “friction” in the purchase funnel.

[08:20] The episode highlights a pivotal moment when Hims aired a Super Bowl ad for its GLP1 medication without disclosing side effects, prompting bipartisan senators to lobby the FDA for stricter advertising regulations. The proposed Protecting Patients from Deceptive Drug Ads Act aims to mandate clearer disclosure of risks in telehealth advertisements.

Hims defends its practices by stating that while they provide a telehealth platform, they are not drug manufacturers and that side effects are disclosed on their websites. However, [17:48] Rolf Winkler points out discrepancies in the side effect statistics provided by Hims, suggesting a lack of transparency or possible misinformation.

Conclusion: Balancing Convenience and Safety

The episode concludes by reflecting on the delicate balance between the convenience offered by telehealth services and the imperative of patient safety. Mark Milik expresses regret over the ease with which he accessed finasteride, stating, “If you had told me I would deal with one tenth of what I'm dealing with, I would have never, ever would I have taken that medication.”

The narrative underscores the necessity for more rigorous regulatory oversight and greater transparency in the marketing and provision of prescription medications through telehealth platforms. As telehealth continues to expand, ensuring that patients are fully informed about potential risks remains paramount to prevent similar adverse outcomes.

Key Takeaways

• Finasteride, a popular hair loss treatment, is easily accessible through telehealth services like Hims, often with minimal medical consultation.
• Side effects of finasteride may be more severe and prevalent than initially reported in clinical trials, including sexual, cognitive, and neurological issues.
• Telehealth advertising practices may downplay or omit critical information about drug risks, driven by marketing strategies aimed at maximizing subscriptions.
• Regulatory measures are being considered to ensure better disclosure of side effects in telehealth advertisements, aiming to protect consumers from deceptive practices.
• Personal stories, such as that of Mark Milik, highlight the potential dangers of bypassing traditional medical advice and the need for more comprehensive patient education regarding prescription medications.

This episode of The Journal serves as a cautionary tale about the intersection of convenience, marketing, and health, urging both consumers and regulators to prioritize safety and informed decision-making in the rapidly evolving landscape of telehealth.