A Quick Fix for Hair Loss Is Making Some Men Sick

Summary

A Quick Fix for Hair Loss Is Making Some Men Sick

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

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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.

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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.

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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.

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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.”

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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.

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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.

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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.

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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.

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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.

Transcript

[Kate Linebaugh]

My colleague, Rolf Winkler has a full head of hair still. He gets targeted for hair loss medications all the time, often by telehealth companies like hims.

[Rolf Winkler]

I'm hims.com and it gives you all these different options for medications that they'll sell you on subscription.

[Kate Linebaugh]

Rolf and I decided to see how quickly he could sign up for hair loss meds online. Should we hit regrow hair?

[Rolf Winkler]

Sure, let's try regrow hair. Okay.

[Kate Linebaugh]

All right, I'm clicking that.

[Rolf Winkler]

It offers finasteride, which blocks dht, a hormone that causes hair loss.

[Kate Linebaugh]

Finasteride is the generic version of the brand name pill Propecia. And it has some known and potentially nasty side effects.

[Rolf Winkler]

Then there's an option to click on safety information or side effects. If I want to click on that, I don't have to. I can just sort of continue.

[Kate Linebaugh]

And then you hit submit.

[Rolf Winkler]

Yep.

[Kate Linebaugh]

And in your case, how long did it take before you got approval?

[Rolf Winkler]

60 seconds.

[Kate Linebaugh]

60 seconds. Just about as long as you've been listening to this episode, that's how quickly Rolf could got approved for finasteride. Why is this a problem? Is it even a problem?

[Rolf Winkler]

Well, there are a lot of men we spoke to who got some very gnarly side effects from finasteride that they got from telehealth companies, and they said they really weren't warned about the side effects.

[Kate Linebaugh]

Telehealth companies say they disclose side effects and other risks on their websites. But a lot of men say they wish they would have slowed down and read the fine print because some of them are suffering serious health problems. Welcome to the Journal, our show about money, business and power. I'm Kate LINEBAUGH. It's Monday, April 14th. Coming up on the show, a quick fix for hair loss is leaving some young men sick.

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[Kate Linebaugh]

The drug Finasteride has been around for decades. The FDA approved it for hair loss treatment in 1997, and very soon after.

[Rolf Winkler]

That, there were a lot of controversies about the drug, chiefly the side effects associated with it.

[Kate Linebaugh]

Which are what?

[Rolf Winkler]

Well, the ones that are well Known are sexual side effects. But there are a lot of men who have talked about very serious, and I spoke to many of them. Very serious cognitive side effects, insomnia, panic attacks, suicidal ideation, and behavior, you know, GI issues.

[Kate Linebaugh]

One of those men who Rolf talked to is Mark Milik.

[Mark Milik]

I can't see a situation where I wouldn't have taken this medication unless doctors had told me directly this is a risk.

[Kate Linebaugh]

Mark is 31 years old. He's a veteran and lives in Washington, D.C. he's a construction health and safety manager and gives presentations on how workers can stay safe on job sites. But we're here to talk about hair, right? Mark has short brown hair, but back in 2020, he started getting concerned about hair loss. He remembers the exact moment it really hit him. He was at a fourth of July party with his family.

[Mark Milik]

And I was actually bringing my girlfriend over to introduce her to the family. And I walked into the bathroom and I noticed there was some very harsh overhead lighting. And I happened to notice I could see right down into the back of my scal and I panicked, to be honest with you. I'm like, oh, that's not good.

[Kate Linebaugh]

Mark took out his phone and made a hims account. He filled out the online subscription form and hit submit.

[Mark Milik]

I went through the process in a matter of about five minutes. In the bathroom, in the bathroom, in the bathroom. It took no time at all. That's how quick it was. It was actually pretty incredible.

[Kate Linebaugh]

Why did you go through hims and not go to your doctor?

[Mark Milik]

I think there was sort of a denial phase. You know, you don't want to go to a doctor and have them directly tell me not to my face. You're losing your hair. So you kind of get to avoid confronting the issue while still confronting the issue, if that makes sense. Right.

[Kate Linebaugh]

How did you feel at that point?

[Mark Milik]

Felt like I was being proactive.

[Kate Linebaugh]

In recent years, telehealth companies like himss, keeps and roman have boomed.

[Rolf Winkler]

A key reason they exist is convenience. Some people just want to go on the Internet and get a solution. You never have to see a doctor in person. They don't take insurance. It's cash pay model. You give them their credit card for the medications that you get from them. And they've grown, you know, very, very large.

[Kate Linebaugh]

Himss is part of the parent company HIMSS Herz Health, which went public in 2021.

[Rolf Winkler]

They had a billion five in revenue last year, and they had over 2 million customers whom they call subscribers.

[Kate Linebaugh]

The main way HIMSS and its rival companies get customers is through aggressive TV and social media ads.

[Advertisement]

Getting help for hair loss used to be hard. IMS makes it simple. It all starts with one click. By starting keeps now I can keep the hair I have and get my.

[Mark Milik]

Treatment without leaving the couch.

[Kate Linebaugh]

Guys, listen up. If you want to not only have a better sex life, but also regrow your hair at the same time, check out this 4 in 1 pill by Hims. It contains tadalithyl for strong. Are they like tapping sort of fundamental insecurities?

[Rolf Winkler]

Yeah, I think that's the main goal here. A lot of younger men are probably insecure about their hair.

[Advertisement]

Guys with hair or without hair?

[Kate Linebaugh]

With hair. Hair with hair. I prefer hair. The way these telehealth ads handle side effects is very different from the usual drug commercial.

[Rolf Winkler]

You know, when you watch a commercial for a drug on the evening news or something, a narrator says a whole bunch of things very quickly and a whole bunch of small print goes past you on the screen. And you're supposed to, you know, know before you go and ask your doctor about this medication that there are some risks. And moreover, your doctor is trained to tell you about those risks so you can make an informed decision whether this medication is right for you. Right. So what's interesting about telehealth companies? Well, they're not required in their advertisements to disclose side effects, so they typically don't.

[Kate Linebaugh]

But changes could be coming for telehealth advertising. This past February, HIMSS had a minute long ad during the super bowl for its GLP1 medication, its version of ozempic. Obesity is America's deadliest epidemic.

[Advertisement]

This is America.

[Kate Linebaugh]

74% of us are overweight.

[Rolf Winkler]

They didn't include any side effect information or other risks.

[Kate Linebaugh]

Hmm.

[Rolf Winkler]

And two senators, one Republican, one Democrat, wrote to the FDA saying this is a problem. These companies should be disclosing risks in their ads, and they're not.

[Kate Linebaugh]

Hims defended the ad saying the company provides a telehealth platform and isn't a drug manufacturer. The senators have since introduced a bill called the Protecting Patients from Deceptive Drug Ads Act. While telehealth companies are able to market their services without the burden of disclosing side effects, they are required to disclose side effects somewhere on their websites.

[Rolf Winkler]

So basically, you get into a situation where a lot of men are seeing these ads on social media, on television, and clicking through to these websites that are designed to get you through a product flow quickly without reading all of this information.

[Kate Linebaugh]

And that's what happened to Mark Milik.

[Mark Milik]

So I got to a point, I'm like, you know what it's something that everything else in my life is going great. You know, I've got a great job, I'm making great money, I got this beautiful girlfriend. But it's like hair loss is. Hair loss is bothersome. You know, hair loss sucks, to put it bluntly, especially when you're in your 20s. It's not something fun to deal with. So it's like if I just take this medication, I don't have to worry about it. I can carry on with my life without having to worry about this again.

[Kate Linebaugh]

Mark started taking the medication he'd bought online, but it didn't go as he'd hoped. That's next.

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[Kate Linebaugh]

Mark was aware that finasteride did have possible side effects. He'd read through the HIMSS website and did his own research online. But to Mark, the risks seemed minimal.

[Mark Milik]

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. But the side effects only included sexual issues and I think maybe some depression issues, right. That would go away upon cessation of the drug. So that was it. It's like I don't really have anything to lose. If I deal with side effects. I come off the drug and, you know, I just carry on with life and that's, that's kind of the end of it right there.

[Kate Linebaugh]

About a week or two after Mark started taking the hair loss drug, he began to feel off.

[Mark Milik]

I do a lot of presentations, right? So I mentioned I do safety trainings, things like that. And I was just having a tougher time getting through my presentations, which is something I never struggled with before.

[Kate Linebaugh]

Around six months later, things got even worse.

[Mark Milik]

The transition came, and this was very notable. It was in June of 2021. I woke up that morning. It was a Monday morning, and it felt like I'd been lobotomized. Everything changed. I had developed, at the time, permanent slurred speech, anhedonia, couldn't feel any emotions, felt very foggy. It was like the worst hangover of my life. And I went to work that morning, that Monday morning, to do a new higher orientation and information. I'd been teaching at that point for several years. I completely forgot. It's like the first time I'd been. I'd ever, ever read it before.

[Kate Linebaugh]

Must have been so scary.

[Mark Milik]

It was. It was horrifying. And that was around the time when I realized I have to go to a doctor, you know, specifically a neurologist, because these are neurological issues.

[Kate Linebaugh]

Mark says he went to see a neurologist and other doctors who gave him tests like an mri, EMG, and EEG scans. But the results came back clear and benign. Still, his symptoms kept getting worse.

[Mark Milik]

I also developed severe muscle twitching, muscle twitching all over my body, my hands, my feet, my face, my arms, my back, my stomach, everywhere.

[Kate Linebaugh]

It didn't occur to Mark that what he was experiencing may have had to do with the hair loss meds.

[Mark Milik]

During that period, when I'm going to the doctors, my mom even brought up, she said, hey, could this be the hair loss medication you're taking? Because I had mentioned it to her at that point, I was taking this hair loss medication kind of just in passing. And I almost got oddly defensive about it because I said, mom, this. It would make no sense. This medication doesn't have anything to do with the brain. So I completely kind of blocked that out of my mind, to be honest with.

[Kate Linebaugh]

But then about 15 months after Mark started taking finasteride, he hit a breaking point.

[Mark Milik]

There was one day I just reached my wit's end. I'm like, what? What could this be? Because this wasn't just a subtle. Like, every now and then, I'm tripping over words. It's like I can't enunciate. You know, I can't do anything. I'm a vegetable here.

[Kate Linebaugh]

Mark went on Reddit and searched for finasteride side effects. He found a subreddit of people sharing horror stories.

[Mark Milik]

And, you know, I just. I freaked out. I'm like, okay, there's no evidence. There's no reason to Believe this. This is all anecdotal, but let me just stop the medication just to see. Maybe things will improve if I come off the medication.

[Kate Linebaugh]

Mark stopped taking the drug, but the symptoms didn't go away. They only got worse.

[Mark Milik]

It was like a complete nuking of my endocrine system. In six weeks, I lost 20 pounds. I developed loose skin. My face started to change. I developed lipoatrophy on my face. My voice became higher pitched. My cognitive impairment continued to get worse. I developed joint issues. It was difficult to walk. I'd go to the gym and try to work out. My body would be shaking. My muscles became squishy, like they lost density. In some sense. My beard started to fall out. Also when I came off, that's when I developed the sexual issues. Low libido, erectile dysfunction issues. I probably developed somewhere between 25 and 30 symptoms in that timeframe. And that was a scary thing. That didn't make sense. It's like I'm off the medication. Why am I now developing all these side effects?

[Kate Linebaugh]

Mark's doctor said she believes the symptoms that he reported to her were were caused by the hair loss drug. Hims declined to comment on Mark's care. Many of Mark's symptoms weren't identified as potential side effects during finasteride's clinical trials and aren't listed on the drug's label. My colleague Rolf spoke to an endocrinologist who said the clinical trials had flaws that might have underestimated the incidence and severity of side effects and that they didn't follow its subjects long enough. Merck, the company that developed finasteride, referred questions about the trials to Organon, a company it spun off. Oregonon said it didn't run the trials and stood by the drug's safety and efficacy. Regulators have revisited finasteride's side effects in the past. In 2011 and 2012, the FDA revised the drug's label to highlight sexual side effects. In 2022, the agency updated the drug's label to include the risks of, quote, suicidal ideation and behavior. The side effects that HIMSS and other telehealth companies list on their websites are based on what's on the drug's label. Most men tolerate finasteride well. The drug's label currently says 3.8% of patients experienced one or more sexual side effects during the clinical trial. The risk of experiencing one of the main sexual side effects was under 2%.

[Rolf Winkler]

For a medication that is being prescribed to millions of people. I mean, that's a lot of men out there.

[Kate Linebaugh]

That's Rolf again, that less than 2% risk is the stat that Hims shows potential customers when they sign up online. Rolf also noticed that HIMS was citing a statistic in its list of side effects he'd never seen before.

[Rolf Winkler]

I asked him, where's that number from? And their first answer was, well, our medical team reviews all our safety disclosures, okay, but that one doesn't appear anywhere on the drug's label. So where does it come from? I said, oh, well, you found a typo.

[Kate Linebaugh]

A HIMS spokeswoman said HIMSs communicates transparently with patients about all essential details and safety information, and customers can ask clinicians about side effects. She said customers go through a, quote, comprehensive intake that is reviewed by a licensed provider who makes a clinical determination about the patient's eligibility for medication.

[Rolf Winkler]

And you know, when I spoke to former employees, the reason side effect information is not prominent is because it's what they called friction. Right? Again, this is an e commerce model, and the people who are designing the websites are marketing people. Their job is to get you through the funnel, through the purchase funnel, right? Show up at the website, put something in the cart, check out with it, maximize that. That's their job.

[Kate Linebaugh]

The HIMSS spokeswoman said its systems help clinicians make decisions quickly by flagging if a patient's case is routine or more complex. As convenient as the process was, Mark wishes there'd been a little more friction when he signed up with hims.

[Mark Milik]

My wife and I were talking this within the past two or three weeks and she said, do you feel like you learned anything about vanity? And I actually said, no, I don't feel like I did because I don't have an issue with people wanting to take care of themselves and wanting to look their best. The issue is that I just think they do everything in their power to market this medication to get as many people to take it because it's about profit. At the end of the day, it is about profit for not just himssbutt, but all these other telehealth companies as well. 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.

[Kate Linebaugh]

That's all for today. Monday, April 14 the Journal is a co production of Spotify and the Wall Street Journal. If you like our show, follow us on Spotify or wherever you get your podcasts. We're out every weekday afternoon. Thanks for listening. See you tomorrow.