Male Pattern Hair Loss Drugs Risk Significant Side Effects

Abdulmaged Traish; Photo by Vernon Doucette for Boston University Photography Interview with:
Abdulmaged M. Traish, MBA, Ph.D.
Professor of Biochemistry
Professor of Urology
Boston University School of Medicine
Boston, MA 02118


Medical Research: What is the background for this study?

 Dr. Traish: This study was undertaken to evaluate the data in the contemporary literature on the use of finasteride and dutasteride for treatment of ( benign prostatic hypertrophy) BPH and androgenetic alopecia (AGA). These drugs were proven effective in management of patients withy BPH andandrogenetic alopecia; however, these drugs inhibit a family of enzymes widely distributed in many tissues and organs and therefore may have undesirable effects. Most importantly, few studies have been undertaken to evaluate the effects of these drugs on the central nervous system. The adverse impact of these drugs on sexual function and well-being in a subset of patients raised the questions that we do not know much about the safety of such drugs.

Medical Research: What are the main findings?

 Dr. Traish: The main findings of this study is that these agents, while useful in treatment of BPH and androgenetic alopecia, exert undesirable side effects on sexual function and well-being. More importantly, limited data is available on the impact of these agents on the central nervous system.

Medical Research: What should clinicians and patients take away from your report?

 Dr. Traish: The data in the scientific and clinical literature suggests that use of Finasteride and Dutasteride (5-RIs) in management of patients with BPH or androgenetic alopecia are associated with serious and in some cases irreversible side effects, especially those patients who may be predisposed and more susceptible to such adverse effects. The assertions that these drugs are well-tolerated and safe are at best inaccurate and are unsubstantiated. Physicians need to make a careful re-examination of the impact of the potential adverse effects of these agents not only on sexual function and psychological well-being, but also on other health concerns such as diabetes, bone metabolism, vascular disease, dementia and cerebrovascular disease.   Physicians prescribing these agents bear the responsibility to inform their patients on the seriousness and potential adverse and sometimes debilitating and persistent side effects on patient’s sexual health, mental health and overall health. Physicians should discuss such serious adverse effects of these agents with their patients prior to commencing therapy.

Medical Research: What recommendations do you have for future research as a result of this study?

 Dr. Traish:

In this study we have made four recommendations for future research:

  1. We suggest that future research should focus on the scope and scale and the degree of persistence of sexual side effects. This area of investigation remains controversial and requires urgent, well thought out and well-designed studies to ascertain if these drugs do indeed cause enduring sexual side effects in vulnerable patients. More importantly, the underlying pathology and epigenetics of these potential changes need be investigated and delineated, in order to develop better management strategies.
  1. We point out to recent investigations demonstrating various adverse effects on glucose metabolism, insulin resistance and potentially type 2 diabetes. These studies raise additional concerns and require further investigations. Epidemiological studies suggesting that these agents may impact bone metabolism is of concern and also need be studied clinically.
  1. The effects of 5α-RIs therapy on the peripheral and CNS is not fully understood and merits critical evaluation through fundamental basic and clinical research. The data reported by Melcangi and his colleagues challenges the current dogma and necessitates expanding such studies to understand the impact of these agents on the CNS in order to appreciate the potential impact on depression, dementia, AD and other CNS related disorders.
  1. Finally, although there is only rudimentary data on the potential effects of these drugs on the dolichol phosphate pathway, the impact these agents may have on biochemical signaling and protein glycosylation is of critical importance and needs be investigated.


Abdulmaged M. Traish, Roberto Cosimo Melcangi, Marco Bortolato, Luis M. Garcia-Segura, Michael Zitzmann. Adverse effects of 5α-reductase inhibitors: What do we know, don’t know, and need to know?Reviews in Endocrine and Metabolic Disorders, 2015;
DOI: 1007/s11154-015-9319-y

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Abdulmaged M. Traish, MBA, Ph.D. (2015). Male Pattern Hair Loss Drugs Risk Significant Side Effects

Last Updated on August 27, 2015 by Marie Benz MD FAAD