A Quick Fix for Hair Loss Is Making Some Men Sick

0:05My 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 HIMSS. I'm on HIMSS.com, and it gives you all these different options for medications that they'll sell you on subscription. Rolf and I decided to see how quickly he could sign up for hair loss meds online. Should we hit regrow hair? Sure, let's try regrow hair. Okay, all right, I'm clicking that. It offers finasteride, which blocks DHT, a hormone that causes hair loss. Finasteride is the generic version of the brand name pill Propecia, and it has some known and potentially nasty side effects.

0:52Then 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. And then you hit submit. Yep. And in your case, how long did it take before you got approval? 60 seconds. 60 seconds. Just about as long as you've been listening to this episode. That's how quickly Rolf got approved for finasteride. Why is this a problem? Is it even a problem? 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.

1:43Telehealth 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 Leinbaugh. It's Monday, April 14th.

2:15Coming up on the show, a quick fix for hair loss is leaving some young men sick. official

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3:01The drug finasteride has been around for decades. The FDA approved it for hair loss treatment in 1997. And very soon after that, there were a lot of controversies about the drug, chiefly the side effects associated with it. Which are what? 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. One of those men who Rolf talked to is Mark Millick. I can't see a situation where I wouldn't have taken this medication unless doctors had told me directly this is a risk.

3:54Mark 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 4th of July party with his family. 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 scalp.

4:39And I panicked, to be honest with you. I'm like, oh, that's not good. Mark took out his phone and made a HIMSS account. He filled out the online subscription form and hit submit. 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. Why did you go through HIMSS and not go to your doctor? 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?

5:22How did you feel at that point? I felt like I was being proactive.

5:31In recent years, telehealth companies like HIMSS, Keeps, and Roman have boomed. 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 a 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. HIMSS is part of the parent company HIMSS & HERS Health, which went public in 2021. They had$1.5 billion in revenue last year. and they had over Tulian customers whom they call subscribers. The main way HIMSS and its rival companies get customers is through aggressive TV and social media ads.

6:20Getting help for hair loss used to be hard. HIMSS makes it simple. It all starts with one clip. By starting Keeps now, I can keep the hair I have and get my treatment without leaving the couch. 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 four-in-one pill by HIMSS. It contains Tadalithol. Are they like tapping sort of fundamental insecurities? Yeah, I think that's the main goal here. A lot of younger men are probably insecure about their hair. Guys, with hair or without hair? With hair. Hair. Hair. With. With hair. I prefer hair.

7:03Why? The way these telehealth ads handle side effects is very different from the usual drug commercial. 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?

7:43Well, they're not required in their advertisements to disclose side effects. So they typically don't. But changes could be coming for telehealth advertising. This past February, HIMSS had a minute-long ad during the Super Bowl for its GLP-1 medication, its version of Ozempic. Obesity is America's deadliest epidemic. This is America. 74 % of us are overweight. They didn't include any side effect information or other risks. 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. HIMSS defended the ad, saying the company provides a telehealth platform and isn't a drug manufacturer.

8:33The 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. 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. And that's what happened to Mark Millick. So I got to a point, I'm like, you know what?

9:20It'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 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. Mark started taking the medication he'd bought online. But it didn't go as he'd hoped. That's next.

10:07Mark 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. 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 kind of the end of it right there.

10:44About a week or two after Mark started taking the hair loss drug, he began to feel off. 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. Around six months later, things got even worse. 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.

11:23It was like the worst hangover in my life. And I went to work that morning, that Monday morning, to do a new hire orientation. And information I'd been teaching at that point for several years, I completely forgot. It's like the first time I'd ever read it before. Must have been so scary. 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. 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.

12:03Still, his symptoms kept getting worse. 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. It didn't occur to Mark that what he was experiencing may have had to do with the hair loss meds. 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, it would make no sense.

12:37This 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 you. But then, about 15 months after Mark started taking Finasteride, he hit a breaking point. There was one day I just reached my wits end. I'm like, 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. Mark went on Reddit and searched for finasteride side effects. He found a subreddit of people sharing horror stories. And, you know, I just, I freaked out.

13:17I'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 won't improve if I come off the medication.

13:31Mark stopped taking the drug. But the symptoms didn't go away. They only got worse. 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.

14:18I probably developed somewhere between 25 and 30 symptoms in that time frame. 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? Mark's doctor said she believes the symptoms that he reported to her were caused by the hair loss drug. HIMSS declined to comment on Mark's care.

14:44Many 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. Organon said it didn't run the trials and stood by the drug's safety and efficacy.

15:27Regulators have revisited finasteride 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%.

16:16For a medication that is being prescribed to millions of people, I mean, that's a lot of men out there. That's Rolf again. That less than 2 % risk is the stat that HIMSS shows potential customers when they sign up online.

16:36Rolf also noticed that HIMSS was citing a statistic in its list of side effects he'd never seen before. I asked them, 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? And I said, oh, well, you found a typo. A HIMSS 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,

17:22And,

17:27you 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. The HIMSS spokeswoman said its systems help clinicians make decisions quickly by flagging if a patient's case is routine or more complex.

18:08As convenient as the process was, Mark wishes there'd been a little more friction when he signed up with HIMSS. My wife and I were talking about 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 HIMSS, but all these other telehealth companies as well.

18:46If you had told me I would deal with one-tenth of what I'm dealing with, I would have never, ever would have taken that medication.

19:06That's all for today, Monday, April 14th. 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.