While popping my daily dose of pills the other day — you know, the drugs guys over 60 often take to try to squeeze out another decade or two — I stumbled across a news story describing the drugs President Donald Trump takes, according to his personal physician.
The list took me aback. The 45th president and I are aging like blood brothers. We’re both using baby aspirin to stave off heart attacks, a statin to lower our cholesterol, and doxycycline to control a similar skin-reddening condition called rosacea.
But there’s one drug in Trump’s reported regimen that I would never touch — a medication to prevent premature baldness called Propecia. Never mind that my hair is thinning faster than the South American rain forest. You still couldn’t pay me to take Propecia. Here’s why:
Propecia, a simple daily capsule, may help the president preserve his famous hairline. His New York physician, Harold N. Bornstein, told the New York Times recently that he, too, takes Propecia, which may foster the flowing locks the doctor sports at age 69.
But keeping one’s hair through the miracles of modern medicine comes with risk. Propecia, the brand name for drug giant Merck’s finasteride, has become a magnet for personal injury lawyers with, by one count, 1,370 lawsuits filed by plaintiffs. There’s no indication that Trump — who’s famous for enjoying a spirited lawsuit now and then — has made any legal filings against Propecia. The White House press office did not respond to phone and email requests for comment.
The stories laid out in court filings are enough to make a bald man accept a hairline in full retreat. Complaints chronicle sexual dysfunction, mood swings, ruined relationships, even suicides, allegedly linked to the pills intended to keep hair intact. “The company intends to defend against these lawsuits,” Merck said in a statement.
Propecia was approved by the Food and Drug Administration in 1997. Its Madison Avenue-invented name rhymes with felicia, similar to the word for “happy” in Spanish.
A product label available online details how the drug works: It blocks the body’s ability to turn testosterone into dihydrotestosterone or DHT, a hormonal change that somehow keeps hair from falling out of prematurely balding male scalps (the medical term is androgenetic alopecia).
The literature reports a 48-week study of more than 200 men with androgenetic alopecia. Some participants were given placebos, but the ones taking Propecia “showed increase from baseline in total and anagen hair counts of 7 hairs and 18 hairs, respectively.” The men on placebos lost hair throughout the study.
Rival drug Rogaine, by Johnson & Johnson Consumer, also has been the subject of lawsuits, but most of those involve various allergic reactions to the minoxidil in Rogaine, not allegations of sexual dysfunction.
Many of the Propecia lawsuits allege that victims experienced sexual side effects after they stopped taking Propecia and/or Proscar — which, at 5 mg of finasteride, is five times the strength of Propecia and is specifically intended for men with enlarged prostates. About 50 lawsuits allege that Propecia caused or can cause prostate cancer, testicular cancer, or male breast cancer, according to a financial statement from Merck. Others have sued Merck for memory loss or a combination of sexual side effects and memory loss.
Hundreds of these lawsuits have been consolidated into multi-district litigations. A trial, once scheduled for late 2016, has been delayed until at least September 2017.
On its website, Merck spells out three “most common side effects” of Propecia: decreased sex drive, decreased semen count, and trouble with erections.
The company’s statement notes: “Merck stands behind the demonstrated safety and efficacy profile of Propecia (finasteride), which has been prescribed to millions of men.”
The warnings alone are enough to keep me from pondering Propecia. But then there are real-life stories such as that of Mikael Mikailian, 39, an entrepreneur who lives in Encinitas, Calif.
Mikailian started taking Propecia around the time he turned 20 and first noticed thinning hair. “I didn’t want to deal with the shame and embarrassment of being bald at a young age,” he said. A doctor prescribed Propecia and assured him it was safe. He estimates that the drug cost him about $90 per month.
The good news: His hair quickly started to grow and his bald spot disappeared.
The bad news: Within three years, Mikailian’s sex life was declining. He also noticed memory problems. One night, on a dinner date, he couldn’t remember his date’s name. He contacted Dr. Irwin Goldstein, a San Diego urologist known for mitigating the sometimes unpredictable side effects when men stop using Propecia.
Over 18 months, Goldstein slowly weaned Mikailian off of Propecia — while closely tracking his hormone and mood levels. Goldstein also prescribed a hormonal drug more commonly used by women.
“My body hadn’t produced testosterone for 20 years,” Mikailian said. “I was experiencing a complete lack of motivation and low sexual interest.”
Mikailian’s short-term memory problems worsened. “I 100 percent attribute this to the effects of Propecia,” he said.
Under care, he eventually reclaimed both his memory and his libido. But it cost him thousands of dollars that his health insurance wouldn’t cover.
Goldstein, in a phone interview, said he has more than 100 Propecia patients. “For many of them, it’s a nightmare situation,” he said. “It gets so emotional for me that I’m at a loss for words.”
Merck had no specific response to Goldstein’s criticism — nor to the negative experiences his patients say they had with Propecia.
In 2012, the FDA made Merck change the label for Propecia and Proscar to warn they may be linked to “libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug.”
“We encourage patients to talk with their doctor if they have any questions or concerns about their health or about Propecia,” Merck said in a statement.
Goldstein declined to specifically discuss Trump’s purported use of Propecia.
Mikailian, who is not currently involved in any of the Propecia lawsuits, said Trump should be attuned to possible memory loss.
As for me, hey, at 64, I can experience memory loss just by waking up. I don’t need drugs to exacerbate that. Nor is the potential replenishment of my hair worth jeopardizing my precious manhood.
So, I’ll stick with the baby aspirin and work toward building a healthier heart. You won’t find me counting hairs. Just blessings.
This story was originally published by Kaiser Health News. KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.