Vitality Unleashed: The Functional Medicine Podcast

The Finasteride Scandal: Why Thousands Are Suing but Your Doctor Doesn't Know

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 225

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Finasteride is prescribed to millions of men for hair loss. Your dermatologist says sexual side effects are rare. Yet over 1,400 lawsuits have been filed against Merck, the FDA issued a warning in 2012, and thousands of men report persistent sexual dysfunction years after stopping the drug. In this episode, Dr. Kumar breaks down what the clinical research actually shows—the neurosteroid mechanism, the lawsuit settlements, the FDA warnings, and why your doctor may not know the full story. If you're taking finasteride, considering it, or struggling with persistent sexual dysfunction after use, this episode is essential listening. Learn the evidence gap between pharmaceutical claims and real-world patient experiences. Call LifeWellMD for specialized care in medication-related sexual dysfunction.

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SPEAKER_01:

I want to start with a moment that I think almost every guy fears. It's that specific morning. Maybe you're 25, maybe 30. The bathroom lighting is just a little too harsh and lean into the mirror and you see it. Yeah. The hairline is moving back, or maybe there's that little patch on the crown that looks, you know, thinner than it did last month. Yeah. It's a visceral moment.

SPEAKER_02:

Oh, absolutely. It is what we call the hair loss paradox. It is one of biology's cruelest jokes, really. Oh, so the very same hormone that drives all these masculine traits, the beard, the body hair, the deep voice, is the exact same one that strangles the follicles on your scalp.

SPEAKER_01:

It feels like a betrayal by your own body.

SPEAKER_02:

It really does.

SPEAKER_01:

Exactly. And for decades, we've been told the problem is solved. You go to the dermatologist and they hand you what they call the gold standard, finasterized.

SPEAKER_02:

Or propetia, the brand name.

SPEAKER_01:

Right, propacia. It stops hair loss in 80 to 90% of men. I mean, it's practically a miracle drug, commercially speaking. You take a pill, you keep your hair. Simple.

SPEAKER_02:

It sounds simple. And if you only look at the marketing, yeah, it is simple. But if you look at the legal and medical reality, miracle is not the word you'd use. You'd probably use liability. Wow. I mean, we are looking at a drug that has triggered over 1,400 lawsuits. We're looking at a federal mandate from the FDA forced on the manufacturer to rewrite safety labels. To include what? To include permanent sexual dysfunction. And we're looking at thousands of men who say their lives have been just fundamentally altered.

SPEAKER_01:

And that is the friction point we're exploring today, the finasteride dilemma. And I want to be really clear up front. We are not here to do the standard internet debate of is it safe, yes or no?

SPEAKER_02:

No, that's way too binary. That's what gets people hurt.

SPEAKER_01:

It is.

SPEAKER_02:

We need to look at the actual data stack, the clinical research from people like Melkongi and Trash, the Reuters investigation into Merck's own internal emails, and the FDA's regulatory shifts.

SPEAKER_01:

So the mission for this deep dive is informed consent. If you're going to biohack your hormones to save your hair, you need to know exactly which wires you're cutting.

SPEAKER_02:

Because you aren't just cutting the wire to your scalp.

SPEAKER_01:

Yeah.

SPEAKER_02:

You're tampering with the wiring of your entire central nervous system.

SPEAKER_01:

Okay, so let's get into the mechanism first. I think most guys have a rough idea of how this works. You have testosterone, it converts to dihydrotestosterone, DHT. DHT kills hair follicles.

SPEAKER_02:

Right.

SPEAKER_01:

Phenasteride stops that conversion.

SPEAKER_02:

That's the let's call it the whiteboard explanation. And on a whiteboard, it looks great. Phenasteride is a five-alpha reductase inhibitor. It blocks that enzyme.

SPEAKER_00:

Five alpha reductase.

SPEAKER_02:

Exactly. It stops it from turning testosterone into DHT.

SPEAKER_00:

Yeah.

SPEAKER_02:

And you're right, lowering DHT saves scalp hair. But here's the problem.

SPEAKER_00:

Yeah.

SPEAKER_02:

The human body is an ecosystem. It's not a whiteboard.

SPEAKER_01:

You can't just delete one variable and expect nothing else to change.

SPEAKER_02:

You can't. Because five alpha reductase isn't just a hair loss enzyme, it does incredibly important work elsewhere. Okay. This is the part your dermatologist probably won't draw for you. That same enzyme is also responsible for synthesizing neuroactive steroids in your brain.

SPEAKER_01:

Neuroactive steroids, that sounds intense. Let's break that down. When people hear steroids, they think of bodybuilders.

SPEAKER_02:

Yeah, rage muscle building. No, this is totally different. We are talking about neurochemistry. These are chemicals made inside the nervous system that modulate brain function.

SPEAKER_01:

Like what?

SPEAKER_02:

We're talking about compounds like allopregnanolone. These are crucial regulators. They bind to the GABA receptors in your brain.

SPEAKER_01:

And GABA receptors, those are the ones that calm you down, right? They're sort of the brakes on the system.

SPEAKER_02:

The brakes, exactly. They regulate mood, they dampen anxiety, and yes, they play a massive role in libido and sexual function. They tell your brain it's okay to be calm, it's okay to feel pleasure.

SPEAKER_01:

So let me follow the logic here. When you take phenasteride to block the enzyme in your scalp to save your hair, you are also systematically blocking that same enzyme's ability to produce these mood regulators in your brain.

SPEAKER_02:

Correct. You are inhibiting the production of the brain's own natural anti-anxiety and prosexual chemicals. And this isn't just a theory. This is the key finding from the Milhangi studies.

SPEAKER_01:

Okay, what did they do?

SPEAKER_02:

They looked at the cerebrospinal fluid of men taking phenasteride.

SPEAKER_01:

So the fluid bathing the brain and spine.

SPEAKER_02:

Exactly. And they found that phenasteroid treatment significantly altered the levels of these neurooxidative steroids in that fluid. It was a direct biological link.

SPEAKER_01:

Aaron Powell Which completely reframes the side effects. Because usually we talk about phenasteride side effects like it's a plumbing issue. You know, can you get an erection? Right. But if we're messing with neurosteroids, the side effects should look n neurological.

SPEAKER_02:

Aaron Ross Powell And that is exactly what the research shows. If you look at the studies from Tresh, Erwig, and Ganser, the symptom list reads like a neurological condition, not just a plumbing problem.

SPEAKER_01:

Aaron Powell So what's on that list?

SPEAKER_02:

Yes, there's erectile dysfunction and loss of libido. But there's also severe depression, crippling anxiety, panic attacks, and something the patients themselves call brain fog.

SPEAKER_01:

Aaron Powell Brain fog is such a vague term, but I remember in that Ganser study from 2015, they got more specific, they called it cognitive impairment.

SPEAKER_02:

Aaron Powell They did. Men feeling emotionally flat, mentally slow, unable to process things the way they used to. It's like a dampening of the self.

SPEAKER_01:

Aaron Powell And here's the huge disconnect, right? A guy feels this happening. He feels foggy, depressed, his sex drive is gone, he goes to his doctor.

SPEAKER_02:

Yeah.

SPEAKER_01:

The doctor runs a standard blood panel.

SPEAKER_02:

And they check his testosterone. And usually the testosterone looks fine. Sometimes it's even a little elevated because it's not being converted to DHT.

SPEAKER_01:

So the doctor looks at the lab result and says, You're fine.

SPEAKER_02:

It's not the drug, it's just stress, or it's all in your head.

SPEAKER_01:

But the doctor isn't checking the cerebrospinal fluid for allopregnant alone.

SPEAKER_02:

Exactly. Yeah. They're measuring the plumbing when the problem is in the wiring. That's the invisible damage.

SPEAKER_01:

Aaron Powell, I want to touch on something you mentioned earlier, this permanence issue. The standard medical advice has always been it's reversible. If you get side effects, just stop taking it and you'll go back to normal.

SPEAKER_02:

Aaron Powell That was the marketing promise. It washes out of your system. But the data on what we call post-phenasteride syndrome or PFS just challenges that directly.

SPEAKER_01:

So for some men, these symptoms, sexual and cognitive, they just don't go away.

SPEAKER_02:

They persist for months or even years after they stop the pill.

SPEAKER_01:

Aaron Powell, Why would that happen? I mean, if the drug is gone, why is the effect still there?

SPEAKER_02:

That is the million-dollar question, and it's terrifying. The leading theory involves epigenetic changes, meaning the drug might permanently alter how your androgen receptors express themselves. Or the long-term depletion of those neurostroids causes a structural change in the brain's chemistry that just doesn't bounce back. You've altered the baseline.

SPEAKER_01:

Which brings us to the numbers game. This is where the real controversy lives. If you look at the box, the pamphlet, it says sexual side effects happen in what, 1 to 2 percent of users?

SPEAKER_02:

Aaron Powell That is the official line, 1 to 2%.

SPEAKER_01:

Aaron Powell But if you go to any online community, Reddits, Artris List, patient forms, the anecdotal rate feels so much higher. People are talking 10, maybe 15%. Why is there such a massive gap between the official data and the real world data?

SPEAKER_02:

Aaron Powell Well, the manufacturer, Merck, and a lot of dermatologists, they lean very heavily on the nocebo argument.

SPEAKER_01:

Aaron Powell The Nocebo effect. That's the evil twin of the placebo effect, right?

SPEAKER_02:

Aaron Ross Powell, Jr. Exactly. The idea is because men read on the internet that the drug causes ED, they get anxious about it. Yeah. And that anxiety is what actually causes the ED. Aaron Powell, Jr.

SPEAKER_01:

So it's cytosomatic, induced by fear, not by biology.

SPEAKER_02:

Aaron Powell That's the argument. And to be fair, the mind is powerful. Anxiety can absolutely cause sexual dysfunction. No SIBO is real. But, and this is a massive but, you cannot psychosomatically alter the chemical composition of your own spinal fluid. You can't think your allopragnotalone levels down.

SPEAKER_00:

Right.

SPEAKER_02:

The physiological evidence from Melkinke just contradicts the idea that it's all in their heads.

SPEAKER_01:

Aaron Powell Plus, there's the whole issue of how that 1 to 2% number was calculated in the first place. This is where we get into the cover-up side of things. We have to talk about that Reuters investigation from 2019. Trevor Burrus, Jr.

SPEAKER_02:

This was a pivotal moment. Reuters got their hands on unsealed court documents, internal communications from Merck about the original trials. And it was a masterclass in how to manipulate data to get the result you want.

SPEAKER_01:

Aaron Powell What was the trick? How did they keep the numbers so low?

SPEAKER_02:

Aaron Powell Well, they made some very specific exclusions. For example, they excluded men who dropped out of the trial due to sexual side effects if those side effects didn't resolve quickly.

SPEAKER_01:

Okay. That already sounds bad.

SPEAKER_02:

But the biggest red flag was how they handle the timeline.

SPEAKER_01:

The timeline.

SPEAKER_02:

They didn't really account for men who developed sexual issues after the first year of the trial in the same way.

SPEAKER_01:

Wait, hold on. So if I take the drug and I'm fine for year one, but in year two my libido crashes, I might not be counted in that primary safety calculation.

SPEAKER_02:

Aaron Powell According to the Reuters report, that seems to be the case. It artificially front loaded the safety data to make it look much cleaner. But the real smoking gun was how they handled persistent side effects.

SPEAKER_01:

The ones that didn't go away?

SPEAKER_02:

Right. The document suggests that Merck knew about reports of persistent dysfunction men who didn't get better after stopping, but failed to include that warning on the label for years.

SPEAKER_01:

They knew it was happening, but they didn't put it on the box.

SPEAKER_02:

Until the FDA forced their hand.

SPEAKER_01:

This is in 2012.

SPEAKER_02:

Right. The FDA mandated a label change. They required the inclusion of, and I'm quoting here, libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug.

SPEAKER_01:

That label change is basically the federal government admitting we were wrong about this being reversible.

SPEAKER_02:

It is the government acknowledging that the washout theory is flawed. And of course, that admission is what led to all the lawsuits.

SPEAKER_01:

Let's talk about the settlement, 2018. Trevor Burrus, Jr.

SPEAKER_02:

Merck agreed to a settlement. They resolved about 562 lawsuits for an aggregate amount of$4.3 million.

SPEAKER_01:

Aaron Powell I did the math on that. That is roughly$7,650 per person.

SPEAKER_02:

It's a shockingly low number.

SPEAKER_01:

If you're a young man who has lost his sexual function, maybe his mental health,$7,000 feels like an insult.

SPEAKER_02:

It highlights a grim reality. It is very hard to prove causation in these cases to the standard required for a massive payout. Merck never admitted liability. They paid a nuisance fee.

SPEAKER_01:

So just because the payout was low doesn't mean the suffering wasn't real.

SPEAKER_02:

Not at all. It just means the legal system puts a low price tag on men's sexual suffering when it's hard to quantify in a courtroom.

SPEAKER_01:

Okay, I want to introduce a complexity here because we promise not to fear monger. We have to look at the whole picture. There's the prostate cancer prevention trial, the PCPT.

SPEAKER_02:

Yes. The phenastride paradox, part two.

SPEAKER_01:

What did it find?

SPEAKER_02:

This trial found that phenastride actually reduces the overall risk of prostate cancer by about 25%.

SPEAKER_01:

So on one hand, it might ruin your sex life. On the other, it might prevent cancer. That's a brutal trade-off.

SPEAKER_02:

It creates a massive demographic split. And we have to look at who is taking the drug and why.

SPEAKER_01:

Right.

SPEAKER_02:

If you are 55 years old, married, done having kids, and you have a family history of prostate cancer, phenasteroid is a very different value proposition.

SPEAKER_01:

The risk of side effects might be a trade-off you're willing to make.

SPEAKER_02:

Versus a 22-year-old single guy who just wants to keep his hairline for dating. For him, the cancer benefit is hypothetical and decades away. But the sexual risk, that's immediate.

SPEAKER_01:

And it impacts his prime years.

SPEAKER_02:

Exactly. It's a completely different ethical equation.

SPEAKER_01:

Aaron Powell, so let's try to synthesize this. We have a drug with a mechanism that affects the brain. We have trials that seem to have manipulated the data. We have a low-ball legal settlement, but people still take it, and for most of them, it works.

SPEAKER_02:

And we have to acknowledge that.

SPEAKER_01:

But the risk is not zero.

SPEAKER_02:

The risk isn't zero. And the consequences, if you lose that gamble, can be catastrophic.

SPEAKER_01:

Aaron Powell So how does a listener stratify that risk? If someone is listening to this right now, staring at that prescription bottle, what questions should they be asking?

SPEAKER_02:

You need to do a personal risk audit. First question: What is your family history regarding mental health?

SPEAKER_01:

Aaron Powell Why mental health specifically?

SPEAKER_02:

Aaron Powell Because we know this drug impacts neurostroids. If you're already prone to depression or anxiety, you are likely removing a biological safety net. You're depleting the very chemicals that help you cope.

SPEAKER_00:

That is a huge takeaway. If you struggle with mental health, you need to be extremely careful with these drugs.

SPEAKER_02:

Aaron Powell Absolutely. Second, consider your tolerance for the worst case scenario. Are you really willing to accept a 1 or 2% risk of persistent dysfunction? If you're an actor, maybe that risk is acceptable. If not, maybe it isn't.

SPEAKER_01:

What about alternatives? Is there a middle ground?

SPEAKER_02:

There are attempts at one. Toptical phenasterite is becoming very popular.

SPEAKER_01:

The liquid you put directly on your scalp.

SPEAKER_02:

Right. The theory is you apply it locally, so less of it goes systemic and travels to your brain.

SPEAKER_01:

Does it work?

SPEAKER_02:

The studies show it does lower blood serum DHT, less than the oral pill, but it still goes systemic. It's not a magic bullet. It is likely safer, though.

SPEAKER_01:

And then there's monoxidol.

SPEAKER_02:

Monoxidol, totally different mechanism. Doesn't mess with hormones at all. Less effective for the hairline, though. And then, of course, is the option nobody wants to hear.

SPEAKER_01:

Acceptance.

SPEAKER_02:

The bows cut.

SPEAKER_01:

The only option with zero side effects.

SPEAKER_02:

And zero financial cost. And frankly, for many men, the anxiety of going bald is worse than the reality of being bald.

SPEAKER_01:

I want to pivot now to the guys who are listening to this and thinking, great, I wish I knew this three years ago. The guys dealing with post-finasteride syndrome, the gaslighting seems to be the worst part.

SPEAKER_02:

It is psychological torture. Imagine you're a young man, your body isn't working, you have no libido, ED, deep chemical depression, you go to a doctor.

SPEAKER_01:

And you tell them, I think it's the propecia.

SPEAKER_02:

And they look at their textbook from 1995 and say, That's impossible. It's out of your system. You're just depressed. Here's an antidepressant.

SPEAKER_01:

Which might be the worst thing you could give them.

SPEAKER_02:

Often, yes, it invalidates their reality. But we need to be clear. The medical community is slow. It takes about 17 years for new research to become standard practice. We're in that lag period right now.

SPEAKER_01:

So these men aren't crazy.

SPEAKER_02:

They are not crazy. They are suffering from a drug-induced alteration of their neuroendocrine system. And acknowledging that is the first step.

SPEAKER_01:

And treatment is possible.

SPEAKER_02:

It's difficult and nuanced, but yes, it involves detailed hormonal panels, looking at inflammation, gut health. You have to treat the whole ecosystem. But you can't do it with a doctor who doesn't believe the condition even exists.

SPEAKER_01:

Aaron Powell Which brings us back to the central theme here: the body as an ecosystem. We treat our bodies like car, swap apart, fix a tire. Biology doesn't work that way.

SPEAKER_02:

Aaron Powell No. You can't just turn off one major biological pathway and expect the effects to stay contained to your scalp. We're biohacking our vanity.

SPEAKER_00:

Biohacking our vanity, that's a strong phrase.

SPEAKER_02:

Sometimes you get away with it. Most people do. But when the biology hacks back, it hacks back hard. And the price you pay is much higher than the price of a hair transplant.

SPEAKER_01:

So if you're a listener holding that prescription, you now have the full picture. You know about the neurostroids, the lawsuits, the permanence risk.

SPEAKER_02:

Informed consent means knowing the worst case scenario, not just the best case scenario. Now you know.

SPEAKER_01:

And for those of you who have already answered that question the hard way and are dealing with the consequences, there is a path forward. You don't have to navigate this with a doctor who tells you it's all in your head.

SPEAKER_02:

You don't have to go it alone. The science is on your side, and there are doctors who understand it.

SPEAKER_01:

That's right. If you're experiencing persistent sexual dysfunction after phenasteride, you need specialized help not dismissal from conventional medicine. Call LifeWell MD today. Dr. Kumar specializes in exactly this men with medication related sexual dysfunction who need unbiased, fearless medical care. Stop suffering in silence. Call now to schedule your consultation.

SPEAKER_02:

There is help out there. Don't give up.

SPEAKER_01:

Thanks for diving deep with us. We'll see you on the next one.