When Adam Macciocchi-Lancia noticed his hair was thinning, he decided to do whatever it took to reverse the problem.
The then 27-year-old artist from Toronto, Canada worried that a receding hairline would make him appear far older than what he was and ruin his dating life.
So, he booked an appointment with a hair-loss specialist and asked whether he would be eligible for a hair transplant.
But, the surprising answer he received was that the surgical procedure was unnecessary.
Instead, all he needed was a daily tablet that cost less than £1. The drug, called finasteride, or the branded Propecia, is taken by millions of men with hair loss, including President Donald Trump.
And, as the doctor explained to Adam, finasteride works wonders. According to studies, more than four in five men who take finasteride stop losing their hair.
Nearly three in five see their hair begin to grow back, often within months.
‘I was told the tablets would be as good if not better than a hair transplant,’ says Adam. ‘And there were apparently very few side effects.’
Adam Macciocchi-Lancia was informed that, in less than one per cent of cases, finasteride patients experienced low mood and erectile dysfunction
The drug, called finasteride, or the branded Propecia, is taken by millions of men with hair loss, including President Donald Trump
Adam was informed that, in less than one per cent of cases, finasteride patients experienced low mood and erectile dysfunction.
‘But the doctor said, if these symptoms happened, I could just stop taking the pills and they would go away,’ he says.
‘So it wasn’t something I was worried about at all.’
However, as Adam soon found out, this is not always the case.
Because, soon after beginning the treatment, Adam developed a debilitating series of symptoms that plagued his life for years – even after he stopped taking the pills.
These long-lasting problems, which Adam says destroyed his life, have been recorded in thousands of men who take finasteride for hair loss. It even has a name: Post-finasteride syndrome.
Where persistent physical and mental adverse reactions take place both during treatment and after men stop taking the medication.
Tragically, there are no approved treatments, meaning many men live with these symptoms, which include depression, insomnia, low libido and erectile dysfunction, indefinitely.
However, nearly a decade after he first began taking finasteride, Adam, now 36, believes he has found a cure – and wants to share it with others afflicted with the terrible condition in order to help them turn their lives around.
Finasteride works by blocking the conversion of the male hormone testosterone into the adrogen dihydrotestosterone, or DHT. High levels of DHT are believed to lead to hair loss by shrinking follicles on the scalp.
It was originally developed, and taken at higher doses, to treat having an enlarged prostate. Researchers then noticed that prostate patients taking the tablets experienced hair regrowth, and trials were launched which involved giving lower doses to treat hair loss.
Adam developed a debilitating series of symptoms that plagued his life for years – even after he stopped taking the pills
Not only did these trials prove that finasteride was highly effective, they also concluded that the tablet was safe. Fewer than four per cent of participants experienced temporary side effects including mental health problems and erectile dysfunction.
Unsurprisingly, given more than six million men in the UK alone have male pattern baldness, finasteride was a blockbuster success from its relaunch as a treatment for hair loss in 1997, quickly becoming one of the most popular drugs in the world.
However, as far back as 2011, the drug company behind finasteride, Merck & Co, have been aware of severe side effects linked to the drug including suicidal thoughts.
In 2021, Reuters news agency revealed it had obtained US court documents which show that US health watchdogs had received more than 700 reports of suicide and suicidal thoughts linked to the drug since 2011.
These included at least 100 reported suicides. The documents also revealed Merck & Co had paid about £3.5million to settle lawsuits brought by people claiming to suffer persistent side effects.
In court, Merck denied the drug caused problems with sexual function after men stopped taking it, and links to mental illness. The claims were settled without admission of liability.
Last year, the UK medical safety watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), concluded that packs of finasteride should include a patient alert card that warned of the risks of post-finasteride syndrome.
The MHRA said it had received nearly 300 reports of depressed mood disorder, suicidal and self-injuries behaviours linked to the pill. It also identified more than 400 cases linked to sexual dysfunction.
However, none of this was known to Adam when he began taking the tablets.
He started taking finasteride in September 2016 and within two months, he says things started going downhill.
He began to experience dark thoughts about suicide, which he’d never had before. ‘I was just hit with this awful depression,’ says Adam, who is visually impaired.
‘I couldn’t get out of bed, I couldn’t hold a conversation, I couldn’t do anything. I told my parents and, by the third month, came off the pills. But nothing changed.
‘Instead, it was around then that I developed erectile dysfunction. I felt like killing myself all the time. It was like I’d lost my soul.’
At the same time, Adam also developed brain fog – which made it impossible for him to think clearly – he also developed exercise intolerance, meaning that any physical activity worsened his symptoms.
Adam repeatedly sought medical help. First, at his local hospital, then with the specialist who had prescribed him the finasteride.
Each time, he was brushed off. ‘I was told these issues were all in my head,’ says Adam. ‘The doctors said that it was impossible that finasteride had caused these issues. They said it was completely safe.’
Adam’s condition was so severe that he was unable to work and he lost his job at a construction firm that he did alongside his art.
Over the years, he tried a number of experimental treatments – including painful injections into his penis – but nothing worked.
Adam listened to a podcast which described how magic mushrooms could cure severe bouts of depression
Then, in late 2019, Adam listened to a podcast which described how magic mushrooms could cure severe bouts of depression.
The hallucinogenic fungus contains a compound called psilocybin which has been shown in studies to help with a number of mental health issues such as Post-traumatic stress disorder and Obsessive-compulsive disorder.
And while it is illegal to buy magic mushrooms in Canada – as it is in the UK – Adam decided that it was worth trying seeing if the drug could help improve his Post-finasteride syndrome.
‘I had nothing to lose,’ he says. ‘I was willing to try anything to break free of this condition.’
Adam took three grams of magic mushrooms – a high dose capable of triggering intense hallucinations – along with a friend.
‘We went for a walk in the woods while we did them,’ he says. ‘I didn’t know what to expect.’
Astonishingly, Adam says he noticed an immediate difference, saying: ‘When the mushrooms kicked in, it was like my brain fog disappeared.
‘I felt like myself for the first time in years, it was one of the most profound experiences of my life.’
Over the following months, Adam took mushrooms several more times. Eventually, he switched to microdosing them – this involves taking small daily doses of the drug.
‘Most of my side effects would go away when I was on them,’ he says. ‘However, I felt like I started to reach a limit to my improvement. I would get better for a week or two and then all the symptoms would return with a crash.
‘And no matter what I did, the erectile dysfunction was still just as bad as before.’
So, in 2023, Adam decided to try an even more intensive therapy: The potent psychedelic drink ayahuasca.
The illegal beverage, first used by Amazonian tribes, is so strong that it can trigger mental health problems in some people who take it. It can even be deadly.
However, this did not put off Adam, who believed it was his only hope of curing himself.
‘I went to see a Shaman in Ontario,’ Adam says. ‘After I drank the ayahuasca I started hallucinating.
‘When I came to, I knew that the crippling depression was gone.’
Experts warn that patients who experiment with illegal drugs could be putting themselves in danger.
‘I’ve never heard of anything like this before and it’s not a good idea to try illegal drugs in this way,’ says Dr David Fenton, a Harley Street consultant dermatologist.
‘These drugs have many side effects and often are not safe.’
A year-and-a-half on, Adam’s condition has continued to improve. He has been able to return to his work as an artist and he regularly exercises.
He is now side effect free with the exception of the erectile dysfunction. However, Adam says his erections continue to improve slowly and he is hopeful for the future.
‘I finally feel like I’ve got my soul back,’ he says.
‘I’ve done so much work on myself, and now I feel open and ready to finally enjoy life again.’
Not only can this be illegal, it can also be dangerous. Both magic mushrooms and ayahuasca have been linked to mental health issues and deaths.
Any new treatment should always be discussed first with a medical professional.
WHAT IS FINASTERIDE? TRUMP’S HAIR LOSS DRUG TIED TO ANGER, SELF HARM, ERECTILE DYSFUNCTION AND DEPRESSION
The prostate-reducing drug that Donald Trump uses to treat hair loss has been linked to an increased risk of depression, self-harm and erectile dysfunction.
Finasteride is a widely-used drug that reduces the size of prostate glands and stimulates hair growth – and is widely believed to be a significant factor affecting the president’s low PSA (prostate) levels and thick mane.
However, it has been tied to many severe and uncomfortable side effects.
A research paper published in March 2017 by Western University in Ontario offered the first concrete evidence showing the pills’ mental health risks, and appeared to confirm many medics’ fears that it increases a risk of suicidal tendencies.
The same week, a study by Northwestern University Feinberg School of Medicine found most study participants were left impotent for four years after taking Propecia (the brand name for finasteride).
Finasteride, a widely-used drug that reduces prostate glands and stimulates hair growth, increased risk of depression by 94 percent in the first 18 months, a study by Western University found. Another study by Northwestern University found it causes erectile issues
Finasteride belongs to a class of medications known as 5-alpha-reductase inhibitors (5ARIs).
5ARIs have come under increasing scrutiny in recent years by regulators in the United States and Canada because of a possible link to mental health issues, according to the researchers.
Finasteride was originally developed to treat urinary problems in men.
Studies showed the drug made prostate glands smaller by reducing the levels of the hormone dihydrotestosterone in participants.
But during the clinical trials, scientists saw an unexpected side effect – hair growth.
And so in 1997, the FDA approved the steroid inhibitor as the first ever drug to treat male pattern baldness.
Taken once a day, the drug is mainly sold under the brand name Propecia. Millions of American adults use the pills, which are proven to be 90 percent effective.
In February 2017, Donald Trump’s doctor Harold Bornstein revealed the president takes a small dose of finasteride to stimulate hair growth.
Bornstein told the New York Times that he, too, takes the drug, saying it helped him keep his shoulder-length locks and helped Trump keep his own hair.
The doctor said: ‘He has all his hair. I have all my hair.’
The news that Trump takes finasteride explained why his PSA (prostate specific antigen, produced for the cells by the prostate) is so low.
Finasteride reduces PSA levels to reduce swelling of prostate glands.
Men aged 60-69 normally have between 4.0 and 5.0ng/ml. That is higher than younger men since PSA and testosterone levels rise with age.
The number may be lower than usual if a man has prostate cancer or inflammation, causing more PSA to seep into the bloodstream.
Trump’s PSA level was 0.15, Bornstein said in two letters he’d written about Trump’s health. The first letter came out in December 2015, followed by the other letter in September 2016.
The level prompted urologists – who weren’t linked to Trump – to say he had to have received care for an enlarged prostate or prostate cancer.
Bornstein told the Times that the commander-in-chief hasn’t had an enlarged prostate nor prostate cancer, and attributed Trump’s PSA level to Propecia.
LINKS TO MENTAL HEALTH ISSUES
The researchers at Western University examined finasteride and dutasteride, another 5ARI.
‘There wasn’t a lot of good studies in this area, and it’s a very common medication for urologists to use,’ said lead author Dr Blayne Welk.
Welk’s team analyzed data from 93,197 men who were at least 66 years old when they received prescriptions for 5ARIs between 2003 and 2013, plus another 93,197 similar men who had never filled a prescription for a 5ARI.
Overall, 5ARIs were not linked with an increased risk of suicide, the researchers reported in JAMA Internal Medicine.
During the first 18 months, however, the men using 5ARIs had an 88 percent higher risk of harming themselves. That risk did not extend beyond 18 months.
Men in the 5ARI group also had a 94 percent higher risk of depression in the first 18 months, compared to men not using these drugs. Beyond 18 months, the increased risk of depression fell to 22 percent.
The type of 5ARI did not appear to significantly alter the results.
Welk cautions that the actual risk of depression and self-harm is very low.
If the drugs were actually causing these side effects – which this study wasn’t design to prove – ‘you’d need 470 men to take this medication for a full year to have a new case of depression,’ Welk said.
That number would have to be even higher to cause a new case of self-harm, since self-harm is less common than depression.
‘It is a risk potentially and patients and physicians should be aware of it,’ Welk said.
ERECTILE DYSFUNCTION RISKS
A separate study in the journal PeerJ evaluated another concern about 5ARIs – erectile dysfunction.
Drs Tina Kiguradze and William Temps of Northwestern University Feinberg School of Medicine in Chicago and colleagues found that when erectile dysfunction occurred in men taking 5ARIs for at least 180 days, the dysfunction was more likely to last at least 90 days after stopping the medication.
Erectile dysfunction, when it occurred, resolved faster in men who took the medications for shorter periods.
The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent, according to Dr. Landon Trost, who is head of andrology and male infertility at the Mayo Clinic in Rochester, Minnesota.
But it’s not clear how many men suffer persistent erectile dysfunction after stopping 5ARIs, said Trost, who was not involved with either of the new studies.
‘I think it’s important to be educated about the potential side effects,’ he said.
Men who are already at increased risk for these potential side effects must weigh the risks and benefits of the drugs, Trost said.
He said older men taking 5ARIs for prostate problems might come to different conclusions than young men taking the pills for hair loss.
Additionally, he said, men should tell their doctors if they experience these symptoms.
