The Journal. - A Quick Fix for Hair Loss Is Making Some Men Sick

Episode Date: April 14, 2025

Telehealth companies make hair loss drugs easy to get. They also don’t have to disclose side effects in ads. WSJ’s Rolfe Winkler reports that some young men say they are suffering serious health consequences, and that they didn’t understand the risks. Kate Linebaugh hosts.  Further Listening:  - Testosterone Clinics Sell Virility. Side Effects Sometimes Included.  - ‘Uncontrolled Substances’ from The Journal.  Sign up for WSJ’s free What’s News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

My 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 HIMS. I'm on HIMS.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, alright, 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. Then 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. Telehealth 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 Leimbach. It's Monday, April 14th.

Coming up on the show, a quick fix for hair loss is leaving some young men sick. The 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 Rolfe 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. Mark is 31 years old. He's a veteran and lives in Washington, DC. 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 Fourth of July party with his family. And I was actually bringing my girlfriend over to introduce her to the 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 to the back of my scalp. And I panicked, to be honest with you. I'm like, oh, that's not good. Mark took out his phone and made a HIMS 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 HIMS and not go to your doctor? I think there was sort of a denial phase. You don't want to go to a doctor and have them directly tell me 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? How did you feel at that point? Felt like I was being proactive. Ah, it felt like I was being proactive. In recent years, telehealth companies like Hymns, 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 cash pay model. You give them your credit card for the medications

that you get from them. And they've grown, you know, very, very large. Hymns is part of the parent company, Hymns and Hers Health, which went public in 2021. They had a billion five in revenue last year, and they had over two million customers whom they call subscribers The main way hims and its rival companies get customers is through aggressive TV and social media ads Getting help for hair loss used to be hard

Hims makes it simple. It all starts with one click 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 4-in-1 pill by Hems. It contains toadalithol for strong...

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. You guys with hair or without hair? With hair. Hair. Hair. With.

With hair. I prefer hair. 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 prints 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? Well, 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. Hymns defended the ad, saying the company provides a telehealth platform and isn't a drug manufacturer. The 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. That's what happened to Mark Millick. So I got to a point, I'm like, you know what? It's something that everything else in my life is going great. I've got a great job, I'm making great money, I got this beautiful girlfriend. But it's like, hair loss is bothersome. Hair loss loss sucks to put it bluntly, especially when you're in your

twenties, 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. ... rookie's hockey cards featuring exclusive NHL and PWHL players and retired legends. Collect them all only at Tim's at participating restaurants in Canada for a limited time. Mark 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 I just carry on with life. And that's kind of the end of it right there. About 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, anedonia, couldn't feel any emotions, felt very foggy. It was like the worst hangover of 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've been so scary. It was horrifying, and that was around the time when I realized I have to go to a doctor, 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. Still, 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 doctor's, 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, this, it would make no sense. This 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 wit's end. I'm like, what, 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 sub Reddit of people sharing horror stories. And you know, I freaked out. I'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 will improve if I come off the medication. Mark 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. I probably developed somewhere between 25 and 30 symptoms in that timeframe. And that was the 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. Hymns declined to comment on Mark's care. Many 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.

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.

Regulators 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 the past. In 2011 and 2012, the FDA revised the drugs label to highlight sexual side effects. In 2022, the agency updated the drugs label to include the risks of quote, suicidal ideation and behavior. The side effects that HIMS and other telehealth companies list on their websites are based on what's on the drugs label.

Most men tolerate finasteride well. The drugs 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%. For a medication that is being prescribed to millions of people, I mean, that's a lot of men out there. That's Rolfe again. That less than 2% risk is the stat that HIMSS shows potential customers when they sign up online. customers when they sign up online.

Rolfe also noticed that HIMSS was citing a statistic in its list of side effects he'd never seen before. I asked him, 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. safety disclosures. Okay, but that one doesn't appear anywhere on the drugs label, so where does it come from? And I said, oh, well, you found a typo.

A HIMS spokeswoman said HIMS 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, comprehensive intake that is reviewed by a licensed provider who makes a clinical determination about the patient's eligibility for medication. And, you 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 HIMS spokeswoman said its systems help clinicians make decisions quickly by flagging if a patient's case is routine or more complex.

As convenient as the process was, Mark wishes there'd been a little more friction when he signed up with Hems. 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 him, but all these other telehealth companies as

well. If 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. That's all for today, Monday, April 14. 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.