The reasons for not wanting to take the FDA Approved pharmaceutical drug, Propecia, are many. In a nutshell, there are both sexual and neurological side effects that are well established to occur in a significant portion of users. Most in the medical community, at least in the U.S., have dismissed these side effects as transient, and in all cases, reversible upon discontinuation.

      More recent studies though, have found that sexual side effects may in fact be long standing after discontinuation, prompting a class action lawsuit to be filed in Europe.

      This just published study looms equally ominous, showing a specific measurable and objective criteria that revealed there are, in association with Propecia, alterations of specific neuro-steroid blood levels that predispose to Depression and Anxiety that persist even after the discontinuation. 

      This study puts the nail in the coffin of the argument that Propecia side effects are of psychological origin, which has been routinely posited by its proponents for years. 

Patients treated for male pattern hair with finasteride show, after discontinuation of the drug, altered levels of neuroactive steroids in cerebrospinal fluid and plasma. 

Caruso D, Abbiati F, Giatti S, Romano S, Fusco L, Cavaletti G, Melcangi RC
Department of Pharmacological and Biomolecular Sciences – Center of Excellence on Neurodegenerative Diseases, Università degli Studi di Milano, Milano, Italy.
The Journal of Steroid Biochemistry and Molecular Biology

Observations performed in a subset of patients treated for male pattern hair loss indicate that persistent sexual side effects as well as anxious/depressive symptomatology have been reported even after discontinuation of finasteride treatment. Due to the capability of finasteride to block the metabolism of progesterone (PROG) and/or testosterone (T) we have evaluated, by liquid chromatography-tandem mass spectrometry, the levels of several neuroactive steroids in paired plasma and cerebrospinal fluid (CSF) samples obtained from post-finasteride patients and in healthy controls. At the examination, post-finasteride patients reported muscular stiffness, cramps, tremors and chronic fatigue in the absence of clinical evidence of any muscular disorder or strength reduction. Although severity of the anxious/depressive symptoms was quite variable in their frequency, overall all the subjects had a fairly complex and constant neuropsychiatric pattern. Assessment of neuroactive steroid levels in CSF showed a decrease of PROG and its metabolites, dihydroprogesterone (DHP) and tetrahydroprogesterone (THP), associated with an increase of its precursor pregnenolone (PREG). Altered levels were also observed for T and its metabolites. Thus, a significant decrease of dihydrotestosterone (DHT) associated with an increase of T as well as of 3α-diol was detected. Changes in neuroactive steroid levels also occurred in plasma. An increase of PREG, T, 3α-diol, 3β-diol and 17β-estradiol was associated with decreased levels of DHP and THP. The present observations show that altered levels of neuroactive steroids, associated with depression symptoms, are present in androgenic alopecia patients even after discontinuation of the finasteride treatment. This article is part of a Special Issue entitled ‘Sex steroids and brain disorders’. 

      There are alternatives to Propecia that lower serum DHT not only without side effects, but with numerous cross over health benefits as well. Briefly, these are a combination of Astaxanthin with Saw Palmetto/Beta sitosterol, Theaflavin (Black Tea) Extract, and a combination of Green Tea Extract with Soy Isoflavone Extract.

      Like Propecia these compounds are documented to have hair growth effects, and unlike Propecia they are established to ENHANCE and not diminish, cognition, libido and sexual function.