Propecia’s side effects are well established. They include, but are not definitively limited to reduced libido, sexual performance dysfunction, gynocomastia, increased fat deposition, anxiety, and depression. According to Merck, the manufacturers of Propecia,the overall incidence of these side effects is less than 2%, but there are no available data detailing how they arrived at this number. Real world feedback from both patients and physicians indicate that at least 1 in 3 users will manifest some type of side effect, ranging from subtle to severe. There are currently several class action law suits being bought against Merck for side effects in some patients that have been deemed to be permanent.

      Side effects notwithstanding, there are those who choose to continue Propecia despite side effects and the existence of viable alternatives that fuction with the same mechanism of action. Fortunately, there are compounds that according to many users, can be concurrently used with Propecia that will largely ameliorate the associated side effects. 

      The libido supressing and other estrogenic side effects typically respond well to using aromatase inhibitors, Aromatase is an enzyme that converts testosterone into estrogen. Since Propecia raises testosterone by 10% by virtue of its inhibiting its conversion to DHT, some of that excess testosterone gets converted to estrogen, thus creating estrogenic or feminizing side effects. There are both pharmaceutical and plant based aromatase inhibitors that work fairly well at suppressing this excess estrogen caused by Propecia. 

      The two avialable pharmaceutical aromatase inhibitors are Arimidex and Aromasin. Both Aromasin and Arimidex were originally designed to be used by breast cancer patients to keep estrogen levels down. Arimidex has been used for years in the Body Building community to neutralize the unwanted estrogenic effects of anabolic steroids, which can often both build muscle and simultaneously enlarge breast (GYNO), due to this aromatization effect. Arimidex reportedly prevents Gyno, body fat accumulation, and libido issues associated with both Anabolic steroids and Propecia. Interestingly, this suppression of estrogen caused by Arimidex also makes it useful as a intervention to increase height in developing adolescents, creating a likely 3 inch increase in final adult height, according to 1 study.

      The disadvantage of both Arimidex and Aromasin is that they by themselves can cause hair loss in women,( which they won’t do in the presence of Propecia, but women who are at risk or have any history of breast cancer should NEVER use Propecia). This is a noted side effect of both in breast cancer patients. They also require a prescription, and their usage in men is considered entirely off label, which precludes insurance coverage for this purpose. They are also quite expensive-even in their generic forms. 

      Plant based Aromatase Inhibitors also reduce estrogen and raise testosterone, and in some cases further lower DHT, giving an additional benefit to hair. There are several that have this effect. The most documented are Resveratrol, Theaflavin (Black Tea) Extract, Grape Seed Extract, and Pomegranate Extract. Unlike Arimidex and Aromasin, all of these compounds have multiple additional properties that support hair growth as well, in addition to increasing testosterone, libido and peripheral blood flow. Theaflavin Extract in addition to inhibiting aromatase, thereby reducing estrogen, also lowers serum DHT. 

      The benefits of these plant based aromatase inhibitors goes well beyond hair and libido, providing health and anti-aging properties that include cardio-vascular benefits, anti-inflammatory, skin aging protection and cancer chemo prevention. 

      The documented neurological and psychiatric side effects of Propecia, most notably Anxiety and Depression, has been traced directly to its effects on Allo-Pregnenolone, a neurosteroid which it effectively obliterates. Some have reported successfully dealing with this side effect by using supplementary Pregnenolone, an OTC supplement, (popular with college students as a smart drug) indicated for Depression and cognitive enhancement If you have previously or are using Propecia and are experiencing these side effects, Pregnenolone may be worth a try.

      Although there are no published studies as of yet that deal with the management of Propecia side effects, it is quite plausible, given the consistent anecdotal feedback and identified mechanisms implicated in Propecia;s side effects, that they can be readily neutralized which some of the aforementioned interventions. Anecdotal accounts in this regard have been generally positive. 

      As mentioned in prior updates, I personally discontinued Propecia (1/4 Proscar) in 2004, and haven’t had any hair loss in response, due to my extensive array of other interventions. My personal recommendation for Propecia side effect management or Prophylaxis would be to minimally concurrently use either Black or Green Tea Extract along with 50-100 mg of Pregnenolone. As mentioned in our last update it is also advantageous, and in some individuals, imperative, to use a concentrated extracts of Phytosterols as well due to the up-regulation in Androgen Receptor (AR) Activity caused by Propecia, which causes some to actually lose hair in response to its usage. This continued increase in AR activity is also thought by some researchers to reduce Propecia’s effectiveness over time.

      Again if you feel you must remain on Propecia, despite side effects, you may find that some are to a large degree, avoidable.