Dear Dr G,

My name is Jamie and I am 38 years old.

For the last two years, I have been experiencing the horrible problem of hair loss.

I have been to the doctors and specialists and they all assured me that this is a “normal” path of ageing, and nothing can be done about it.

Six months ago, I approached a pharmacist who recommended a medicine called Finasteride.

I must say the medication works wonders. Within the three months of starting the medication, I noticed minimal thinning. The hair loss had definitely decreased.

However, I began to notice some problems in the bedroom.

I realised my desire for sex has decreased dramatically. Before the treatment, my wife and I were having sexual intimacy at least twice a week.

Of late, we are only having intercourse about once a week.

The lack of sex is probably caused by the lack of erectile rigidity. In recent weeks, I also noticed the erection is not as strong as it used to be.

I am so sorry to put Dr G on the spot, I know that this is not all about sexual health, but can you explain why men get male pattern baldness?

What exactly is Finasteride? Does it cause  sexual dysfunction?

I read an article recently and realised that this is a common problem suffered by men who took Finasteride.

Some of them even have sexual dysfunction persisting for years, is that true?

I look forward to your opinion.

Regards

Jamie

The male pattern hair loss (MPHL), or androgenic alopecia is a common hair loss condition that primarily presents as receding hairline, and affects the loss of hair at the top and front of the scalp.

The loss usually emerges after the age of 40 and it is estimated to affect half of men by the age of 50.

The exact cause of hair loss is unknown. The main etiology is believed to be the combination of genetics and the deranged male hormone.

The testosterone tends to stimulate the hair growth on the face, but also suppress growth at the temples and scalp vertex. This is referred as the “androgen paradox”.

Men with androgenic alopecia typically have higher enzyme of the 5 alpha-reductase.

The enzyme is responsible for converting the testosterone into the active component of the hormone, dihydrotestosterone (DHT).

DHT is most prevalent in the scalp and is the main culprit for the androgenic paradox.

Most men with male pattern baldness will accept the fate of baldness with no treatment. However, men who are reluctant to accept the eventuality are often keen to seek help.

Not all type of hair loss is treatable, as some alopecia may be permanent. Effective treatments for hair loss include medications, surgery and even laser interventions. The goals of the treatment are essentially promoting hair growth and minimising further loss.

The two medications that are approved by the FDA for the treatment of baldness are Minoxidil and Finasteride. Minoxidil is over-the-counter foam that is rubbed into the scalp twice a day to promote hair growth.

The effect is reported to peak at 16 weeks and continuous application is necessary to retain the benefit.

Finasteride is also a prescription medication available to men with hair loss. The medication slows down the hair loss and provides around 30% improvement within 6 months of treatment. The drug is used to inhibit the enzyme, 5 alpha reductase.

With the lowered active form of the male hormone, the side effect of Finasteride can diminish sex drive and induce erectile dysfunction.

Apart from sexual dysfunction, the intervention is also reported to cause gynecomastia (man boobs). Although the side effects are rare, the adversity can be a source of psychological distress, especially in younger men.

In the last decade, a group of men from North America, who were treated with Finasteride, claimed to have persistent sexual, neurological and psychological side effects.

In 2012, a health advocacy group called “Post Finasteride Syndrome” Foundation was formed with the primary goal of finding a cure for the syndrome and raising awareness.

Although the syndrome is not formally proven, it has raised concerns among men contemplating to start the treatment.

Larry David, the comedian who created the television series, Seinfeld once said: “Anyone can be confident with a full head of hair. But a confident bald man - there’s your diamond in the rough.”

Some studies highlighted that women even found balding men oozing sex appeals and wisdom. If Dr G is put on the spot to choose between sex and baldness, there is little doubt that I will go for the latter.

Dr G hopes to have the best of both world by compensating the erection problems with the blue pills. On that note, I wish Jamie a luscious growth of hair with no compromises in the pants.