Hair transplants have become difficult to miss, as videos of planeloads of men with reddened scalps bulging above tight headbands have gained traction on social media over recent years. In most of the videos, the men are flying home from Turkey – now a global mecca for restoration procedures thanks to the affordability of its clinics. The trend is not limited to online impressions. In its 2025 census, the International Society of Hair Restoration Surgery reported a 20 percent increase since 2021 in the average number of patients treated by its members. In 2024 alone, among first-time surgical patients, 95 percent began treatment between the ages of 20 and 35 — and 44 percent said they planned to tell other people they had undergone the procedure. A transplant moves follicles from the back and side of the head to areas affected by male pattern hair loss, known clinically as androgenetic alopecia. Those transplanted follicles are generally more resistant to the dihydrotestosterone (DHT) that triggers sensitive hairs to fall, so once relocated, they tend to stay. What far fewer of them mention is what tends to come next: a routine part of aftercare that a growing number of men say quietly reshaped their lives – with some still living with the consequences more than a decade later. So Bored Panda set out to learn how honestly that risk is being presented to the men now signing up in record numbers – by becoming one of them. But that story starts with the drug itself. Despite the transplant, the patient's remaining hair is often likely to continue thinning. To preserve it, many clinics recommend the use of finasteride, a U.S. Food and Drug Administration (FDA) approved drug that prevents hair loss and can promote regrowth in some patients by inhibiting DHT production. Finasteride has long been recognized for causing side effects in a minority of users, including reduced libido and erectile dysfunction, widely believed to reverse after discontinuation. Less understood, but increasingly documented in patient reports, scientific research and regulatory warnings, is that some people experience persistent sexual and neuropsychiatric symptoms — including depression and suicidal thoughts — after they stop taking the drug. In some cases, users report persistent debilitating side effects more than a decade after discontinuing the drug. Commonly referred to as post-finasteride syndrome (PFS), the prevalence and biological cause of the condition remain disputed. But clinical evidence has mounted significantly since the first study on the condition was published in 2011, and regulators now acknowledge that some adverse effects may continue after discontinuation. For this investigation, Bored Panda contacted multiple hair transplant clinics in Turkey, Colombia, Hungary, the United Kingdom, and the United States, under the guise of being a potential patient, in order to understand how prevalent finasteride use is in aftercare, as well as how the risks are being presented. Only one out of the nine clinics that responded to concerns expressed about finasteride stated that they don’t recommend it because of the side effects risk. Several gave assurances that are difficult to reconcile with current regulatory warnings. Finasteride was not originally developed as a hair-loss treatment. Pharma giant Merck first sold a 5-milligram dose under the name Proscar for enlarged prostate, which was approved by the FDA in 1992. According to the American Hair Loss Association, after the drug was found to promote hair growth, Merck developed a lower-dose version for male pattern hair loss and in 1997 the FDA approved Propecia, a 1-milligram dose of finasteride, for male pattern hair loss in men. A Merck research facility in San Francisco. (Source: Coolcaesar) The early safety information focused on sexual side effects reported during treatment. In the first year of three controlled Propecia trials, decreased libido was reported by 1.8 percent of men taking the drug, erectile dysfunction by 1.3 percent and ejaculation disorder by 1.2 percent. The label stated that these effects resolved in men who discontinued Propecia and in many of those who continued taking it. The warning language broadened over time. A Merck periodic safety report from 2006, subsequently made public through litigation, recorded one clinical-trial participant whose sexual adverse event was still present six months after discontinuing finasteride, with no further follow-up available. Depression was added to the U.S. Propecia label in 2011. In 2012, it was updated to include sexual dysfunction continuing after discontinuation, including erectile dysfunction, libido disorders, ejaculation disorders and orgasm disorders. Suicidal ideation and behaviour were added in 2022. The FDA’s 2022 updated warning for Propecia In 2025, the European Medicines Agency confirmed suicidal thoughts as a side effect of finasteride and dutasteride tablets, with the latter being an even more potent DHT inhibitor. Most reported cases involved men using the 1 milligram dose prescribed for hair loss, but the agency said the frequency could not be estimated from the available data. The online patient forum Propeciahelp gives some indication of how different patient accounts can be from the limited sexual side effects addressed in Propecia’s original trial data. Its standard template for member stories lists 41 symptoms for users to check off, as well as an option to add others. They range from sexual dysfunction and loss of libido to emotional blunting, memory problems, suicidal thoughts, muscle weakness, fatigue and digestive problems. These accounts are self-reports. They do not establish how often such symptoms occur, nor prove that finasteride caused them. But they show that people have been reporting a broad pattern of persistent symptoms for decades. In some cases, users report the development of symptoms after the stopping the drug following a decade of use without problems. Many users report complex and persistent neuropsychiatric side effects. Image for reference. One forum member, reported taking the standard 1 milligram Propecia dose for hair loss for just ten days before developing sexual, cognitive and emotional symptoms after stopping. In updates posted over the following decade, he reported that some symptoms had improved, while loss of libido, reduced genital sensation and anhedonia had persisted, with the latter referring to an inability to feel joy or pleasure. While ten days of use may seem short for someone to develop long-term debilitating side effects, Propeciahelp and other forums host many more similar accounts of catastrophic reactions to short-term usage. According to Professor Roberto Cosimo Melcangi, who has studied PFS for 15 years, some people report being affected by just one dose. “We have a patient that takes finasteride for one year, the other for one month, the other for one week, the other only a single time,” he told Bored Panda in reference to PFS patient testimony during studies he has published, before stressing that such accounts do not establish incidence or causation. Dr Roberto Cosimo Melcangi (Source: PFS Foundation / ByoBlu) Melcangi and his team have detected altered neuroactive steroid levels in the cerebrospinal fluid and plasma of patients reporting PFS, and have also examined possible epigenetic and gut microbiota changes. According to Mitch Sabine, president of patient advocacy organization PFS Network, people whose symptoms persist often believe the possible consequences of taking the drug were not properly explained to them. “It’s not just like ‘a little bit of ED’ or ‘a little bit of depression,’” he said. “It’s quite serious, multi-systemic, physical, neurological, sexual, cognitive symptoms, which do not go away… They persist indefinitely.” Armed with a head bald enough to be a convincing prospect for transplant clinics, this reporter’s consultations began as ordinary enquiries about what a procedure could realistically achieve. Advice varied, from offers of extensive coverage to more cautious assessments based on limited donor hair and the possibility that a second operation would be needed. Questions about finasteride were then raised as a concern about aftercare: would the medication be recommended, and what would happen if it caused side effects? The answers varied significantly. A representative of Sapphire Hair Clinic, in Turkey, initially said side effects were not common and that “in most cases” they were reversible. When asked whether that meant side effects could persist, they changed to a categorical reassurance: “No, if you notice any side effects and stop taking the medication, you would not be left with permanent side effects. Once the medication is discontinued, things return to normal.” A prospective patient image modified by Sapphire Clinic to outline available options (Source: Charles Parkinson) When asked again about people reporting symptoms for years after using finasteride, the clinic replied: “Yes, once the medication is stopped, the side effects go away.” A representative for Bosley in the United States acknowledged sexual side effects, depression and gynecomastia (abnormal enlargement of breast tissue in males), but said a patient experiencing side effects could stop taking the drug and “go right back to normal.” Meanwhile, a representative for New York clinic Wolfeld said reports of lasting effects were “kind of sensationalized online” and that the side effects patients read about were “not permanent, they’re reversible.” A representative of The Growth Clinic in London, U.K., said: “Most people tend not to get side effects. Some people could. There's not much we can kind of do about that.” While, at Hero Institute in Colombia, a consultant acknowledged that a specialist would be better placed to answer the questions. The consultant also said side effects were reversible and suggested reduced libido was often related more to the patient’s thinking or emotional predisposition. When asked whether the effects always resolved after stopping treatment, she replied: “Exactly.” Men apparently at an airport in Turkey after having hair transplants (Source: Instagram / hairtransplantworbimed) Now Hair Time, in Turkey, said it had not witnessed negative side effects from finasteride and added: “As you know it’s an FDA approved medication. We wouldn’t recommend it if it wasn’t approved by worldwide health organizations.” The one clinic that took a markedly different position was Hair Palace in Budapest, Hungary, which said some patients decided to take it to preserve native hair, but warned against using it. “We always say that we actually don’t recommend it exactly because of the side effect,” its representative said. “If you can avoid it, then we don’t recommend it.” Three clinics relied on a 2 percent or less-than-2-percent figure when concerns about finasteride were raised. Vera Clinic said side effects affect “a very small minority (less than 2% of users).” Hero Institute said reduced libido occurred in only 2 percent of patients. Bosley used the figure after mentioning sexual side effects, depression and gynecomastia. The number closely resembles Merck’s original trial reporting, in which each individual sexual adverse event recorded during the first year affected fewer than 2 percent of men taking Propecia. But that does not mean fewer than 2 percent reported any sexual side effect. The U.S. product label states that 3.8 percent of men taking Propecia in the first-year trials reported one or more specified sexual adverse experiences, compared with 2.1 percent receiving a placebo. Before and after surgery to address gynocemastia (Source: Medical News Today) More importantly, the original trial figures do not estimate the risk of persistent symptoms after stopping the drug. Used in response to direct questions about long-term harm, the figure addresses a different and narrower question. What’s more, internal communications among senior staff at Merck have explicitly acknowledged the unreliability of study results. In an August 2000 internal email made public during legal proceedings, Keith Kaufman, the company’s clinical head for Propecia at the time, described a long-term sexual adverse-event figure used in company material as “totally misleading,” because men who experienced such effects had already dropped out of the study, according to Reuters. Two clinics presented liquid topical finasteride as a way to avoid or sharply reduce concerns about taking the drug orally. The representative at Vera Clinic said topical finasteride was applied directly to the scalp and “does not process through your entire system,” significantly reducing the risk of side effects. Wolfeld’s rep went further, saying the topical version presented “essentially no chance of side effects” because it was not going through the bloodstream. Promotional material from the highly regarded Harley Street clinic in London, U.K. That assurance conflicts with an FDA alert issued in April 2025 about compounded topical finasteride products. The agency said there is no FDA-approved topical finasteride formulation in the United States and that absorption through the skin into the bloodstream is expected. The FDA said it received 32 reports of adverse events involving compounded topical finasteride between 2019 and 2024. Reported effects included erectile dysfunction, anxiety, suicidal ideation, brain fog, depression, fatigue, insomnia and decreased libido. Most of the reports said adverse events continued after the product was discontinued. The reports do not establish the frequency of harm from topical finasteride, or show that its risk is equal to oral medication. They do mean it cannot accurately be presented as a formulation with essentially no chance of systemic or persistent effects. Propeciahelp also contains multiple accounts from people attributing persistent symptoms to topical finasteride and to saw palmetto -- a herbal product with DHT-inhibiting activity. Wolfeld’s representative did not specifically recommend saw palmetto, but made it clear it recommended “some sort of DHT inhibitor” to prevent further hair loss. Saw palmetto is a powerful herbal DHT blocker (Source: Pexels / Afterave Essentials) The clinic responses reflect a disagreement that remains active within medicine. A 2026 survey of 54 dermatologists in the Spanish Hair and Nail Disorders Group found that 83.3 percent said they had never encountered a PFS patient in clinical practice. Most considered it psychiatric in origin and believed adverse effects from finasteride or dutasteride were reversible after stopping treatment. The authors concluded that high-quality longitudinal studies are needed. Dr Mayer Brezis, a professor of medicine emeritus at the Hebrew University of Jerusalem, takes a sharply different position. In a 2025 review, he argued that evidence from experimental, clinical and epidemiological studies supports a causal association between finasteride and depression and suicidality, particularly among younger men taking it for hair loss. “Patients are unlikely to ascribe a worsening mood to a cosmetic medicine, and clinicians unaware of this risk overlook the connection. Only epidemiological studies can identify the problem, and this is what was found with finasteride, with overwhelming consistency across studies,” he told Bored Panda. Dr Meyer Brezis (Source: Post Finsteride Syndrome Foundation) For Brezis, that makes it inappropriate for clinicians to tell patients persistent adverse effects cannot occur or will always reverse. U.S. and European regulators have now recognised serious adverse reactions linked to finasteride, while questions about incidence, susceptibility and the precise biology remain unresolved. More than 1,100 Propecia lawsuits were consolidated in U.S. federal litigation, with Merck settling most of them in 2018 for $4.3 million without admitting wrongdoing. The company told Reuters that it stood behind the safety and efficacy of Propecia and rejected claims that the drug caused persistent sexual or mental health problems. The drug is now owned by Organon, an entity created by Merck to separate its women’s health and trusted legacy brands from the rest of operations, which was spun out into an independent company in 2021. Organon has also said it stands behind the drug’s safety and efficacy. It’s important to note that many clinics provide alternative treatments to anyone who prefers not to use finasteride. Bosley, for example, offers patients a discounted price on an LED hair growth stimulation cap that its manufacturer boasts has proven clinical results – albeit based on a small compliant subgroup. Some LED caps have been FDA cleared as hair growth stimulators (Source: REVIAN) It´s also necessary to categorically state that hair transplants alone do not cause PFS, most people who take finasteride do not report persistent effects, and the drug is not mandatory after surgery. However, patients considering a cosmetic procedure should be properly informed that long-term sexual and psychiatric harms have been reported for many years and are now reflected in regulatory warnings — not assured that stopping the drug is guaranteed to make them disappear. For Brezis, the fact those warnings emerged only after years of use, while clinics continue to minimise the risks, points to a wider breakdown in adequate monitoring. “This is a major failure of regulation in the face of industry,” he said.
