For most of his 20s, Elliot Connors did not think a lot about his hair. He was losing some of it, maybe — but so what? This was what happened to men. He was funny and sharp; he had a girlfriend.
He began to worry only after he and some friends from graduate school in New York started a group chat last summer. In it, they talked about their classes and sports and joked about their love lives, and the thread frequently digressed into a series of semiserious conversations about hair loss: whether their hairlines were staying the same or, God forbid, receding; which products to apply, which medications to take; how much they did or didn’t care.
Several of Connors’s friends were taking a drug called finasteride, which is remarkably effective — the research shows that it significantly slows hair loss in most men for at least 10 years (with many men reporting effectiveness well beyond that); studies have found that it stimulates at least some renewed hair growth in a majority of men.
Connors’s friends kept close track of their progress from week to week. Dermatologists commonly recognize seven stages of hair loss, which were refined and popularized in the 1970s by O’Tar Norwood, a dermatologist and pioneer of hair transplant surgery. Many of Connors’s friends, young men in their 20s, were a Norwood 2 or even a Norwood 3, displaying the beginnings of a creeping V on both sides of the forehead. (When you reach a Norwood 6, you may be “cooked,” in the online discourse of hair loss: too far gone for help.)
Before too long, Connors began inspecting his hands after washing his hair. Was more of it falling out than usual? He examined old photos of himself and compared them with his reflection in the mirror, looking for signs of change. He grew increasingly observant of other men’s hair: He noticed whose hairline was receding, and who was so young that he took his lush mane for granted, blissfully ignorant of the hair loss that was most likely in his future. He started to think he had no choice if he wanted to keep up: He’d better start taking finasteride.
He had read that finasteride could cause worrisome side effects — low libido, for example, or depression — and he would come to feel conflicted about the popularity of the drug. “We could all just not be on any of this stuff, and then our relative appearances would be the same,” he said. “But now we all have to be on it just to keep up with everyone else who’s on it. It’s like a nuclear arms race.”
Losing your hair, for men, was once largely inevitable and nearly universal. Two-thirds of American men will experience hair thinning by their mid-30s, and 85 percent will experience significant hair loss by 50, according to the American Hair Loss Association. “People used to say, ‘Losing your hair is just part of life — accept it,’” said Marc Avram, a dermatologist in New York who specializes in treating hair loss. In earlier eras, Hollywood’s leading men — Paul Newman, Jack Nicholson, Bruce Willis — played romantic leads long after their hairlines started to recede. Fathers and uncles counseled the young men in their lives to come to terms with the changes as part of the journey into adulthood. “There was literally no other option,” Avram said, “other than plugs.”
Today that’s no longer true. Celebrities and others who can afford it shell out up to $20,000 to get hair transplants, which have become harder to detect and ever more precise. Surgeons can now extract individual healthy follicles from abundant areas of their patients’ heads and implant them, one by one, into the scalps’ hair deserts. This more expensive, newer approach promises a more natural hairline, although those who know what to look for can still tell when someone has had the procedure. “If an actor has a full head of hair sticking straight up from his forehead and he’s over 30, he’s probably had one,” said Leah Ansell, a dermatologist in Rye, N.Y., who says she likes to point them out to her husband during awards shows. “They’ve all had one. All of them.”
Men with more modest means can find packages that fly them to Turkey and deliver the same procedure for around $3,000 — or they can start with the cheapest option of all, which is going on finasteride. Prescriptions for the drug in the United States tripled between 2017 and 2024, a time when telehealth companies were taking off, just as men started spending hours a day staring at their hairlines on Zoom.
Feeding that anxiety is a mass-marketing campaign teaching men the same brutal self-scrutiny that women have long been trained to perform. A typical male in his 20s or 30s is likely to receive a flood of ads and shout-outs on Instagram, TikTok, YouTube and the livestreaming platform Twitch for hair-growth products that appeal to men their age: not just the usual tablets but chewable pills and sleek black bottles of “Mane Spray.”
Young men have also been encouraged to care deeply about their appearance by their country’s own commander in chief, whose highest praise for various appointees includes comments about their good looks. He’s “central casting,” President Trump said of his new pick for the chair of the Federal Reserve, Kevin Warsh — a man in his 50s, it must be noted, who has a full head of hair. (Pete Hegseth, the secretary of defense, is more like a Norwood 2.) Trump seems to have a particular obsession with hair, talking at one campaign rally about all the best products he douses his head with in the shower, and famously asking a young woman at another event to come up and inspect his hair to verify that it was all his own (and not, as one radio personality was suggesting, a toupee).
Young men who have come of age in the time of the manosphere are prime audiences for endless reels from influencers — some of them exceptionally buff, some of them funny, some of them with millions of followers — who are trying various treatments in the hope of regaining a full head of hair. The hair-loss influencer (it’s a category unto itself) Zeph Sanders has over one million TikTok followers tracking his “hair journey.” Typical content: “POV: You spent the last year falling in love with yourself,” reads the text introducing a quick montage of all the steps he has taken over the past 12 months to improve his hair (starting with a hair transplant). The ubiquity of this kind of content makes losing one’s hair no longer seem inevitable; going bald can now feel like a choice — a conscious decision.
Frequently the advertising and those influencers are conveying the message to young men that they should start taking finasteride young — in their early 20s — so that they don’t lose their hair in the first place. Andrew Dudum, a co-founder of Hims & Hers, one of the main telehealth companies selling hair-loss medication, said in a 2017 interview that their goal was to market those treatments to a younger audience, adding that while he was in his college, he and his friends could have benefited from products that protected their hairlines. The approach fits into the broader “prejuvenation” trend, in which young men and women are using lasers, fillers and products like Botox to fend off signs of aging before they start, rather than doing damage control when degradation is already well underway.
Ansell, the dermatologist, said she has had parents come in asking about finasteride for their teenage sons, looking to make sure they get “all the best they can have in order to succeed in life.” Young men are also coming in on their own for help keeping their hair. “More of them are really anxious about it,” Ansell said. “There’s no new epidemic of hair loss, but there is an epidemic of men freaking out about it.”
Before there was finasteride, there was rosemary oil, there was sunlight-exposure therapy, there were hair plugs, there were comb-overs, there were toupees. Before there was hair-loss medication prescribed by online pharmacies in elegantly designed, minimalist, earth-toned packaging, there was the exclusive-sounding Hair Club for Men, a business created by Sy Sperling, a former pool salesman who collaborated with a hair stylist to offer weaves that blended a man’s own remaining hair with color-matched hair on a nylon mesh. “I’m not only the Hair Club president,” Sperling says in a commercial from 1984, displaying a full head of chestnut brown hair, “but I’m also a client.”
In the 1970s, doctors studying minoxidil for its effects on blood pressure noticed in early trials that it caused men’s hair to grow. It was later brought to market for hair loss under the name Rogaine. The drug, which seems to make it easier for blood, oxygen and nutrients to reach hair follicle cells, has been wildly popular ever since, but only in about half of men will minoxidil trigger the kind of enzyme activity required for the drug to be effective. A majority of men who use it do find that it thickens their hair and slows the hair-loss process — but it seems to delay hair loss, not prevent it altogether.
Finasteride, by contrast, tends to yield better results for men hoping to hold on to their hair and to promote new growth. Researchers first noticed its effects on hair in the early ’90s, when the drug was being administered in a trial to treat men with enlarged prostates. The drug inhibits the conversion of testosterone into a hormone known as DHT, which is crucial in the development of male characteristics. In adult men, DHT is also associated with hair growth on their bodies and hair loss on their heads. Why hair follicles respond to DHT so differently depending on where they are on the body is one of the hormone’s mysteries. Doctors don’t even understand why men tend to lose the hair above their temples first, but they do know that finasteride is especially effective in bringing back hair on the top and toward the back of the head. Once an area of the scalp is shiny smooth, that means that the hair follicles in that area may be too shriveled to be revitalized.
First brought to market for hair loss by Merck as Propecia in 1997, the pill became available in generic form in 2013. By the time the pandemic hit and telemedicine took off, it was already cheap; now men could access it privately, in some states, simply by uploading a few photos and answering a few questions online. Also available at big-box-store pharmacies for as little as $5 a month — less than the cost of a single day’s latte fix — the drug is nonetheless a lifelong commitment, at least for men who continue to care about their hairlines. When men go off the drug, their hair loss resumes in about six months.
Finasteride, many dermatologists think, is one of the great cosmetic cures of the 20th century. And yet there is a catch: As many as one in 20 men who take the drug orally will experience a side effect — erectile dysfunction, low libido or, occasionally, low sperm count or depression. A vast majority of the time, those symptoms resolve in a few weeks after men go off finasteride (and sometimes even when they stay on it), according to studies of the drug. But in rare instances, men have reported debilitating symptoms that continue even after they stop taking the drug. In addition to erectile dysfunction, low libido and depression, some men have also reported symptoms such as genital numbness, cognitive difficulties, a shrinking of the penis and even suicidal ideation. Having one or more of these ongoing symptoms is known among some researchers and patients as post-finasteride syndrome, which is poorly understood and a topic of considerable debate in the field.
Well-conducted research from a randomized controlled study published in 2021 found that using finasteride topically — applying a spray or a gel on the head — reduces the likelihood of serious side effects and is almost as effective as the oral version. And new drugs, including one that stimulates hair follicles’ mitochondria, are expected to come on the market in the next few years and reportedly have no side effects. But for now, most dermatologists still prescribe oral finasteride, which has been studied the longest. Topical versions, which are still not approved by the F.D.A., typically cost more and have to come from a compounding pharmacy. Many men also grow frustrated with regularly applying serums or gels because the products mat their hair during the day or leave their pillow greasy at night. Doctors worry about finasteride coming into close contact with women who are pregnant (or may become pregnant), given that DHT plays a significant role in a developing male fetus. And although finasteride itself won’t cause hair growth on, say, a girlfriend’s cheek, it’s often compounded with minoxidil, which might.
“I, for one, would never take the medication,” said Jonathan Clavell, a urologist in Houston. “Because if I were one of the unlucky few who turns out to get the syndrome, I know I’d regret it.” While the dermatologists I spoke with said they’ve never seen a patient who suffered from ongoing symptoms, Clavell is one of five urologists I interviewed who said they had. He even suspects that the number of people reporting those serious problems could be artificially low, because so many men secretly suffer in shame with erectile dysfunction and never seek a diagnosis or help. And men suffering from depression or brain fog might not make the connection — Clavell has seen some patients who have no idea, until he asks them for a list of the drugs they’ve taken, that finasteride might be associated with those symptoms.
Clavell has tremendous sympathy for his patients — earlier in his 40s, he himself was a quickly balding man who was tempted to do anything he could to keep his hair (for years he relied on minoxidil, which eventually stopped working). “I believe there’s a very big misconception that only women care about their appearance,” he said. “And it’s not true. Men just don’t talk about it with our friends. But secretly, behind closed doors, we are trying to keep our younger selves for as long as we can.” Maybe it is some kind of machismo, he mused, that makes men so likely to compare their own hair with others’. “When you watch TV and movies and all these actors,” Clavell said, “they have beautiful, long hair. You’re like, ‘Man, how are they able to keep all that volume?’”
Clavell’s wife, Mildred Lopez Pineiro, a dermatologist with a thriving practice in Houston, regularly prescribes finasteride once she’s alerted patients to the possible side effects. “If they’re informed and willing to take the risk, why not?” she said. But she has assured her husband that she does not feel as if he needs it and supports whatever choices he makes about his hair. Clavell recently gave up on salvaging it and shaved his head, as have many balding men, some of whom are active on dedicated forums or proudly serving as social media cheerleaders for the look. He has been at peace with his choice, even when his 5-year-old daughter commented on the change. “Daddy,” she said to him, “you don’t have hair anymore!”
The social media universe expends so much energy on the topic of male hair loss that meta conversations online can assume viewers’ familiarity with the obsession. “What would you rather lose: a finger or your hair?” the comedian Hannah Berner asked a series of men on her Instagram feed last December. “Finger,” answered her fellow comic Erik Scott. “Fingers!” When the comedian Adam Friedland filmed an episode of his show with the influencer Clavicular, a steroid-loving, status-chasing champion of a classically handsome aesthetic, he asked a question that made it clear how ubiquitous concerns are about finasteride’s side effects: Would you rather lose your hair or your penis? Friedland and Clavicular agreed: They’d want to keep their hair.
The dilemma over the drug’s trade-offs is a perennial topic of debate on one of the more popular men’s health subreddits on Reddit, r/tressless, a space where men have been discussing hair loss and treatment since 2011. The subreddit saw a huge spike in traffic during the pandemic and now has about 413,000 weekly visitors (roughly four times the number of weekly visitors to r/WegovyWeightLoss, for example, a popular subreddit devoted to that GLP-1). Men share pictures of triumphant hair regrowth, seek reassurance, pour out their hearts, vent their frustrations about the women who reject them and get into vicious debates about whether or not the drug actually poses a real risk. “Doctors tell me to avoid finasteride” is the name of one thread; “Finasteride changed my life for the better” starts another.
The discourse veers from admissions of profound insecurity to signs of real mental health struggles. “I hate hairloss to my core,” one poster wrote three months ago. “I’m literally gonna cry bro.” He couldn’t even lead a normal life, he wrote, with his hair thinning starting so young. Another man said going bald was so awful for him that he was wondering whether anyone else was reconsidering having children, given that hair loss is genetic.
After I posted a request on Reddit for men to share their thoughts about finasteride and hair loss, Kieran (his middle name), a project manager in London, reached out to me in the spirit of making a public service announcement: He worried that needless fears of rare side effects were keeping men from leading happier lives. He was so concerned about his hair loss, which started in his 20s, that his anxiety seemed akin to what experts call hair loss dysmorphic disorder. When he socialized, he always wore a cap; he was embarrassed when he met up with his old friends from high school because of the jokes they made about his skull. He became convinced that his social status had plummeted. He had a girlfriend, but he felt insecure in the relationship.
He started on finasteride and was seeing results — but the reports on Reddit unnerved him and he went off the drug for several years, until he felt his hair loss was intolerable enough that it was worth taking whatever small risk was involved. “My relationship got better because I felt so much more confident,” he told me. “I volunteer for things I never would have done. I’m competing in a CrossFit competition. I’m doing more public speaking at work.” He was convinced that men with more hair who look younger are treated differently. “People make quick judgment calls,” he said. “They might see someone whose hair is thinning and think they’re a stressed-out person who doesn’t look after themselves.”
Another man who responded to me was a 27-year-old lawyer in New Jersey who had also become somewhat obsessed with his balding crown. He felt shame about his hair, and maybe even more shame about how much he cared. “On a distress scale of 1 to 10, I was at about an 8,” he said. He found r/tressless and was unsure which worried him more: the stories of so many men who claimed that hair loss tanked their dating opportunities or the ones who said the drug tanked their sex lives. Finally, more persuaded by all the positive comments he was reading, he decided to go on the drug — and quickly observed a troubling change in his sex life: He was producing more watery semen, a rare but known side effect of the drug’s tendency to shrink the prostate. His erections were also not as hard.
From everything the lawyer read, his symptoms would resolve as soon as he stopped taking finasteride — which he knew some posters saw as an argument to persist, at least until he had a girlfriend. “But it felt weird to be taking a medication that would do that to me and somehow say, ‘That’s OK,’” he said. “I just felt like I couldn’t be sure that this wouldn’t somehow have long-lasting effects.” He went off the drug. The symptoms did quickly resolve, and he looks back at that period of misery as wasted energy. Now happily married, he responded to me to urge men to stay off the message boards. “They’re an echo chamber of anxiety,” he said.
One young man told me he first ordered finasteride from a telehealth platform when he was 23. He was new to a relationship and got nervous when he started experiencing sexual side effects. He went to another online provider and ordered a pill that treats erectile dysfunction, rather than lose more of his hair. Rachel Rubin, a urologist who specializes in sexual medicine in the Washington, D.C., area, told me that some patients who come to her for sexual problems refuse to go off finasteride, even after she has explained that the drug could well be causing or exacerbating the issue. It worries her that they prioritize their hair, even as their sex lives might suffer, making their search for intimacy that much harder.
Finasteride might be the ultimate drug for a generation of young men who have never been more focused on optimizing their looks — and yet have never been less connected, romantically or socially. Social media not only feeds men self-improvement content on their phones but also encourages them to curate images of themselves for others to scrutinize. Plenty of men in their 50s might be hard-pressed to find more than a few dozen photos of themselves from their 20s — but a typical 20-something guy might post that many in just a few months, putting himself out there to be appraised and judged.
Psychologists have known for years that women who are especially preoccupied with their physical appearance tend to have more difficulty with anxiety and sexual satisfaction. “Women have had this kind of thing to deal with for so many years,” said Ryan, one of the friends in Elliot Connors’s group chat. “While it’s awful that this is now happening to men, there is also a kind of a poetic justice to it.”
Connors and a few friends from the chat group had agreed to join me at a restaurant in SoHo in March to talk about their hairlines. Ryan, who asked to use only his first name so he could speak frankly about something so personal, described how he became fixated on his hair loss right after graduating from the University of California, Santa Barbara. The town was full of young students, who made him all the more self-conscious; at home during the pandemic, he had far too much time on his hands to watch social media and then stare at his receding hairline in the mirror. He had been taking finasteride since 2023 and was relieved by the volume he’d recaptured.
Ryan didn’t have any side effects from the medication, which Alex, a young man sitting next to him, was also taking. Only when I posed the question directly to the gathering did he mention that he, in fact, had experienced a dip in his sex drive when he went on the medication.
This was news to the group. “You didn’t text the group chat,” Connors said. “You have to tell us!”
Alex (who also asked that only his first name be used) defended himself — this was before the group chat started. At the time, he was unprepared for this possibility; the doctor who offered him the prescription did not mention anything about low libido. He went off as soon as he noticed — but then all the hair that had filled in started noticeably thinning. He decided he would try the drug once more. “If it happens again, then I’ll go off it for good,” he told himself. The second time around, he said, the issue seemed to resolve. He was relieved by how much his hair had filled in since then.
Connors himself started taking finasteride last fall. At first, he thought he’d made a mistake. He was rattled: He kept worrying about potential side effects he’d read about on Reddit. He couldn’t remember precisely if some depressive symptoms he started feeling had come on soon after he first took the drug — but to be safe, after a few weeks, he went off it. When his low mood persisted, he kept up a running joke with his friends: He definitely had post-finasteride syndrome! Then again, maybe he was just feeling depressed because he knew he was no longer helping his hairline.
Eventually, having chalked up that previous dark mood to a stressful time in his life rather than to the finasteride, he went back on the drug. He said he wouldn’t be surprised if at some point he returns to perseverating and second-guessing his decision, but for now, about three months into his second effort, he feels fine and is hopeful that he’s had some hair regrowth. Lately he’s even been thinking he should talk to his brother, who’s three years younger. Get started now, he’d tell him. Before it’s too late.
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