--:-- [Theme music fades out]
--:-- Kate Leinbaugh: Welcome to The Journal, our show about money, business, and power. I'm Kate Leinbaugh.
--:-- Rolf Winkler: Hi Kate.
--:-- Kate Leinbaugh: Today, we're talking about a quick fix for hair loss that's leaving some young men sick. My colleague Rolf Winkler has a full head of hair. Still, he gets targeted for hair loss medications all the time, often by telehealth companies like HIMSS.
--:-- Rolf Winkler: That's right, Kate. I'm on HIMSS.com, and it gives you all these different options for medications that they'll sell you on subscription.
--:-- Kate Leinbaugh: Rolf and I decided to see how quickly he could sign up for hair loss meds online. Should we hit regrow hair? Sure. Let's try regrow hair.
--:-- Rolf Winkler: Okay. I'm clicking that. It offers finasteride, which blocks DHT, a hormone that causes hair loss.
--:-- Kate Leinbaugh: Finasteride is the generic version of the brand name pill Propecia. And it has some known and potentially nasty side effects.
--:-- Rolf Winkler: Then there's an option to click on safety information or side effects. If I want to click on that, I don't have to. I can just sort of continue.
--:-- Kate Leinbaugh: And then you hit submit. Yep. And in your case, how long did it take before you got approval?
--:-- Rolf Winkler: 60 seconds. 60 seconds. Just about as long as you've been listening to this episode.
--:-- Kate Leinbaugh: That's how quickly Rolf got approved for Finasteride. Why is this a problem? Is it even a problem?
--:-- Rolf Winkler: Well, there are a lot of men we spoke to who got some very gnarly side effects from finasteride that they got from telehealth companies. And they said they really weren't warned about the side effects.
--:-- Kate Leinbaugh: Telehealth companies say they disclose side effects and other risks on their websites. But a lot of men say they wish they would have slowed down and read the fine print. Because some of them are suffering serious health problems.
--:-- [Theme music fades in briefly before fading out]
--:-- Kate Leinbaugh: Welcome back to The Journal. Today, we're talking about a quick fix for hair loss that's leaving some young men sick.
--:-- Rolf Winkler: That's right, Kate. The drug finasteride has been around for decades. The FDA approved it for hair loss treatment in 1997.
--:-- Kate Leinbaugh: And very soon after that, there were a lot of controversies about the drug, chiefly the side effects associated with it. Which are what?
--:-- Rolf Winkler: Well, the ones that are well-known are sexual side effects, but there are a lot of men who have talked about very serious, and I spoke to many of them, very serious cognitive side effects, insomnia, panic attacks, suicidal ideation and behavior, you know, GI issues.
--:-- Kate Leinbaugh: One of those men who Rolf talked to is Mark Millick. I can't see a situation where I wouldn't have taken this medication unless doctors had told me directly this is a risk.
--:-- Mark Millick: Hi Kate.
--:-- Kate Leinbaugh: Mark is 31 years old. He's a veteran and lives in Washington, D.C. He's a construction health and safety manager and gives presentations on how workers can stay safe on job sites.
--:-- Mark Millick: But we're here to talk about hair. Right. Mark has short brown hair.
--:-- Kate Leinbaugh: But back in 2020, he started getting concerned about hair loss. He remembers the exact moment it really hit him.
--:-- Mark Millick: I was at a 4th of July party with my family. And I was actually bringing my girlfriend over to introduce her to the family. And I walked into the bathroom and I noticed there was some very harsh overhead lighting. And I happened to notice I could see right down into the back of my scalp. And I panicked, to be honest with you.
--:-- Kate Leinbaugh: I like oh that not good
--:-- Mark Millick: Mark took out his phone and made a HIMSS account. He filled out the online subscription form and hit submit.
--:-- Kate Leinbaugh: I went through the process in a matter of about five minutes in the bathroom.
--:-- Mark Millick: In the bathroom? In the bathroom.
--:-- Kate Leinbaugh: It took no time at all. That's how quick it was. It was actually pretty incredible.
--:-- Mark Millick: Why did you go through HIMSS and not go to your doctor?
--:-- Kate Leinbaugh: I think there was sort of a denial phase. You know, you don't want to go to a doctor and have them directly tell me not to my face. You're losing your hair. So you kind of get to avoid confronting the issue while still confronting the issue, if that makes sense, right?
--:-- Mark Millick: How did you feel at that point?
--:-- Kate Leinbaugh: I felt like I was being proactive.
--:-- Rolf Winkler: In recent years, telehealth companies like HIMSS, Keeps, and Roman have boomed. A key reason they exist is convenience. Some people just want to go on the internet and get a solution.
--:-- Kate Leinbaugh: You never have to see a doctor in person. They don't take insurance. It's a cash pay model. You give them their credit card for the medications that you get from them.
--:-- Rolf Winkler: And they've grown, you know, very, very large. HIMSS is part of the parent company, HIMSS and HERS Health, which went public in 2021.
--:-- Kate Leinbaugh: They had a billion five in revenue last year, and they had over two million customers whom they call subscribers.
--:-- Rolf Winkler: The main way HIMSS and its rival companies get customers is through aggressive TV and social media ads.
--:-- Kate Leinbaugh: Getting help for hair loss used to be hard. HIMSS makes it simple. It all starts with one click.
--:-- Rolf Winkler: By starting Keeps now, I can keep the hair I have and get my treatment without leaving the couch.
--:-- Kate Leinbaugh: Guys, listen up. If you want to not only have a better sex life, but also regrow your hair at the same time, check out this four in one pill by HIMSS.
--:-- Rolf Winkler: It contains Tadalipol. Are they like tapping sort of fundamental insecurities?
--:-- Kate Leinbaugh: Yeah, I think that's the main goal here. A lot of younger men are probably insecure about their hair.
--:-- Mark Millick: With hair or without hair?
--:-- Kate Leinbaugh: With hair.
--:-- Mark Millick: Hair.
--:-- Kate Leinbaugh: Hair. With.
--:-- Mark Millick: I prefer hair. Why?
--:-- Kate Leinbaugh: Why hair?
--:-- Mark Millick: The way these telehealth ads handle side effects is very different from the usual drug commercial.
--:-- Rolf Winkler: You know, when you watch a commercial for a drug on the evening news or something, a narrator says a whole bunch of things very quickly and a whole bunch of small print goes past you on the screen.
--:-- Kate Leinbaugh: And you're supposed to, you know, know before you go and ask your doctor about this medication that there are some risks.
--:-- Rolf Winkler: And moreover, your doctor is trained to tell you about those risks so you can make an informed decision whether this medication is right for you, right?
--:-- Kate Leinbaugh: So what's interesting about telehealth companies? Well, they're not required in their advertisements to disclose side effects, so they typically don't.
--:-- Rolf Winkler: But changes could be coming for telehealth advertising. This past February, HIMSS had a minute-long ad during the Super Bowl for its GLP-1 medication, its version of Ozempic.
--:-- Kate Leinbaugh: Obesity is America's deadliest epidemic. This is America. 74% of us are overweight.
--:-- Rolf Winkler: They didn't include any side effect information or other risks.
--:-- Kate Leinbaugh: And two senators, one Republican, one Democrat, wrote to the FDA saying, this is a problem. These companies should be disclosing risks in their ads, and they're not.
--:-- Rolf Winkler: HIMSS defended the ad, saying the company provides a telehealth platform and isn't a drug manufacturer.
--:-- Kate Leinbaugh: The senators have since introduced a bill called the Protecting Patients from Deceptive Drug Ads Act.
--:-- Rolf Winkler: While telehealth companies are able to market their services without the burden of disclosing side effects, they are required to disclose side effects somewhere on their websites.
--:-- Kate Leinbaugh: So basically you get into a situation where a lot of men are seeing these ads on social media, on television, and clicking through to these websites that are designed to get you through a product flow quickly without reading all of this information.
--:-- Mark Millick: So I got to a point, I'm like, you know what? It's something that everything else in my life is going great. You know, I've got a great job, I'm making great money, I got this beautiful girlfriend.
--:-- Kate Leinbaugh: But it's like, hair loss is bothersome, you know? Hair loss sucks, to put it bluntly.
--:-- Mark Millick: Especially when you're in your 20s, it's not something fun to deal with. So it like if I just take this medication I don't have to worry about it I can carry it with my life without having to worry about this again.
--:-- Kate Leinbaugh: Mark started taking the medication he bought online. But it didn't go as he'd hoped.
--:-- Mark Millick: That's next.
--:-- Kate Leinbaugh: Mark was aware that finasteride did have possible side effects. He'd read through the HIMSS website and did his own research online.
--:-- Mark Millick: But to Mark, the risks seemed minimal. What I recall is that they talked about how side effects were rare.
--:-- Kate Leinbaugh: I think it was 1.2% was the statistic I had read.
--:-- Mark Millick: But the side effects only included sexual issues and I think maybe some depression issues, right, that would go away upon cessation of the drug.
--:-- Kate Leinbaugh: So that was it. It's like I don't really have anything to lose. If I deal with side effects, I come off the drug and, you know, I just carry on with life.
--:-- Mark Millick: About a week or two after Mark started taking the hair loss drug, he began to feel off.
--:-- Kate Leinbaugh: I do a lot of presentations, right? So I mentioned I do safety trainings, things like that. And I was just having a tougher time getting through my presentations, which is something I never struggled with before.
--:-- Mark Millick: Around six months later, things got even worse. The transition came, and this was very notable.
--:-- Kate Leinbaugh: It was in June of 2021. I woke up that morning. It was a Monday morning, and it felt like I'd been lobotomized.
--:-- Mark Millick: Everything changed. I had developed, at the time, permanent slurred speech, anhedonia, couldn't feel any emotions, felt very foggy.
--:-- Kate Leinbaugh: It was like the worst hangover in my life. And I went to work that morning, that Monday morning, to do a new higher orientation.
--:-- Mark Millick: And information I'd been teaching at that point for several years, I completely forgot. It's like the first time I'd been, I'd never ever read it before.
--:-- Kate Leinbaugh: Must have been so scary. It was horrifying.
--:-- Mark Millick: And that was around the time when I realized I have to go to a doctor. You know, specifically a neurologist, because these are neurological issues.
--:-- Kate Leinbaugh: Mark says he went to see a neurologist and other doctors who gave him tests like an MRI, EMG, and EEG scans.
--:-- Mark Millick: But the results came back clear and benign.
--:-- Kate Leinbaugh: Still, his symptoms kept getting worse.
--:-- Mark Millick: I also developed severe muscle twitching, muscle twitching all over my body, my hands, my feet, my face, my arms, my back, my stomach, everywhere.
--:-- Kate Leinbaugh: It didn't occur to Mark that what he was experiencing may have had to do with the hair loss meds.
--:-- Mark Millick: During that period when I'm going to the doctors, my mom even brought up, she said, hey, could this be the hair loss medication you're taking?
--:-- Kate Leinbaugh: Because I had mentioned it to her at that point.
--:-- Mark Millick: I was taking this hair loss medication kind of just in passing. And I almost got oddly defensive about it because I said, mom, this, it would make no sense.
--:-- Kate Leinbaugh: This medication doesn't have anything to do with the brain. So I completely kind of blocked that out of my mind, to be honest with you.
--:-- Mark Millick: But then, about 15 months after Mark started taking finasteride, he hit a breaking point.
--:-- Kate Leinbaugh: There was one day I just reached my wits end. I'm like, what could this be? Because this wasn't just a subtle, like, every now and then I'm tripping over words.
--:-- Mark Millick: It's like, I can't enunciate. You know, I can't do anything. I'm a vegetable here.
--:-- Kate Leinbaugh: Mark went on Reddit and searched for finasteride side effects. He found a subreddit of people sharing horror stories.
--:-- Mark Millick: And, you know, I just, I freaked out. I'm like, okay, there's no evidence. There's no reason to believe this. This is all anecdotal.
--:-- Kate Leinbaugh: But let me just stop the medication just to see. Maybe things won't improve if I come off the medication.
--:-- Mark Millick: Mark stopped taking the drug. But the symptoms didn't go away. They only got worse.
--:-- Kate Leinbaugh: It was like a complete nuking of my endocrine system.
--:-- Mark Millick: In six weeks, I lost 20 pounds. I developed loose skin. My face started to change.
--:-- Kate Leinbaugh: I developed lipoatrophy on my face. My voice became higher pitched.
--:-- Mark Millick: My cognitive impairment continued to get worse. I developed joint issues.
--:-- Kate Leinbaugh: It was difficult to walk. I'd go to the gym and try to work out. My body would be shaking.
--:-- Mark Millick: My muscles became squishy, like they lost density in some sense. My beard started to fall out.
--:-- Kate Leinbaugh: Also, when I came off, that's when I developed the sexual issues, low libido, erectile dysfunction issues.
--:-- Mark Millick: I probably developed somewhere between 25 and 30 symptoms in that time frame. And that was a scary thing. That didn't make sense.
--:-- Kate Leinbaugh: It's like, I'm off the medication. Why am I now developing all these side effects?
--:-- Mark Millick: Mark's doctor said she believes the symptoms that he reported to her were caused by the hair loss drug.
--:-- Kate Leinbaugh: HIMSS declined to comment on Mark's care.
--:-- Rolf Winkler: Many of Mark's symptoms weren't identified as potential side effects during finasteride's clinical trials and aren't listed on the drug's label.
--:-- Kate Leinbaugh: My colleague Rolf spoke to an endocrinologist who said the clinical trials had flaws that might have underestimated the incidence and severity of side effects, and that they didn't follow its subjects long enough.
--:-- Rolf Winkler: Merck, the company that developed Finasteride, referred questions about the trials to Organon, a company it spun off.
--:-- Kate Leinbaugh: Organon said it didn't run the trials and stood by the drug's safety and efficacy.
--:-- Rolf Winkler: Regulators have revisited finasteride side effects in the past. In 2011 and 2012, the FDA revised the drug's label to highlight sexual side effects.
--:-- Kate Leinbaugh: In 2022, the agency updated the drug's label to include the risks of, quote, suicidal ideation and behavior.
--:-- Rolf Winkler: The side effects that HIMSS and other telehealth companies list on their websites are based on what's on the drug's label.
--:-- Kate Leinbaugh: Most men tolerate finasteride well. The drug's label currently says 3.8% of patients experienced one or more sexual side effects during the clinical trial.
--:-- Rolf Winkler: The risk of experiencing one of the main sexual side effects was under 2%. For a medication that is being prescribed to millions of people, I mean, that's a lot of men out there.
--:-- Kate Leinbaugh: That's Rolf again. That less than 2% risk is the stat that HIMSS shows potential customers when they sign up online.
--:-- Rolf Winkler: Rolf also noticed that HIMSS was citing a statistic in its list of side effects he'd never seen before.
--:-- Kate Leinbaugh: I asked him, where's that number from? And their first answer was, well, our medical team reviews all our safety disclosures.
--:-- Rolf Winkler: Okay, but that one doesn't appear anywhere on the drug's label, so where does it come from? And I said, oh, well, you found a typo.
--:-- Kate Leinbaugh: A HIMSS spokeswoman said HIMSS communicates transparently with patients about all essential details and safety information.
--:-- Rolf Winkler: And customers can ask clinicians about side effects. She said customers go through a, quote, And, you know, when I spoke to former employees, the reason side effect information is not prominent is because it's what they called friction.
--:-- Kate Leinbaugh: Right? Again, this is an e-commerce model, and the people who are designing the websites are marketing people.
--:-- Rolf Winkler: Their job is to get you through the funnel, through the purchase funnel, right? Show up at the website, put something in the cart, check out with it. Maximize that. That's their job.
--:-- Kate Leinbaugh: The HIMSS spokeswoman said its systems help clinicians make decisions quickly by flagging if a patient's case is routine or more complex.
--:-- Rolf Winkler: As convenient as the process was, Mark wishes there'd been a little more friction when he signed up with HIMSS.
--:-- Kate Leinbaugh: My wife and I were talking about this within the past two or three weeks. And she said, do you feel like you learned anything about vanity?
--:-- Mark Millick: And I actually said, no, I don't feel like I did, because I don't have an issue with people wanting to take care of themselves and wanting to look their best.
--:-- Kate Leinbaugh: The issue is that I just think they do everything in their power to market this medication to get as many people to take it because it's about profit.
--:-- Mark Millick: At the end of the day, it is about profit for not just HIMSS, but all these other telehealth companies as well.
--:-- Kate Leinbaugh: If you had told me I would deal with one-tenth of what I'm dealing with, I would have never, ever would I have taken that medication.
--:-- [Theme music fades in]
--:-- Kate Leinbaugh: That's all for today, Monday, April 14th. The Journal is a co-production of Spotify and The Wall Street Journal.
--:-- Rolf Winkler: If you like our show, follow us on Spotify or wherever you get your podcasts.
--:-- Kate Leinbaugh: We're out every weekday afternoon. Thanks for listening. See you tomorrow.
