Should You Try a Combo Drug for Hair Loss and Erectile Dysfunction?

Note: Compounded drugs are not approved by the U.S. Food and Drug Administration (FDA) and may carry greater risks than FDA-approved treatments.

But how well do these two work when combined in one pill?

“Combination medications aim to treat hair loss and erectile dysfunction simultaneously,” says Shoshana Marmon, MD, PhD, an assistant professor and the director of clinical research in the dermatology department at New York Medical College in New York, who has researched hair loss treatments. “The rationale behind combining them is that tadalafil can improve erectile function and potentially counteract the sexual side effects that some men experience with finasteride alone.”

“None of these are new medications — it’s the bundling that’s new,” says Jamin V. Brahmbhatt, MD, a urologist at Orlando Health and an assistant professor of urology at the University of Florida College of Medicine in Orlando, Florida.

Each of the medications in the combination works in the body in a different way.

• Tadalafil is a phosphodiesterase 5 (PDE5) inhibitor that blocks an enzyme in blood vessel walls. Prescribed to treat ED and symptoms of BPH, tadalafil works by increasing blood flow.

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   (It’s also available as the standalone brand-name medication Cialis.)
• Finasteride is a 5-alpha-reductase inhibitor, which blocks an enzyme found in the prostate and scalp, prescribed to treat BPH and male pattern hair loss. It works by preventing a type of testosterone production.

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   (It’s also available as the standalone brand-name medication Propecia.)

Importantly, though, there aren’t any large-scale studies on tadalafil/finasteride for these purposes — and that type of clinical evidence would be required before experts could start to think about broadly recommending the combo drug in this way.

“Most studies of this type of combination therapy focus on BPH patients using finasteride 5 mg — not the 1 mg dose used for hair loss,” Marmon says. “Well-designed trials specifically evaluating finasteride 1 mg plus tadalafil would strengthen evidence.”

As with any medication, there are potential side effects and risks to be aware of.

Potential Side Effects, Risks, and Complications

Each medication has been around for years, establishing a solid history of side effects, along with potential risks and complications.

• Erectile dysfunction
• Decreased libido
• Ejaculation problems
• Depression
• Breast tissue changes
• Rash, itching, or hives

In addition, some men may experience persistent ED, even after stopping finasteride.

• Headache
• Skin flushing
• Acid reflux
• Back, stomach, muscle, arm, or leg pain
• Low blood pressure (hypotension)
• Dizziness
• Rapid heartbeat
• Vision changes
• Hearing loss
• An erection lasting longer than four hours

Who Should Try (or Avoid) Combo Treatments for Men

Some people may be better suited to try a hair loss-ED combination medication than others.

While there isn’t an official candidate for the compounded finasteride/tadalafil combination to treat hair loss and ED together, the best fit may be men with male pattern baldness who also truly have erectile dysfunction or urinary symptoms, Brahmbhatt says.

• Take nitrate medications (such as nitroglycerin)
• Have had a heart attack within the last three months
• Have had a stroke within the last six months
• Have severe liver or kidney disease
• Are allergic to either medication

In addition, finasteride/tadalafil should be used with caution if you have a new or unexplained case of erectile dysfunction that hasn’t been evaluated by a healthcare professional yet, Brahmbhatt says.

Here are a few tips to get started.

• Consult a healthcare professional. As a first step, Dr. Marmon recommends discussing your medical history, current medications (especially nitrates, alpha-blockers, blood pressure medications [antihypertensives], and heart health with a physician (not someone from a telemedicine or other retail health website). “Be specific about hair loss patterns and any erectile dysfunction concerns,” she adds. Have a conversation to discuss your individual risks and potential medication interactions, and to review possible side effects.
• Discuss realistic expectations. This medication generally takes at least a month to show initial results, Marmon points out, and continuous use (up to six months) to maintain benefits.

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• Decide on the best treatment. Ask your clinician whether an FDA-approved combination medication (designed to treat BPH), separate medications, or a compounded medication would be more appropriate for your situation, Marmon suggests.

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   Pricing and insurance coverage may play a role here. “Sometimes, combination medications are actually more affordable to get separately,” Dr. Malik says.
• Only use prescriptions from qualified pharmacies. “Ensure you are getting the medication(s) from a legitimate pharmacy — with a real prescription, clear dosing, and an easy way to reach a pharmacist/clinician. If it sounds too good to be true, it probably is,” Brahmbhatt says. This includes vetting online pharmacies thoroughly. Marmon recommends verifying whether a compounding pharmacy is accredited by the National Association of Boards of Pharmacy or the Pharmacy Compounding Accreditation Board, and checking your state’s board of pharmacy website for complaints. “Avoid services making unrealistic claims about results or safety,” she adds.

• Combination medications like finasteride/tadalafil are approved to treat benign prostatic hyperplasia (BPH), but are sometimes used off-label to treat hair loss and erectile dysfunction.
• While finasteride and tadalafil are safe and effective medications on their own for FDA-approved conditions, there haven’t been large-scale clinical trials on their combined use for hair loss and ED. Potential side effects and risks include headache, back pain, potentially permanent changes in libido, erection, and ejaculation, and contamination and quality risks when using a compounded medication.
• If the convenience of a combination medication for these purposes is appealing, experts recommend discussing this option with a healthcare professional to ensure it’s right for you. People with a history of recent heart attack or who are taking nitrate medications are likely not candidates for this combination drug.