President of the United States Donald Trump is reportedly using a pharmaceutical drug that often accompanies anabolic steroid use by bodybuilders. Finasteride was identified as one of three drugs regularly used by Trump according to his long-time personal physician and gastroenterologist Dr. Harold Bornstein.
The degree to which this doctor has violated confidentiality repeatedly is really something. https://t.co/3vJ1SiFM0U
— Maggie Haberman (@maggieNYT) February 2, 2017
In a series of four interviews conducted with the New York Times, Dr. Bornstein told reporter Lawrence Altman MD, without Trump’s permission, that Trump uses Propecia (finasteride) to prevent hair loss and possibly promote hair growth, prescription antibiotics to manage rosacea and a statin drug to control blood cholesterol and lipids. The first drug is the one that has a long history of use by anabolic steroid users.
Finasteride, which comes in a 1-milligram version (Propecia) marketed for male pattern baldness (MPB) as well as a 5-milligram version (Proscar) marketed for benign prostatic hyperplasia (BPH), has been widely used by steroid-using bodybuilders since the early 1990s.
Finasteride is a 5α-reductase inhibitor that prevents the conversion of testosterone to dihydrotestosterone (DHT). For bodybuilders, one of the most feared side effects from anabolic steroids is hair loss. Those steroids which readily convert to DHT such as testosterone have long been thought to be the biggest culprits although most steroids can exacerbate hair loss in individuals with a genetic predisposition to MPB.
The hysteria over hair loss led many bodybuilders to experiment with finasteride over the years. Unfortunately, finasteride only works by blocking conversion to DHT and some steroids don’t require conversion to DHT before they exacerbate hair loss. However, finasteride does not just block DHT levels in the scalp. It also has systemic effects throughout the body.
DHT is a very important hormone for male libido and sexual function. DHT also has strong anti-estrogenic effects. These two beneficial effects of DHT are blocked with the use of finasteride (Propecia or Proscar). The most common side effects are related to sexual function e.g. reduced libido, impotence, erectile dysfunction and ejaculation disorder.
Internet forums are full of anecdotal reports of a so-called “post-finasteride” syndrome in which some men report a semi-permanent sexual dysfunction, cognitive dysfunction and “brain fog” long after discontinuing the use of Propecia and Proscar.
These side effects have been used to, fairly or unfairly, explain and criticize President Trump’s actions as POTUS. At the very least, his finasteride use has been used to poke fun at the possibility of an impotent president.
Sadly, we can only imagine what would happen if Dr. Bornstein revealed that Trump was on testosterone replacement therapy (TRT). At 70 years of age, Trump would seem to be a prime candidate for TRT. Unfortunately, if any politician, much less the POTUS, was known to use testosterone for entirely legitimate therapeutic purposes, his or her political opponents would have a field day demonizing anabolic steroids (testosterone) in the name of partisanship. Just look at the response to the revelation that the POTUS used a relatively benign hair loss drug.