For men, Propecia seemed like a dream come true — a gift from the hair gods.

But then came the lawsuits, the horror stories, and the new research.

On a humid South Florida day, I sat waiting on a dermatologist’s examination table, still sweating a little from my time outside. Running a hand through my dirty blond hair, I stared in the office mirror. Eighteen years old, horny, and gay, I was about to head off to college and was worried I’d never go all the way with a guy in school, or after. Physically, I had a lot going for me — green eyes, cute facial hair, height — but the distressing appearance of my forehead prevented me from considering any of these traits. I was going bald.

In the back of my mind, I’d always known this day would come. My father, uncles, grandfathers, cousins, second cousins, on and on — they all lost their hair in their twenties. Any time my mom got pissed, she reminded me of my fate: “One day you’ll be bald, just like your frickin’ father!” Although two baldies had impregnated my mom several times, and I grew up on a diet of pro-wrestling-era Dwayne “The Rock” Johnson — pop culture’s strongest, manliest, baldest man — what I took from my mom’s jab was that I would be ugly. I viewed hair loss the same way Urban Dictionary would one day define male baldness: “A guy with a receding hairline. Truly laughable yet sad at the same time.”

To my teenage ears, my mom’s diss meant I would die a virgin. I’d experienced blowjobs by this point, but who was going to let me pillage the tight, dark recesses of their body if my head resembled Dr. Evil’s? I vowed to avoid this fate. A veterinarian my dad knew recommended a solution — Propecia, a medication that prevents, and in some cases, reverses balding. An eight-sided, orange-colored pill, Propecia, the vet said, had succeeded in saving his son’s luxurious hair — a first in their clan of bald men. “It’s a miracle drug,” the animal doctor told my dad.

I decided Propecia would make me happy. When my doctor, bald himself, came into the room, I detailed my predicament, then said, “Give me Propecia!” The doc blinked.

“No, I will never prescribe that drug.”

“But I want it.”

“No, you don’t. There’s evidence it can cause permanent erectile dysfunction.”

“But then I can just take Viagra, the blue pill.”

“Research says it won’t help.”

“I could be totally bald by 25.”

“I won’t prescribe it.”

I grimaced. Back then, there wasn’t a lot of online information available, and nothing like today’s impassioned user forums on Reddit and elsewhere. The stuff I’d looked at mostly just discussed the medical-breakthrough aspect of Propecia, and I hadn’t run into the kind of dangerous stuff that crops up when you google the drug now. (“Merck stands behind the demonstrated safety and efficacy profile of Propecia, which has been prescribed to millions of men since its FDA approval in the U.S. in 1997,” the company told NBC News in 2017, in defense of its product. It added, “Merck conducted well-designed clinical trials on the product and stands behind the results.”)

But the fact that my doctor was against the drug gave me pause. I trusted him. He patted my shoulder and looked me in the eye: “Listen, you’re eighteen. I know what you’re worried about. But you’ll be fine. Plus, what’s the point of having hair if your dick doesn’t work?” I pondered this, then concluded: Yep, he’s right. I went on my merry way, and over the next decade, fucked loads of people.

As much as “bald” can still sound like a diss, shiny-domed men have risen in contemporary cultural stature, and changed standards of male attractiveness. Baldy Jeff Bezos became the richest man alive. Dwayne Johnson jumped from wrestler to movie star, joining the ranks of Vin Diesel and Bruce Willis, while Michael Avenatti has assumed the mantle of thotty liberal avenger.

This fall, a story in the Hollywood Reporter was headlined: “Hollywood’s New Power Move: Going ‘Full Bald.’” On Instagram, women cry with joy over an account called DILFs at Disneyland, where the “dads they’d like to fuck,” often bald, are shown pushing strollers through the Magic Kingdom. People have long cried “daddy” during sex. All sex goes back to the family, and lovers want to feel dominated, but society has only just come around to admitting we want to screw people who look like dads who could overpower us. All this has occurred while aging men with hair — Donald Trump, Kevin Spacey, Alec Baldwin — have found themselves in trouble because of their behavior.

Despite scary reports of patient side effects, each year thousands of American men continue to turn to that orange pill as they begin their lifelong battle against baldness. One of its new users is a member of my extended family. At a recent holiday dinner, a relative around my age announced, “I’m taking Propecia.”

“Your dick won’t work,” I said.

“But I need hair.”

His statement encapsulates the logic that explains why the drug remains popular, not only in America but around the world. Even our current president, according to his former personal physician, Dr. Harold Bornstein, was a Propecia user — and might still be. (The long-haired Bornstein spilled the beans to the New York Times in 2017, and two days later, he says, Trump’s then bodyguard, a lawyer, and a third man raided his office and took possession of Trump’s medical records; around the same time, Trump cut ties with Bornstein after 30-plus years.)

Not surprisingly, lawsuits — more than a thousand of them — have been filed against Merck on behalf of former Propecia users claiming damaged health, especially on the sexual front. This spring, Merck agreed to settle with a plaintiff committee of 562 cases, though terms remain confidential. (Merck has shelled out big money before; in 2007, it paid nearly $5 billion to settle lawsuits stemming from use of an arthritis drug, Vioxx, which doubled the risk of heart attacks and strokes.)

Head to Merck’s product page for Propecia, and you’ll find this: “The most common side effects of Propecia include: decrease in sex drive; trouble in getting or keeping an erection; a decrease in the amount of semen.” Meanwhile, over on Reddit, you’ll find endless debate, with some Propecia users advocating for it based on their own happy experiences. You’ll also find former users sharing horror stories.

It seems to come down to odds, a risk-reward calculation. Let’s say there’s a small chance the pill will kill your sex drive and turn your dick into a noodle. Do you still go for it? Is your hair that important to you? Based on some Reddit responses, there are guys who view follicles on the head as more virile than actual virility. Are they really choosing, as my dermatologist once put it, hair over their dicks?

History had prepared Propecia for a huge consumer base. Men have always battled baldness, and their fights have long been tied up in what men value most: sex.

Evolutionary biologists continue to develop theories concerning hair reduction on the human head and body, trying to pin down what advantages such states might have conferred. For example, as detailed in a 2003 New York Times story, a pair of English researchers proposed that humans lost their body hair as they evolved to remove furry habitats for parasites: disease-carrying lice, ticks, and fleas. And with prehistoric men perhaps drawn to less hairy women because they signaled greater health (fewer fleas), natural selection, powered by the male libido, led to women shedding more of their body hair over time than men.

The patriarch of evolutionary theory, Charles Darwin, would have supported this theory. “The absence of hair on the body,” he writes in The Descent of Men, “is to a certain extent a secondary sexual character; for in all parts of the world women are less hairy than men.” As for age-related balding, evolutionary biologists have proposed various theories.

In 1996, a pair of American researchers hypothesized that, while male facial hair signals sexual virility and aggressive dominance, male-pattern baldness may communicate social maturity, a non-threatening form of dominance associated with wisdom, nurturance, and elevated status. It may have created its own kind of attractiveness to women, while also conferring social-group advantages, earning chrome-domed males respect and security in the tribe.

Then there’s the Turkish plastic surgeon, Dr. Emin Tuncay Ustuner, who turns to physics to explain the hair-loss process. As reported at the online site Science Daily in 2013, Ustaner points the finger at… gravity. Yup, he published a paper arguing that the weight of the scalp puts pressure on follicles at the top of the head, reducing their size over time. (Hair-follicle shrinkage is what makes us go bald; in fact, it’s follicle sensitivity, an inherited trait, that makes some men more prone to losing hair.)

Why we do we get balder as we age? Because, Ustaner theorizes, in childhood our scalps have more fat under the skin, which buffers follicles from gravity’s pressure. And since testosterone contributes to the thinning of subcutaneous fat, male sexual maturity factors in, too. His theory even helps explain why younger women don’t go bald like so many younger men (myself included).

In women, the hormone estrogen prevents the thinning of scalp fat. With the reduction of estrogen during menopause, voilà, women start to experience hair loss. Dr. Ustaner even claims the weight of facial tissue adds pressure at the front of the scalp, while our ears help the scalp fight the effects of gravity. So that can explain horseshoe baldness.

While science has yet to fully understand the evolution of baldness, what is clear is that men for millennia have tried to fight this evolutionary trait as much as they have tried to avoid Death’s knock on the door.

Ancient Greek physician Hippocrates advised balding men to rub pigeon shit on their heads. A little later, in Rome, Julius Caesar reportedly had a habit of standing in front of the mirror obsessing over his smooth bulb. According to the Roman writer Suetonius, Caesar wore that wreath of green leaves on his head — his laurels — to distract people’s eye from his baldness.

In subsequent centuries, men turned to wigs and toupees to disguise their hairless pates. Nowadays, you can try covering your baldness with “hair systems,” you can shell out big bucks for follicular transplant surgery, you can rub Rogaine on your scalp (the active ingredient, minoxidil, is a vasodilator, which enhances blood flow to the follicles), and you can decide if the rewards of Propecia, which are real, outweigh the risks, also real.

Despite centuries of baldness-fighting strategies, cultural messaging about hair loss has not been monolithic. The story of men and their heads is not a simple tale of hair as hero and baldness as villain. In Greek mythology, Kairos, the god of opportunity, Zeus’s youngest son, was depicted as bald up top with a single dramatic lock of hair dropping down from the front of his scalp. This shiny-headed divinity brought you good luck. Turn to the East and you’ll find the Buddha, a sage who did not fight his baldness. Though many American presidents wore wigs, John Adams, John Quincy Adams, and Dwight Eisenhower all rocked bald spots.

It seems to come down to odds, a risk-reward calculation. Let’s say there’s a small chance the pill will kill your sex drive and turn your dick into a noodle. Do you still go for it? Is your hair that important to you?

Arguably, Hollywood typifies our complex cultural relationship to bald men best. Yes, Golden Age studio execs pushed toupees onto their male stars (extremely bald Yul Brynner, star of the King and I in 1956, was a rare exception), and contemporary comedies still traffic in bald jokes. On the other hand, baldies like Bruce Willis and the Rock have dodged bullets and climbed skyscrapers in multiple action films — movies that glorify robust masculinity as much as porn idolizes curvy, feminine women.

The same year Dr. Ustaner published his gravity theory, GQ posted a list called “The 100 Most Powerful Bald Men in the World.” Names ran the gamut, from Michael Jordan, the Dalai Lama, and Jeff Bezos, to Verne Troyer, the two-foot-eight actor who played Mini Me in Austin Powers and the Spy Who Shagged Me. According to the BBC, academic psychologist Frank Muscarella, coauthor of the aforementioned study about baldness and social status, upon researching perceptions of bald men in 2004, found people judged them less attractive but more intelligent.

We both mock and respect bald men. We sort of love them, and we sort of hate them. But in the psychology of the average American male, disdain for baldness, especially when it comes to the possibility of losing one’s own hair, is the clear-cut winner.

Pharmaceutical giant Merck knew this when they began developing Propecia.

In 1974, an American endocrinologist, Dr. Julianne Imperato-McGinley, discovered that testicles and prostates transformed 10 percent of testosterone into dihydrotestosterone, or DHT. A year later, Merck researcher Roy Vagelos established that when DHT is emitted through many men’s scalps, the chemical destroyed their hair. Everyone knows testosterone and its byproducts incite male rage, horniness, and frustration, but the hormone is also so strong, it can shrink hair follicles.

In a Freudian tragedy of sorts, a man’s mother determines whether or not DHT destroys his hair, one of his biggest tools to attract sexual partners. If a woman’s father went bald, so too would her son. Merck researchers later discovered that a chemical compound, finasteride, blocked DHT. They were searching for a drug that might shrink enlarged prostates, and finasteride, by defusing DHT, did the trick. (In 1992, the company debuted Proscar, its finasteride-based prostate medication.) But could finasteride, as DHT’s enemy, also prevent male-pattern baldness? Yes, Merck discovered it could.

Like Indiana Jones finding the Ark of the Covenant, the company had stumbled upon something that had come to seem almost mythical: a drug that keeps dudes from going bald.

Merck gave finasteride a brand name, Propecia (they liked its rhyme with felicia, the Latin word for happy, as the Daily Beast has pointed out). They tested it, and conducted clinical trials. In 1997, the Federal Drug Administration approved Propecia. The drug went on the market, and men everywhere were happy. Simply by popping a pill, they could now keep their hair. The product wasn’t snake-oil. It worked, and it was legal.

Merck began a massive marketing campaign. The chance for a windfall was high. In 2014, the BBC reported that men pay $3.5 billion worldwide on baldness remedies. Pharmacia Consumer Health Care, the maker of Rogaine, told ABC News that American men spend a billion a year to avoid going bald. As part of their online marketing, a Dollar Shave Club blog exploits male anxiety around baldness. The post cites research suggesting women perceived men with George Costanza-ish male-pattern baldness as “weaker,” then it points out that women view totally bald men as confident. (Implication: Buy their razors and shave away that horseshoe of hair!) The post ends citing more research suggesting women prefer men with hair, and that’s how they leave it: Not a real treat for men losing their hair.

Want to read more about hair loss and medical remedies from regular American men, instead of from researchers and corporate marketers? That’s where Reddit comes in — Reddit, the zone where men can unleash their deep, repressed emotions concerning baldness, and write odes to Propecia, or slam it, behind anonymous avatars.

Of Merck’s drug, one Reddit user sings, “PRAISE SCIENCE! Eight years ago I noticed I was losing hair. My boss commented on a ‘thin spot’ I didn’t know I had. I was mortified. Baldness runs in my family, and I saw firsthand my older brother go through it in high school. I got on Propecia within the week. Six years later, and I still have my hair.” This enthusiast includes photos of bald family members (“Here’s my dad’s head” says one caption; another says, “My younger brother when he was 22”).

Adding a selfie showing a handsome, stubbled younger guy, this Propecia fan wraps his post by saying, “I sometimes model locally. This is my hair this month. The flash is to my right, which is between me and the camera, which would shine through my hair if it was super thin.” After expressing understandable pride in his hair, he hits something of a defensive note, because he’s conscious of the ongoing debate about “side effects.”

For years, men were barely aware there was risk to pursuing Propecia’s follicular reward. But over time, research began to appear. In 2008, the Journal of Sexual Medicine found that the rate of users of DHT-blockers reporting some kind of sexual dysfunction could be as high as 38 percent. Three years later, the journal claimed that 5 to 23 percent of users were reporting concerns, with half of these experiencing long-term problems.

In 2012, the FDA added “libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug” to Propecia’s side effects. And in 2015, a major, well-publicized study by Northwestern University researchers found that 4.5 percent of those using finasteride and dutasteride (the generic names for DHT inhibitors; the finasteride in Propecia is one-fifth the dosage prescribed to those with enlarged prostates) experienced short-term erectile dysfunction. The study also found that this dysfunction lasted, on average, for three and a half years after users got off the drug. Moreover, younger men, the researchers wrote in the journal Peer, seemed at greater risk. The risk also appeared to rise the longer the usage period.

“Our study shows men who take finasteride or dutasteride can get persistent erectile dysfunction, in which they will not be able to have normal erections for months or years after stopping,” Dr. Steven Belknap, a Northwestern professor of dermatology and internal medicine, told NBC News. He expressed concern with Propecia’s clinical trials and some follow-up studies, suggesting they don’t accurately capture the risk. He also said despite the FDA’s 2012 warning, doctors don’t always detail the risks, especially for young men.

A San Diego-based doctor of sexual medicine, Irwin Goldstein, has built a cottage industry treating former Propecia patients battling erectile dysfunction and other issues. He told NBC News he’d treated men who’d lost their libido: “They see a woman, they say intellectually, ‘I know I am supposed to be interested in you. But I am actually not interested in you.’”

The drug’s reduction of testosterone byproduct DHT also appears to cause trouble for other hormonal systems, which can impact psychological health. Along with impotency, Dr. Goldstein sees men with “flat emotions” and related problems. According to the Daily Beast, Mikael Mikailian, a former Propecia user, experienced issues with his memory and sex drive. After three years on the orange pill, Mikailian forgot a woman’s name on a date. Dr. Goldstein ended up giving him a drug used by women to produce testosterone, as his body was severely deficient. Goldstein told the Daily Beast he advises close to a hundred other men with similar problems.

Goldstein’s patients are not the only ones who may be experiencing issues that go beyond the sexual. Health Canada, the country’s national health department, has been tracking a small number of cases with potential links between Propecia and suicidal thoughts (they concluded the matter needs more research, but issued a warning). Health Canada also pointed out that the World Health Organization database cites 170 men whose suicidal thoughts may have a link with finasteride use.

In 2016, Tonic shared the story of Eric Carlos Rodriguez, a 33-year-old Californian who committed suicide after developing depression. His family believes it was his use of Propecia that brought on the crisis. Today, nearly 17 percent of those belonging to the International Society of Hair Restoration Surgeons refuse to prescribe Propecia. Some doctors, when discussing the persistence of Propecia-linked side effects, speak of a “post-finasteride syndrome” (PFS).

On Reddit, you can find distressing personal accounts. In a post called, “IAmA male who took Propecia/Finasteride because I was balding… now I don’t want to live,” the user writes, “Seven years ago I was an 18-year-old athlete in top shape. I had scholarship offers to play basketball and football in college. Then I took a few pills of Propecia and one morning woke up and went to the restroom. Noticing that my penis felt like a limp noodle and I could barely urinate… . It sort of dribbled out and I couldn’t push it out at all.” Over time, this user relates, he experienced new side effects: no sex drive, muscle weakness, lethargy, brain fog, inability to focus, restlessness, anxiety, and testosterone levels below women’s. “Basically made my entire endocrine system malfunctioned,” he writes.

His post is not uncommon. “I did notice that I wasn’t getting morning wood, or spontaneous erections, but I kind of dismissed it as having poor sleep, and I didn’t make the connection,” writes another guy. “When I got into a relationship, I was shocked to find I couldn’t get hard enough for penetration.” He compared his new sex life to “trying to shove an uncooked sausage into a hole.” Four years ago he stopped taking Propecia, but his sex life remains horrible. He has not had morning wood, random boners, or full-mast erections when he jacks off. He said he’s had a little success with Cialis, but none with Viagra.

Summing up the situations of the numerous patients Dr. Irwin Goldstein has treated, he said to NBC News, “Their only crime in life is to take an FDA-approved drug.”

Like something out of a bad Black Mirror episode, men are continuing to swallow Propecia.

“Can anyone here convince me NOT to take finasteride?” writes one balding Redditor. “I’m not trying to start anything. I just want some honest attempts to keep me off the drug. If you argue against the drug, expect a rebuttal from me. If I fail to rebut any arguments made by those trying to keep me off of finasteride… then I won’t take it. Anything below a .5 percent risk for permanent side effects is acceptable for me. At a rate this low, I think it’s hard to even say for sure that the side effects are necessarily due to the drug.”

Other Redditors jump in. “You should try it based on your stance,” writes one. “For me, I tried it and noticed that my sex drive went down, my orgasms were weak… and my dick felt cold all the time, almost dead. I’m back to normal without taking it, so for me, the sides aren’t worth it.” And then this poster gets to the heart of the matter, asking: “What good is having hair and being good-looking if my dick can’t be used?”

“Just try it, man,” another guy on the thread writes. “The worst that can happen is you’ll get a side and quit.” In response to this viewpoint, a fourth Redditor says: “Messing with your hormones for cosmetic reasons is a poor idea.”

Online, this kind of caution can be a minority view. When another poster describes his erection problems following six months on Propecia, he turned to propeciahelp.com/forum, he says. The very mention of this site roils some Reddit comrades.

“Dude, as someone who has gotten sides from finasteride and believes you 100%, I urge you: don’t read propeciahelp,” writes someone on the thread. “That forum is full of hypochondriacs and started to convince me, someone who doesn’t even believe in PFS really, that I was going to have permanent side effects after quitting, and I willed them to be so for some time. I am almost a year off the drug now and I am 100% confident that I am back to normal, but I was really unsure for a while after quitting (felt very real sometimes)… Looking back I know it was in my head (the stuff I experienced after quitting, that is). All of these problems are super vulnerable to the power of suggestion.”

The idea that it might be the mind causing (or suggesting the existence of) sexual dysfunction in some Propecia users, triggered by the warnings and the online debates, is in fact entertained by some doctors. And it’s possible to find dermatologists who say they’ve been prescribing Propecia for years and their patients haven’t had problems like those discussed here.

But what about the Redditor who says, while taking Propecia, he developed “man boobs” to the point where you could see his nipples poking through polo shirts?

His mind couldn’t have caused that.

The lengthy online Reddit thread I’ve been quoting also features a guy who says he quit Propecia, went bald, and endured bald jokes. But it was worth it. “Got more women in the later half of my twenties when I went buzzed due to thinning than pre-hair loss,” he writes. “So my advice, man, is embrace it. Not easy and it takes time but you will feel better.”

The Propecia saga goes like this. Men go bald. Men get sad because they associate hair with looking both masculine and hot. Men take a pill to grow hair. The medicine works. Men lose function in their dicks. They get depressed. They turn to Reddit. They vent. They stop taking the pill. They lose their hair (and may or may not regain their dicks), but still they search for it. Their main reason? Hair creates sex appeal. It’s a circular story.

That same Reddit thread eventually turned to hairpieces. “I went to a place that gave me a lace system as my first for 600 dollars, cut and styled and glued,” one guy writes, then adds a DIY note. “Learned what they do after two months and started doing it at home,” he reveals.

It’s a story, this Propecia saga, that weaves together so many fundamentals in life: sexuality, masculinity, physical appearance, aging, genetics, science, health, and the twists and turns of fate. What calculation would you make? If you’re starting to lose your hair, what odds do you play? A .5 chance of trouble? One percent? Five? How important is your hair to you? How much of a gambler are you? This story is still being told.