I’m Not Having Kids. Why Am I Being Denied Medication “Just In Case” I Get Pregnant?

In August 2021, while sitting in a Zoom meeting that should have been an email, I turn off my camera and open Instagram on my phone. My eyes land on an advertisement, a picture of an attractive man with a full head of fiery hair in front of an evergreen mountainside. “Need a hair loss prescription in Canada?” the caption reads. “You can now get it online.”

I can’t believe my luck! I’m a chronically ill storyteller and comedian losing my fine strawberry blonde hair to androgenetic alopecia. Like many people, I’m having a tough time getting an appointment with my dermatologist due to pandemic-related delays. Maybe I can skip the wait and get a prescription with a few clicks and a credit card. When the page loads, I’m slapped in the face with the fact that the treatment I was advertised, finasteride, is only intended for men.

This can’t be right. Women suffer from hair loss, too. More than 40 percent of us will experience androgenetic alopecia—also known as female pattern baldness—in our lifetimes, often after menopause.

Related: What I Learned From Losing My Hair

A quick Google search reveals that finasteride has mostly been studied in men, but the limited trials in women have shown it has the potential for positive results, too. However, the drug is contraindicated in women of childbearing age because it poses a risk of genital birth defects to male fetuses. As a result, finasteride is not approved by Health Canada for use in women, though, like many medications, it can be prescribed off-label, used outside of its intended purpose based on evidence that it can treat other conditions.

I am a 30-something child-free woman diagnosed with a trifecta of chronic illnesses: rheumatoid arthritis, primary ovarian insufficiency and polycystic ovary syndrome (PCOS). I plan to never have children—and even if I wanted to, my diagnoses and the medications that treat them complicate conception and my ability to carry a pregnancy to term. In the four years since a scalp biopsy confirmed I could add androgenetic alopecia to my growing list of ailments, I’ve learned that navigating treatments is a complex process rife with misinformation, under-informed doctors and untested cash-grab products, all fuelled by the desperation of millions who wish to restore what this condition visibly stole from us.

Related: How Getting A Hysterectomy Improved My Life

A harsh reality for hair-loss sufferers is that the treatment they choose must be taken for the rest of their lives. Over the past five years, I’ve tried two different medications, both of which my doctor told me I could not get pregnant while taking because they increase the risk of birth defects. First, I tried topical minoxidil (a.k.a. Rogaine) for two years with little regrowth, and once I went off my hormone replacement therapy for ovarian insufficiency, my hair fell out again. Next, I tried spironolactone, a diuretic used in some diabetic treatments, prescribed off-label for women with PCOS and hair loss as an anti-androgen therapy. In treating the latter, the medication targets male sex hormones that cause scalp hair loss, such as testosterone and DHT. More hair sprouted on my temples than with minoxidil, but a dose increase of spironolactone triggered a massive shed that tortured me for more than a year. I was desperate to try something new before it was too late.

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Finasteride isn’t the only medication that’s contraindicated for women of childbearing age: Specific drugs used to treat bipolar disorder, acne, epilepsy, anxiety, hair loss and opioid addiction can only be accessed if patients are first prescribed a reliable form of birth control. Depending on their doctor, they may not have a say in what form that is, even if they do not have sex with men.

Methotrexate—a drug I'm already taking to treat my rheumatoid arthritis, and that is also used to treat cancer, Crohn’s and other diseases—is also contraindicated as it can induce an abortion. In the United States, the overturning of Roe v. Wade has meant that in some states, women are being denied methotrexate for this reason.

“A practitioner should consider a woman’s identity outside of her childbearing potential and value what she wants for her body,” says Jennifer Bell, assistant professor at the University of Toronto Joint Centre for Bioethics. Not all doctors, however, feel the same.

Related: When Doctors Don’t Believe Women’s Pain

In the months after I discover finasteride, I wait to see my dermatologist while my hair falls out in clumps, progressively thinning on the top of my head. A constant bombardment of hair shedding erodes my self-esteem with every strand that lands at my feet and then disappears down my shower drain.

When my derm appointment finally arrives, I ask my doctor if I can try finasteride, given that the other treatments I’ve tried have shown disappointing results. He seems surprised I am asking for this, likely because he never discussed it as an option with me in the past. Then he says he would never prescribe it to a woman of childbearing age. Fighting tears, I remind him of my chronic conditions. For starters, my ovarian insufficiency means that pregnancy is already unlikely. And thanks to my rheumatoid arthritis, I'm already taking methotrexate, which is in the same pregnancy toxicity category as finasteride. I also talk to him about the promising research on women and finasteride. Still, he refuses to write me a prescription and instead offers me oral minoxidil, prescribed off-label. But this treatment is contraindicated in my case due to the risk of it lowering my already-low blood pressure to dangerous levels, which can cause fainting and other heart complications.

Prescribing any medication for off-label use is ultimately up to a doctor’s discretion, explains Dr. Jeff Donovan, a board-certified dermatologist specializing in hair loss who is based in Whistler, B.C. He also notes that there needs to be “significant counselling around risk” before a woman can be prescribed finasteride. Ultimately, however, he thinks that it can sometimes be an effective treatment for premenopausal women with androgenetic alopecia, and with reliable contraception in place—and a full understanding of its risks and benefits—he will prescribe it.

My doctor’s outright dismissal takes a bite out of the hope I desperately clung to for this drug. Then I remember I have an appointment with my endocrinologist coming up. I decide to do more research, improve my pitch, then ask him to help me.

In the weeks before the appointment, I turn to Reddit hair loss communities to remind myself I’m not alone. I’m validated by reading threads about other women who have been denied finasteride just like I had, but eventually found a doctor to consider their case. On appointment day, I swallow the anxiety swirling in my chest and explain the nightmare that has been my hair-loss journey, with a grand finale of running my hands through my hair and then showing the doctor the clump between my fingers. He raises an eyebrow, then rejects me outright: “I don’t prescribe this drug to women.”

At this point, a part of me wants to give up. But the thought of losing my hair because a specialist who has met me twice wouldn’t consider my specific circumstances enrages me. I decide to fight for myself until I have finasteride in my hands.

Bell understands my frustration, and believes that doctors should be taking cues from the patient themselves and their individual circumstances. In the case of finasteride, they should also reflect upon "their culturally-socially laden assumptions about women’s identities."

Furthermore, the medical community’s refusal to run trials or studies on childbearing women and finasteride is only perpetuating what she calls a “historic cycle.” As long as there is evidence of potential benefits, says Bell, “great weight should be placed on an individual woman's evaluation of the risks and benefits in light of her own personal story and experience.”

A few weeks later, a male friend who uses finasteride sends me a link to an international online pharmacy that would mail me the pills, no questions asked. Until this point, I was terrified to lose any more of my hair. I’d wake up in the middle of the night spiralling about my career stalling because I was losing my confidence. Every day, I find blonde clumps all over my keyboard and pillow and my partner’s clothes. But I don’t want to risk ordering the pills without a doctor’s supervision. Health Canada has warned about counterfeit drugs bought online, and the last thing my sick body needs is another complication.

By now, eight months have passed since I saw the advertisement for finasteride. In a moment of desperation, I beg my nurse practitioner to consider treating me until I can find a dermatologist specializing in hair loss to take over treatment. I bring my partner with me to our appointment. We plead my case, reiterating that we don’t want children, and outline the other hair-loss treatments I’ve tried as well as how detrimental my hair loss is to my career. She performs a hair pull test and removes long tufts of hair. I send her my research on finasteride. She says she will call me when she has made her decision.

One month later, she agrees to write me a prescription if I maintain a reliable method of birth control that she prescribes. Admittedly, I resent that I need to add a hormone pill to my already full slate of medications—and also that I will likely have to pay out of pocket for the finasteride, which is usually the case for any drug prescribed off-label—but for now, I’m overjoyed that I finally get to try this drug. When I hang up the phone, I do a victory dance. Finally, I don’t feel destined to lose my hair simply because I’m a woman harbouring a uterus.

Two months later, I’m in the shower shampooing what’s left of my hair. I lather and go through my routine of running my hands over my scalp to remove any loose strands. When I look down, my palm is empty. I run my fingers through again, thinking it’s a fluke. I repeat, repeat, repeat. Tears well in my eyes. This is my first shed-free shower in almost a year. I drop to my knees and weep. I didn’t think I was responding to the finasteride because I hadn’t experienced any of the side effects I was cautioned about: anxiety, decreased libido, irregular menstruation, breast tenderness, headaches. When I dry off and inspect my forehead in the bathroom mirror, there are tiny dark sprouts of hair for the first time in years. I can’t believe it!

A long road lies ahead in my hair-loss journey. But for now, I’m grateful my nurse practitioner looked beyond my uterus and worked with me to treat a condition that cast a dark shadow over my life. She showed me compassion when others refused to do so. Now, it feels like I have a part of my life back. My self-esteem is no longer under attack with every glance in the mirror because the drug is working.