To date, only one medication has been approved by the Food and Drug Administration (FDA) to help males (not females) to reduce Dihydrotestosterone ("DHT") in your body. While this drug, Propecia, has the ability to accomplish a critical step in helping reverse hair loss, understanding whether it is appropriate to add to your hair loss treatment regimen, requires consideration of many factors, which are summarized below.
To Fight Genetic Hair Loss, DHT Must Be Blocked
To recap from prior Blog posts, male and female pattern hair loss happens because hair follicles are susceptible to a process called androgenic miniaturization. Hair follicles shrink and eventually stop producing hair due to the conversion from ordinary testosterone to a form of testosterone called DHT. For a large percentage of males and females, hair follicles respond to increasing levels of DHT by shrinking and producing thinner hair, until sometimes stopping hair production altogether.
Propecia is the brand name of a prescription drug called finasteride, and it is used as a treatment for male pattern baldness, the most common type of hair loss. Propecia was approved by the FDA in 1997.
It helps block the body's ability to turn testosterone into DHT, a hormonal change that somehow keeps hair from falling out of prematurely (the medical term is androgenetic alopecia).
In pre-market studies, Propecia's manufacturer conducted a 48-week study of more than 200 men with androgenetic alopecia. Some participants were given placebos, but the ones taking Propecia “showed increase from baseline in total and anagen hair counts of 7 hairs and 18 hairs, respectively.” The men on placebos lost hair throughout the study.
How Does Propecia Work?
Propecia works by blocking the conversion of testosterone into DHT and, in many men, this process can slow down the process of male pattern hair loss. In fact, over five years, the majority of men either grow new hair or did not lose more hair while on Propecia, while 75% of men taking a placebo continued to lose hair. The following table outlines the effectiveness of five years of treatment with Propecia versus a placebo:
|Effect of Treatment||Men Taking Propecia||Men Taking Placebo|
|Increase in hair growth||48%||6%|
|No new hair loss||42%||19%|
|Continued hair loss||10%||75%|
Why Isn't Propecia A "Guaranteed" Hair Loss Cure?
While Propecia has the potential the help slow down hair loss and provide some regrowth, its results are mixed.
First, it is not approved for women. The drug can cause serious birth defects
Second, among men, it has been established to provide inconsistent results. During the first couple of months taking Propecia, some men experience additional hair shedding, which can be alarming.
Because hair growth takes time, it generally takes up to 3 months to notice a difference after taking Propecia every day. Thickening and strengthening of hairs that have become miniaturized tends to take six to 12 months.
Due to factors like individual rates of hair growth, doctors typically tell patients taking Propecia for male pattern baldness to give the drug 6 months to a year before deciding whether it’s helping or not.
Doctors also say that how you respond to Propecia during the first year of taking it is an indicator of how effective your long term treatment will be. The better the results during the first year, the more likely you’ll have continued positive results over the long term. Additionally, men over 30 tend to have better hair growth long term than younger men taking Propecia.
Propecia’s effects are in general limited to areas of the scalp that are thinning, but where there is still hair present. In areas that are completely bald, regrowth is rare. While Propecia can produce regrowth, its main benefit appears to be its ability to slow or stop male pattern hair loss. If you want optimal results, it is generally best to start taking Propecia as soon as possible after the onset of hair loss. Even delaying for a year can prevent men from “catching up” to the results seen by men who start taking it early.
Unfortunately, Propecia results can be unpredictable. For some men, it will only slow thinning, not stop it altogether. It is typically best suited for those who are at the beginning stages of hair loss. It is also important to note that hair growth will usually only be seen for the duration of use. Once you stop using Propecia, it is not unlikely that you may lose all the hair that has grown as a result of the prescription within a year
Researchers from George Washington University interviewed 54 men under age 40 who reported side effects for three months or more after taking Propecia to treat their hair loss. None of the men reported having any sexual, medical or psychiatric problems before they took the drug. Some of the men took the drug for a few weeks, others took it for years, but all of them reported side effects such as erectile dysfunction, decreased sexual drive, problems with orgasms, shrinking and painful genitals, even some neurological problems, such as depression, anxiety and mental fogginess.
For 96 percent of the men, the sexual problems lasted for more than a year after they stopped taking the drug.
Propecia’s manufacturer says these effects are rare and impact up to just 2% of drug users. But some studies suggests that incidence is much higher. Further, there are forums dedicated to helping men who once took Finasteride for hair loss, then stopped due to sexual side effects, but after stopping, never saw their sexual side effects resolve.
This is called Post-Finasteride Syndrome, and there’s even a foundation dedicated toward advancing research into why these sexual side effects persist for certain men but not others.