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March 30, 2010 | Comments: 0

Gone Today, Hair Tomorrow

If you’re distressed by hair loss, is Propecia a good option? Here’s what you need to know before taking it.

If you have an enlarged prostate, your doctor may prescribe finasteride (Proscar) at a 5-milligram dose. But at lower dose (1 milligram), the same drug (Propecia) counters male pattern baldness.

Propecia inhibits an enzyme that converts testosterone to dihydrotestosterone (DHT), a hormone that causes hair follicles to shrink. The drug’s benefits are well documented, and clinical trials show that Propecia increases conversion of hairs into the active growth phase, reverses shrinking of hair follicles, and slows progression of hair loss. Propecia works best for men who are beginning to lose hair, not those who are completely bald—and is better for hair loss on the crown than for receding hairlines. It may take at least six months to see results—and the drug must be taken indefinitely to maintain the benefits. If you stop, hair loss will resume. Side effects, including erectile dysfunction and loss of libido, are relatively uncommon.

A hairy proposal

Though there’s no evidence of serious problems, we still hesitate to recommend Propecia. Younger men, the prime candidates, would need to take a drug that affects their hormones for the rest of their lives to maintain results—and there simply are no data yet to back its safety over that many years. Also keep in mind:

• Propecia can affect readings of the PSA (prostate-specific antigen) screening test for prostate cancer. If you take Propecia and are having a PSA test, tell your doctor so the results can be adjusted.

• It’s not cheap—about $70 a month. A generic version of Propecia is available in Canada; Americans can order it online. But be sure the site is reputable, since some sites sell fake Propecia.   

• You may be able to get away with splitting Propecia tablets into halves or quarters to save money, without much difference in effect. Several years ago a study in the Journal of the American Academy of Dermatology showed that the standard 1-milligram dose was optimal, but that smaller doses worked fairly well, too.

• There’s some evidence that finasteride when used as a treatment for an enlarged prostate (5 milligrams a day) may reduce the risk of prostate cancer. It’s not known if the low dose used for hair loss would have this same effect.

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