Finasteride was originally indicated in the 1970’s for the treatment of prostatic hyperplasia, which is a non- cancerous condition also known as an enlarged prostate and was marketed in a 5 mg strength as Proscar. It was found that patients using the drug who also suffered from pattern balding saw hair re- growth while taking the medication. The drug was then developed into a 1 mg strength and marketed as Propecia. Propecia has been proven to be effective in stopping hair loss in the vertex area and growing hair for most men, however clinical studies over time show that this drug is better at preventing hair loss rather than regrowing hair. It is only available for men as a prescription, so it requires a doctor’s prescription. It cannot be used in women.

Propecia users are directed to take one pill every day. To have a chance to work effectively, the drug has to be continuously taken over a period of months. If a patient stops taking the drug, they are advised that they will lose the hair they gained and their hair will return to where it was before treatment. Results generally take six months to one year of continued treatment.

Patients who have used Propecia for a year and do not experience any results are advised that continued treatment will probably not produce any results, and to discuss the advisability of continuing treatment with the drug with their doctor.

How it Works

Finasteride is one of a class of medications called “5-alpha reductase inhibitors”. It works by binding to 5-alpha-reductase, which is an enzyme produced by the body. This enzyme is responsible for the conversion of free testosterone to dihydrotestosterone (DHT), a hormone that plays a significant role in hair loss. Simply put, finasteride treats male pattern hair loss by blocking the body’s production of a male hormone that stops hair growth.

Clinical Proof of Effectiveness

Merck conducted a major 12 month clinical study that demonstrated the effectiveness of Propecia as compared to a placebo.

Hair counts were assessed by photographic enlargements of a representative area of active hair loss. In these two studies in men with vertex baldness, significant increases in hair count were demonstrated at 6 and 12 months in men treated with Propecia while significant hair loss from baseline was demonstrated in those treated with placebo. At 12 months there was a 107-hair difference from placebo in a 1-inch diameter circle (equal to about 20 hairs/cm2).

Hair count was maintained in those men taking Propecia for up to 2 years, resulting in a 138-hair per one inch circle ( about 25 hairs/cm2) difference between treatment groups within the same area. In men treated with Propecia, the maximum improvement in hair count compared to baseline was achieved during the first 2 years. Although the initial improvement was followed by a slow decline, hair count was maintained above baseline throughout the 5 years of the studies. The results of this study was published in a peer-reviewed scientific journal in January of 2000.

FDA Approval

Propecia received approval by the FDA for the treatment of male pattern baldness in 1997, based on the results of another a five-year. Subjects on Propecia experienced visible results, mainly in the crown area of the scalp, but also and to a lesser extent in the front hairline area. Propecia is the only prescription drug approved by the US FDA to regrow hair, but only for men and not women.

Possible Side Effects

Since hair loss is an aesthetic condition, treatment should not involve the risk of side effects developing from the treatment being utilized.

However, with this drug, there have been many reports that Propecia causes sexual side effects that are alleged to be permanent in some cases. These side effects include difficulty in achieving an erection, a diminished desire for sex, and a decrease in the amount of production of semen. Merck claims that these sexual side effects are not common and were only experienced by 2% of men in clinical studies and that the side effects ceased when they stopped taking the drug. However, there has been a ground swell in publicity about the permanency of these side effects and a number of class action lawsuits are in progress.

There has also been a study conducted that showed that Propecia may increase a man’s risk of developing prostate cancer. This led to the labeling changes mandated in the U.S. and Canada.

Although it is rare, possible side effects are changes to a man’s breasts such as breast tenderness and enlargement, lumps, pain and soreness, or discharge from the nipple. These may be indications of male breast cancer. Other possible side effects are depression, prostate cancer and allergic reactions that may result in rash, itching, hives and swelling of the lips and face.

Propecia must not be taken by women as it can cause birth defects.

Pros of Propecia (finasteride)

1. Proven to work. Propecia has been proven in clinical trials to work for in treating hair loss, but mostly in preventing further hair loss.

2. Only FDA approved Rx drug for male pattern baldness. Propecia is the only prescription drug approved by the US FDA to regrow hair.

3. Easy to use. The drug is taken as one pill every day.

4. Relatively inexpensive. The price of prescriptions for Propecia vary, but are in the range of $225 for a 90-day supply, averaging $2.50 per day..

Cons of Finasteride (Propecia)

1. Does not work for everyone. Although it works for most men, it does not work for every man and generally works better in preventing further hair loss.

2. Takes 6-12 months to experience results. For most users, noticeable results are usually experienced after six months to one year of continued treatment.

3. Continued use is required. Propecia must be taken continuously to maintain results. If stopped, the patient will lose the hair they gained within a year of stopping the medication.

4. Side effects. Propecia has been shown to cause sexual side effects such as difficulty in achieving an erection, a diminished desire for sex which some people taking the drug have alleged to be permanent in some cases. The incidence of these side effects is not known at this time.

Some other side effects of using Propecia are rare but can be very serious, such as prostate cancer or male breast cancer. Other side effects may be depression; allergic reactions that may result in rash, itching or hives.

5. Limited Use. Can only be used in men, not women

6. Requires a doctor’s prescription. In the US, Propecia may only be dispensed with a doctor’s prescription.