Should I be concerned about reported sexual side effects of using finasteride (Propecia©)?

On April 29th, 2011, the International Society of Hair Restoration Surgery published findings regarding the use of finasteride (Propecia©) and claims of persistent sexual side effects from a number of younger men. This report states in no uncertain terms that:

“there is no evidence-based data substantiating the link between finasteride and persistent sexual side effects in numerous double blinded, placebo controlled studies…”. Link to complete article at the ISHRS web site:
International Society of Hair Restoration Surgery Task Force on Finasteride Adverse Event Controversies

Why is there a 4-6 month wait for new hair growth?

There is a 4-6 month wait before new hair grows after hair transplants or pharmaceutical treatment for hair loss. This is because the hair follicles have to shift from a resting stage to a growing stage. The new hairs also have to grow out long enough so that they are noticable. All of this takes some time.

Cycle of Growth: Hairs grow from hair follicles, which are miniature organs in the skin. Each individual hair follicle grows a single hair in a cycle consisting of a long period of growth (about 5 years) followed by a relatively short period of rest (about 3-4 months). After each rest period, the hair is shed, and a new hair begins to grow, and the growth cycle starts again.

Catagen Stage: At the end of the growth period, the follicle prepares for a rest. Hair growth for that particular follicle stops. The transition to the resting period is called the catagen stage. This stage usually lasts about a month or so, and during catagen the lower portions of the follicle collapse, and the grip on the hair becomes loose, which allows the hair shaft to be shed.

Telogen Stage: The resting period, called the telogen stage, lasts for another 3-4 months, and sometimes a bit longer. Hair follicles that have been transplanted usually make a transition from growing hair to no growth, and then enter the telogen phase, shed their hair, and then after 4-6 months start growing new hairs. New hair growth resulting from pharmaceutical treatments such as minoxidil and finasteride comes from “waking up” resting hair follicles. It takes some time before these “resting” follicles shift to the growing phase.

Anagen Stage: The hair growth period of a hair follicle is called the anagen stage. The anagen stage for scalp hair follicles lasts about 5 years. The new hairs grow about 1/2 inch per month.

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Recent Answers from AllExperts.com

Q: Hello peter… i am 21 years old (male)… i have been noticing that hair on the frontal part of the forehead is becoming finer n falling…. i have visited a dermatologist and he had prescribed me Propecia(finasteride 1 mg).. One tablet per day after dinner… and ketoconazole lotion… to my surprise i found that Propecia can lead to male infertility, many sexual disorders and DEPRESSION… is it true? And is it safe to use Propecia..? Can u suggest any other drug with lesser side effects?

A: Propecia is VERY SAFE. There are no side effects which can not be reversed in a short period of time by stopping the finasteride. The medication has been used as the 5mg form for several decades and we know there is a very good safety profile. In the studies done to get approval for the FDA there was only one many in 400 who stopped Propecia because of side effects and the major complaint was erectile dysfunction. Now that Viagra is available the few men who had problems can use this to help correct any problems. At 21 years old you probably do not have problems with your sex drive. I think the medication is so safe I have my 22 year old son taking this medication for the past two years. I have taken it for the past 17 years.

You should know that when studies are done to get FDA approval they use a control group of men taking a sugar pill and then ask each group whether they had various side effects. It turns out that 2% of the men taking the sugar pill had sexual dysfunction after one month, after six months, after one year and after two years. It seems that sugar is more dangerous than Propecia from these results. What this does prove is that at lest 2% of people are looking to blame their problems on something other than themselves. There is not other medication that works that has lesser side effects.

Q: I have recently started losing my hair is the above the temples in the front of my head. I am 26 years old. From all I have read propecia and rogaine do not work in this area. Will propecia work in stopping of slowing my hair recession in this area. I am not necessarily looking for hair regrowth but want to stop any further recession. Also would it help to use the rogaine foam.

A: Propecia does work to stop the balding process all over the head, front and back. The studies were done only on the back because it was easier to do but the FDA required the company to repeat the tests and measure the effect on the front in order to claim it works. I strongly suggest you give it a try for a year and see if it doesn’t stop your loss. I have seen young men such as yourself actually grow back much of the hair they lost in the previous three years.

Q: I am a norwood 2 with some thinning on top. Understandably, propecia is the best medication to stop hair loss, however, I tried taking this medication and had some sexual side effects as well as fatigue. So I was wondering if topically applied spironolactone can stop hair loss in some men, if not stop hair loss, can it still slow hair loss considerably? I look quite good with a shaved head and am lucky to have a good head shape but I would prefer to not go shiny bald too soon as I am only 21 years old and was wondering how effective topical spiro. could be in at least delaying hair loss. Also, does rogaine slow down hair loss? Despite that, if topical spiro and rogaine don’t work well, how long would it be for me to go shiny bald and have no coverage what-so ever. Thanks for your help.

A: I would suggest you try Propecia again and this time start more gradually so your body adapts to the decrease in DHT on a gradual basis. Perhaps take one only Monday Wednesday and Friday for two months and then every other day for a month or two before going to one pill daily. This is by far the best treatment for someone your age to prevent male pattern baldness. Topical spironolactone can help block your DHT from getting to the hair follicle but it is not as effective and of you absorb too much of it there could be other problems from it blocking all the other androgen receptor sites. Rogaine helps to keep hairs growing but it does not block the hairs from getting the signal from the DHT hormone to age.

Q: I was wondering if transplanted hair is safe from TE? I have had my iron low for two years and just in the last month and a half my ferritin went from 52 to 102 but if the hair regrowth doesn’t happen I thought maybe i could get a front hairline transplant and then just wear a hairpiece behind but I want to know if transplanted hair is safe from falling out later from stress (TE). Also i want to know how long after your iron doubles as mine has does the shedding stop and regrowth start?

A: Hair all over the scalp can fall out from stress. It just looks more obvious on the front of the scalp. Once transplanted the hairs keep growing just as they would where they came from. If the hairs on the back of the head get stressed and fall out so will the ones that were moved. Once the ferritin has gone to normal- over 70 — it may take up to another four to six months to see the change of hair cycles and increased density

Q: Is transplantation of hair permanent? If so, minimum, how long could it be?

A: Hair tranplants last as long as the hair continues to grow in the area the hair were taken. Most of the hairs in the back and sides remain all your life but do thin out somewhat. If you thin out a lot then those hairs taken from those areas will also thin out. The ideal treatment is to take Propecia so you do not thin out more after you have the transplant.

Q: If a man decides to have hair replacement surgery, there is always that nasty risk of scarring which could doom his newly transplanted hairs, and probably ruin his life. My question is; does it always have to be single hairs that are transplanted? If the doctors took a larger piece of scalp from the back of the head, it would eliminate the fear that each hair would be doomed, and whatever scaring would occur would be on a much smaller scale. Also, if the piece of bald scalp was put in place of the old one on the back of the head, wouldn’t it start generating new hair, due to the lack of DHT on the back of the head? Even if it would not generate new hair, I know that most guys would much rather have hair on the top of their head, and have a bald spot way on the back, instead of it being the other way around.

To sum it all up, why does hair always have to be replaced in single strands, why not take a larger piece of scalp?

A: The question you ask has been answered over the last half century of doing transplants using larger grafts in 1958 to 1980 and moving to smaller grafts and finally to single hairs. You can read about this in my book Hair Loss Answers which you can order from Amazon or read for free online by clicking here. My website also addresses the issues you asked about and shows more pictures./p>

To sum up, it is done one hair to three hairs at a time because it looks better (more natural) and leads to better healing with less scars.

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For more expert advice from Dr Panagotacos, see Chapter 15: “Ask the Expert” from Dr. Panagotacos’ book, Hair Loss Answers