Propecia
(finasteride) Treatment
What it is | Benefits
| Risks | Variations |
History
What Propecia Is
Propecia (finasteride): Propecia is a prescription medication
approved by the United States Food and Drug Administration (US
FDA) originally as a prostate gland shrinking medication, however
in 1998 it was also approved at a lower dosage as an anti-baldness
treatment. It is sold as a prescription prostate medication
in 5 milligram tablet form under the brand name Proscar.
For treatment of hair loss it is sold in 1 milligram tablets
under the brand name Propecia.
 Overview
of how Propecia works to treat hair loss:
5 milligram finasteride tablets have been approved as a safe
and effective for treatment for prostate enlargement
because it has been shown that finasteride effectively blocks
the enzyme that converts testosterone into a form that enlarges
the prostate gland. It was discovered that the same form of
testosterone that is responsible for some prostate gland enlargement,
also plays an important role in signaling certain genetically
predisposed hair follicle cells to miniaturize, eventually leading
to hair loss. By blocking the conversion of testosterone
from one form to another, Propecia helps stop hair loss, and
in many cases regular Propecia use actually results in significant
hair regrowth.
 Lower
Dosage to reduce Baldness: It is
significant to note that the hair loss reduction effect of Propecia
occurs even at a much lower dosage than that needed to treat
enlarged prostrate glands. A single 1 milligram Propecia
tablet (finasteride) taken daily is the usual prescribed dose
for hair loss treatment. Over time, some patients find
that in addition to halting hair loss, they actually start to
regrow hair that had recently been lost.
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Dr. Panagotacos prescribes finasteride
treatments for certain of his hair restoration patients.
This patient illustrates an exceptionally positive response
to finasteride treatment. Typical results are less pronounced:
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Before
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After
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Clinical evidence suggests
Propecia works to slow the rate and degree of hair loss, and
in some cases reverse hair loss, in the following manner:
 5-alpha-reductase
increases DHT: Without Propecia, testosterone, a naturally
occurring hormone in the bloodstream, is converted by the naturally
occurring enzyme 5-alpha-reductase to a form of testosterone
called dihydrotestosterone (DHT).
 DHT
affects hair follicles: In men with pattern hair loss, certain
scalp hair follicles are genetically predisposed to respond
to elevated levels of DHT in the bloodstream. The most
susceptible hair follicles are typically located at the temples,
front, and top of the head, but all hair follicles may eventually
be influenced by elevated DHT levels. The response is
a shortening of the growing phase of the hair follicles,
and the progressive miniaturization of the hair follicles.
The end result is shorter and smaller hairs, and eventually
a decrease in the number of visible hairs on the scalp.
 Propecia
blocks type II 5-alpha-reductase: Propecia blocks
a form of 5-alpha-reductase called type II 5-alpha-reductase
from converting as much testosterone to DHT as would be the
case without treatment. The result is lower levels of DHT in
the blood. Continuous treatment is required to maintain the
benefits, as 5-alpha-reductase will continue converting testosterone
to DHT if treatment is discontinued.
 Propecia
protects susceptible hair follicles: The lower levels of
DHT in the bloodstream appear to inhibit susceptible hair follicles
from further miniaturization. This effect slows, and in
many cases stops further hair loss.
 Some
miniaturized follicles start to grow larger: Over time,
in some individuals, some miniaturized hair follicles begin
to grow back to normal size, and begin to grow normal size hairs
again. The degree of hair regrowth can vary from no measurable
regrowth to significant regrowth.
Finasteride Benefits
 Propecia
stops pattern hair loss: Tests have shown that Propecia
treatment prevents miniaturization of hair follicles, and
thereby stops hair loss. Finasteride prevents the aging
of hair follicles and helps men keep the hair they have.
In one two year study, 83% of men taking Propecia maintained
their hair at the top of their heads (vertex area), compared
to 28% of men taking a placebo (Blue bars). In the
same study, 17% of the men taking Propecia still experienced
measurable hair loss, but 72% of the men taking the placebo
also experienced additional hair loss (Red bars).
After the first two years, results of the group taking Propecia
continued to improve. |
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Propecia can help regrow lost
hair: In another 2-year clinical trial, 66% of men taking
Propecia had visible hair regrowth at the vertex (top
of the head), while only 7% of men taking a placebo had
regrowth (Yellow). Only 1% of men taking Propecia
had hair loss at the top of their heads, while 33% of men
taking a placebo showed a decreased hair count in this area
(Red). A five year study has shown essentially the same
results.
Safety: A level of safety has been established for finasteride
for many years before it was approved as a hair loss treatment.
As a prescription drug already approved by the FDA for treating
enlarged prostate glands, it has been extensively researched
and tested. Based on studies of hormone breakdown products found
in the urine, it seems to affect only the 5-alpha-reductase
enzyme, and not hormones. Propecia is not an antiandrogen.
Finasteride is approved as safe and effective in tablet form
for treating some forms of enlarged prostate gland. It has been
shown to be effective at stopping hair loss when taken by mouth
in table form at much smaller doses than that used to treat
enlarged prostate.
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Beneficial side-effects: Some possible side effects
of finasteride treatment for hair loss may be seen as beneficial,
such as the shrinking of the prostate gland in men susceptible
to an enlarged prostate.
Propecia Risks
Men only: Propecia
is for men only, and is not approved by the FDA as a hair loss
treatment for women or children.
Pregnancy: Women
who have become pregnant while taking finasteride should immediately
discontinue the finasteride treatment. If treatment is continued,
finasteride may cause a male fetus to develop ambiguous genitals,
and have female characteristics.
Less sex drive: Finasteride treatment may cause a loss
of sex drive in 1-2% of patients as a result of reducing levels
of DHT circulating in the blood. Treatment with Viagra
can be helpful in these cases.
Reduced ejaculate: There is a risk of reducing the volume
of ejaculate by up to 20% if the prostate gland is reduced in
size, as a result of finasteride treatment. Sperm activity remains
normal.
Finasteride Variations
Finasteride by mouth:
A single one milligram Propecia tablet is typically taken by mouth
on a daily basis.
Finasteride topical lotion: Finasteride lotion is not
commercially available, however Dr. Panagotacos does offer this
treatment mixed with other medications to block DHT to certain
of his patients, and an examination is required for a
prescription. Applying the lotion is not as effective
as swallowing the tablets. Grinding up finasteride tablets to
make a lotion will not work, as finasteride does not dissolve
easily. Topically applied finasteride is reserved for use by
those who wish to block only 5-10% of the DHT activity
in the scalp, which is a lower level than typically achieved
from ingesting tablets. Finasteride lotion must be specially
prepared by a Pharmacologist or Medical Doctor specializing
in medical hair restoration.
With Minoxidil: Studies have shown that combining oral
finasteride (tablets) and topical minoxidil (lotion) produces
better results than just taking the tablets or using the topical
medication alone.
Finasteride, Proscar, Propecia History
Dominican Republic:
The story of finasteride begins with scientists who were working
with certain Dominican Republic people who had a genetic trait
that caused them to give birth to male children with ambiguous
genitalia. Female babies were not affected. In many cases it was
difficult to determine such an infant's gender by observation
alone. At puberty, when hormone levels in these affected individuals
increased, most of these young boys normalized. They eventually
had children of their own, and perpetuated the genetic trait.
No hair loss: It was also observed that the adult males
in this group being studied never suffered enlarged prostate
glands, never developed prostate cancer, nor did they lose their
hair. No male pattern hair loss! Genetic research
showed that their gene for producing the 5-alpha-reductase enzyme
was inactive. With no 5-alpha-reductase enzyme, testosterone
was not readily converted to DHT.
5-alpha-reductase regulation: Scientists figured that
if they could create or find a medication to regulate the activity
of 5-alpha-reductase they could accomplish some of the positive
effects of this genetic trait, such as prostate gland normalization
and hair loss prevention.
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