PROPECIA or FINASTERIDE FOR HAIR LOSS

About Finasteride: Oral finasteride is available in 5mg dosage under the brand name Proscar or in 1 mg dosage under the brand name Propecia™. Proscar was first available in the market as a the treatment of benign prostate enlargement. It is an oral medication. It was subsequently discovered that people who have been using Proscar also noticed that drug has positive effects on people with hair loss. Merck & Co started clinical testing in the early 90s to evaluate the effectiveness of Finasteride in treating hair loss when taken orally. To minimize the potential of side effects that come with Proscar (5mg finasteride), Merck & Co. conducted clinical testing on 1 mg finasteride as a treatment for hair loss.

In November 1997, Merck has satisfied the panel of scientific advisors (to the FDA) that Propecia (1 mg finasteride) is effective in treating hair loss. In December 1997, the FDA officially approved the drug Propeica as the first ever anti-baldness pill in the world. It is now also standard practice for most dermatologists in the U.S to advise patients to use both Propecia and Rogaine simultaneously for maximum results. 

Finasteride is a 5-alpha reductase (5AR) inhibitor. 5-alpha reductase is an enzyme in our body that converts the male hormone testosterone into DHT. DHT is a more potent derivative of testosterone that is believed to be the main cause of male pattern baldness. Hair follicles that are sensitive to DHT will fall off when exposed to the hormone. Finasteride works by inhibiting the 5 alpha reductase enzyme that is responsible for converting testosterone to DHT. 

Note that there are two types of  5AR, type I and type II. Finasteride works by inhibiting type II 5AR. 

Brand Name: Propecia (1 mg finasteride).  Proscar (5 mg finasteride)

Side effects: Because Finasteride affects the male hormone in our body, women escpecially are cautioned against using the drug since it may give rise to birth defects. 

Also, about 2 % of the participants who underwent the clinical testing for Propecia reported that they have reduced libido. People who decide to take finasteride for hair loss should be aware of this potential side effects. However, Merck argues that the side effects happened to only about 2% of the participants, which is quite insignificant considering the fact that about 1.4% of the controlled group (participants who took a placebo) had the same experience. 

Note that there is a possibility that people may experience shedding or accelerated hair loss in the beginning. While there have been many theories attempting to explain the phenomenon of shedding in patients, this is still largely a mystery in the medical world as to why it happens. We do not know of any scientific studies that sufficient address the issue of shedding. 

Before using finasteride, patients should also be advised that DHT actually has a role to play in our body and it may not be to everyone's advantage to completely eliminate DHT indiscriminately. Read forum discussion for details. 

For discussions about finasteride and liver damage, please read forum discussion for details.

Clinical Studies: 

• In a 24-month clinical study of Propecia on 1,215 men with varying degree of hair loss in the vertex of the scalp, 83% of the participants reported the same of higher hair count versus only 23% of the control group. Most subjects reported an increase in the amount of hair and decrease in hair loss.

• In another clinical testing, over 1,800 men aged 18 - 41 with mild to moderate amounts of hair loss were studied for 12 months. All participants. whether receiving Propecia or placebo (the control group), were given Neutrogena T/Gel - a medicated shampoo. The results showed that the participants who took Propecia maintained or increased the number of visible hairs and noticed improvement in their hair in the first year, with the effect maintained in the second year. However, hair counts in men who did not take Propecia continued to decrease.
   
• Improvement in androgenetic alopecia (stage V) using topical minoxidil in a retinoid vehicle and oral finasteride. Douglas S. Walsh; Cary L. Dunn; William D. James (Arch Dermatol, Vol 131, December 1995, p.1,373)  
  This article talks about the treatment given to a 32 year old man who is in Stage V of the Hamilton scale of male pattern baldness. The patient was instructed to receive the following treatment as a trial: 6-12 month period of topical minoxidil combined with retinoid twice per day and 5mg finasteride taken orally daily. The topical lotion is made up of 3% minoxidil and 0.01% tretinoin. Each application is 1 ml. After following the treatment for about 8 - 12 months, the patient has improved from Stage V to Stage III of the Hamilton scale. Research has shown that finasteride can reduce the level of DHT in bald scalp. DHT is known to be the main cause of hair loss and is formed when the enzyme 5-alpha reductase interacts with the male hormone testosterone. Research also shows that finasteride generate little side effects to human, although about 5% of the patients experienced a decrease in libido and sex drive. However, women considering conceiving are cautioned against using finasteride as it may affect the fetus development. It is suggested that at least 6 months of treatment is required for maximum results to appear. Exactly how minoxidil grows hair is not known. It has been suggested that minoxidil grows hair by stimulating the blood circulation of the scalp. Studies have shown that using minoxidil in conjunction with tretinoin increases the potency of minoxidil, possibly due to an increased minoxidil absorption in the scalp. Clinical studies have shown that using tretinoin simultaneously with minoxidil is three times more effective than using minoxidil alone.
   
• A non-Merck sponsored study on the efficacy concluded that a small percentage of the test subjects felt that they regrew hair while the remaining of the subjects noted poor results. Click here for forum discussion. 
   
• Proscar Cancer Prevention Trial shows conflicting results about Proscar as a cancer prevention drug as well as an alarming finding that some participants showed an increased risk of high grade aggressive prostate cancer.  Click here for forum discussion.

Oral dosage: Use as directed by your physicians. Typical dose is 1 mg finasteride per day. However, due to the short half life of finasteride, some suggest that finasteride should be taken twice daily ,12 hour apart between doses. 

Topical application:  Some suggest that topical finasteride may be effective as an anti-androgen treatment. Some pharmacies are already compounding their own topical finasteride preparations. Waseda, one of our forums most highly respected posters, also commented that there topical finasteride as an anti-androgen is worth looking into...more info. 

Vendors

HairMedics - Oral Finasteride (1 mg or 5 mg)
HairMedics - Topical Finasteride (5% concentration)
Dr. Klein - Propecia

Propecia® / Proscar® are registered trademark of Merck & Co.