Learn the Risks and Benefits of Propecia and Hair Loss


Propecia (1)


Propecia (generic name: finasteride) has been in use as a means to stem hair loss since 1994, per approval of the Food and Drug Administration (FDA). It is taken internally and has a higher success rate than minoxidil (Rogaine), which is applied topically. It is effective in a majority of men, in varying degrees, but comes with at least one significant side effect that warrants concern.

Q. Does Propecia work?

A. Efficacy studies by the manufacturer (Merck & Co., Inc.) shows that Propecia halts hair loss in eighty percent (86%) of men taking it. Additionally, forty-eight percent (48%) regained some hair lost already.

Q. What is Propecia made of?

A. Finasteride (17beta-(N-tert-butylcarbamoyl)-4-aza-5 alpha-androst-1-en-3-one) is an orally active testosterone Type II 5-alpha reductase inhibitor. In a 1-mg dose, it is Propecia, prescribed for hair loss. In 5-mg doses it is Proscar, a medication that offers a small reduction in the chance of developing an aggressive type of prostate cancer and is also prescribed for BPH (benign prostatic hyperplasia), noncancer prostate enlargement that comes with age).

Q. How does Propecia work?

A. Finasteride/Propecia prevents the formation of DHT (dihydrotestosterone), which is in excess supply in men who are losing their hair, by blocking the enzyme that metabolizes DHT. Most patients report a slowing of hair loss in three months and regrowth of hair (if at all) by the six-month point.

Q. Does Propecia have side effects?

A. Men need to be concerned with a small chance (about 3.8 percent in one study) of experiencing one or more adverse effects: erectile dysfunction, decreased libido, and decreased volume of ejaculate. Additionally, some patients experienced pruritus (strong itch), urticaria (hives), testicular pain and swelling of the lips and face.

Of arguably greater concern is how finasteride/Propecia can have serious effects on unborn fetuses. When a pregnant woman has mere skin contact with the drug — for example, when touching a broken pill — it can result in significant genital abnormalities in male offspring.
Men who have had the following conditions should speak with their doctor about using Propecia out of caution: liver disease, abnormal liver enzyme test results, bladder muscle disorders, prostate cancer, difficulty urinating and known strictures of the urethra.

Q. Will Propecia continue to work as a person ages?

A. Individuals using Propecia must continue using it to keep their hair, and it appears to remain efficacious with consistent long-term use.

The drug has been on the market for more than 16 years, and there are no reported negative effects in the long term outside of the known risk of side effects from short-term use. Tests on the incidence of male breast cancer among long-term users have been inconclusive and do not suggest high risk. There may be a benefit among long-term users with a family history of prostate cancer in preventing its incidence.

Q. Will the texture of the hair be the same?

A. A series of small studies on hair texture indicates no change from taking Propecia. A review of blogs suggests that nonprescriptive copycat supplements claiming to deliver similar results may actually cause abnormal texture and other side effects. But of course those observations are not substantiated by research because supplements are not held to the same standards as prescriptive medicine.

Q. Can’t women who are postmenopausal use Propecia?

A. Merck (Propecia’s manufacturer) studied the drug on women who were no longer in danger of becoming pregnant (postmenopause), but after one year the study was discontinued because there was no measurable hair growth. This is believed to be because hair loss in women is due to the enzyme aromatase — over which finasteride has no effect — versus DHT, the cause of male pattern baldness.

Q. Can Propecia be used together with Rogaine?

A. There appears to be no clinical downside to using the two medications in combination, and proponents suggest that together there is a synergistic effect. The FDA does not track or comment on the safety or efficacy of this two-hit approach.

Q. Is finasteride available only under the brand name Propecia?

A. As a 1-mg treatment (for hair loss, versus the 5 mg of Proscar for treating prostate issues), it is currently available as Propecia or the generic finasteride.

Q. Does a person need to have a prescription?

A. Yes, Propecia requires a doctor’s prescription. Some online retailers provide their own doctors who supply the prescription. The reader is advised to exercise all necessary caution with regard to pre-existing conditions and the appearance of side effects after beginning a regimen of treatment.

Q. How was Propecia discovered?

A. Like minoxidil, finasteride was discovered by accident. The Proscar version of finasteride, at 5 mg per dose, was found to regrow hair in men in early studies. Appropriate testing was conducted to get FDA approval for this secondary use at a lower dosage.

Q. Is Propecia expensive?

A. Online sources show a range in price from $28 to $71 (U.S.) per month. Dosage is 1 mg per day.