“I call it vitamin P,” says Dr. Sara Wasserbauer, a Walnut-Creek, California-based board-certified hair transplant surgeon, “because taken daily, it strengthens follicles and keeps them growing, which is especially useful in transplant cases, where you want to halt any additional hair loss around the newly transplanted area.” Dr. Laurence Kirwan, a plastic surgeon specializing in hair transplants, who recently had his own hair transplant, swears by Propecia. “Propecia stops hair loss from increasing and helps the transplant grafts grow in strong and healthy, so I use it myself.”

Possible sexual side effects of Propecia in a small percentage of men

Propecia (generic, finasteride) is also heralded by young men who want to keep their follicles alive, but it doesn’t come without some side effects, according to Propecia’s own Web site. Although in clinical studies by Merck Research Laboratories, makers of Propecia, these side effects were minimal, they are an important consideration because they are sexual in nature. According to the drug’s Web site, sexual side effects of Propecia can include:

  • Diminished sexual desire
  • Erection difficulties
  • Decrease in semen count
  • Breast enlargement or tenderness
  • Nipple discharge

Kirwan continues, “As for sexual side effects, I haven’t had any, but if I did, I’d stop taking the medication immediately because the literature shows that the side effects are temporary and would resolve upon stopping Propecia permanently. I can see how men would be terrified, but the small percentage of men this happens to would most likely not be you.”

In contrast, Wasserbauer explains that usually, sexual side effects will subside once the body acclimates to the medication, so she suggests waiting it out for a few weeks. Since Propecia causes an increase in testosterone initially, when you begin taking it, your body responds by decreasing testosterone production, which can cause sexual side effects. “What most men don’t realize, or don’t want to wait for, is that the testosterone imbalance corrects itself after a few days and any sexual side effects will subside, so I advise my male patients to wait it out before discontinuing or giving up on Propecia.”

Current studies on sexual side effects of Propecia: temporary or permanent?

According to Propecia’s Web site, any sexual side effects reversed upon discontinuation of the medication, but recently, a new study, published in the December 2010 issue of Journal of Sexual Medicine, set out to define the sexual ramifications of Propecia use. “Although the adverse side effects of these agents are thought to be minimal, the magnitude of adverse effects on sexual function, gynecomastia, depression, and quality of life remains ill-defined,” states the study’s objective. Following a review of all the literature and studies, the researchers found adverse persistent sexual side effects in a small subset of men.

Experiment with the correct dosing of Propecia for you

Dr. Robert Bernstein, hair transplant surgeon and hair loss specialist at Bernstein Medical Center for Hair Restoration in New York City, advises his male patients taking Propecia who experience any side effects that bother them to perform the following dosing evaluation:

  • Discontinue the Propecia until the side effects have gone
  • For 2 weeks, take one-quarter pill a day
  • If there are no side effects, take one-half pill per day for the next 2 weeks
  • If no side effects occur, return to full dose of 1 pill per day
  • If you experience side effects, go back to the level that you had no problem and stay at that level for at least 1-2 months before trying to increase the dose again

The bottom line, concludes Wasserbauer, is your own comfort level and paying attention to your body to outweigh any possible side effects against the benefits you are experiencing with Propecia to treat your hair loss.