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Propecia / Finasteride
FINASTERIDE
(Propecia® / Proscar®)
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. 5alpha 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
g 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:
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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.
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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 antiandrogen is worth looking into...more info.
Propecia® / Proscar® are registered trademark of Merck & Co.