Finasteride (Propecia) for Crown Hair Loss

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Finasteride (brand name Propecia) is a 1mg pill administered daily for the treatment of male pattern hair loss. It is the only FDA approved oral treatment for hair loss. It was discovered and introduced by Merck & Co in 1992.

Initially, finasteride was prescribed in 5mg doses (called Proscar) to patients with benign prostrate hypotrophy (BPH). Some of those men reported increased hair growth and Merck then initiated a study to exam this side effect. The clinical study which led to FDA approval was based on three one-year studies involving 1,879 men aged 18 to 41 with mild to moderate crown and mid-scalp hair loss. After one year, 1,215 of those men with crown/vertex hair loss were studied for another year. Results showed that 83 percent of men taking 1mg of finasteride maintained and increased hair count. In contrast, 72 percent of the placebo group continued to lose hair. (47, 49) (Article continues below ad)

In another analysis of those studies, dermatologists evaluated photographic evidence of hair count in 508 patients after 24 months and determined that 66 percent saw new hair growth, compared to only 7 percent for the placebo group.

These studies provided hope for all sufferers from male pattern baldness, and, even better, these positive results could be achieved without having to cash in an Aviva equity release because Finasteride was not going to break the bank. Many new drugs come at such a high price that many people can't use them, not so with this one. Men all over the world would be able to put baldness behind them, or at least postpone it for some time.

Propecia received marketing clearance from the FDA in December of 1997 and the medication began showing up pharmacy shelves in January of 1998. Proscar had already been available and was being prescribed "off label" with it's 5mg dose quartered into 4 sections with a pill cutter by the patient.(47)

Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone, the precursor for hair loss. This conversion takes place with the help of an enzyme called 5-alpha-reductase. "Finasteride works by inhibiting the action of 5-alpha-reductase and thus inhibiting the conversion of testosterone into DHT." (48)

There are 2 types of 5-alpha-reductase. Type I and Type II. Finasteride only inhibits Type II 5-alpha-reductase, which means it will never be 100 percent effective in stopping DHT. There are medications that stop both, which we report more on here.

Important Facts and Notes about Finasteride: (47-52)

Finasteride is most effective in halting/slowing hair loss and regrowing hair on individuals with mild to moderate hair loss and recent hair loss. Patients with extensive, long term hair loss may not see much benefit.

Finasteride is most effective on regrowing hair in the crown/vertex area and mid-scalp portions of the head. It was long thought to be inneffective against frontal and mid-scalp frontal hair loss. However, a 1999 study at the University of Pennsylvania School of Medicine reported: "There was a significant increase in hair count in the frontal scalp of finasteride treated patients... Efficacy was maintained or improved through the second year of the study... Conclusion: In men with hair loss in the anterior/mid area of the scalp, finasteride 1mg/day slowed hair loss and increased hair growth.

Finasteride is not thought to be effective for temple hair loss. It is most effective on mild to moderate crown and mid-scalp hair loss that is recent (within a few years), and mildly effective for frontal hair loss.

Finasteride can be used with minoxidil to improve results and outcome. See minoxidil.com for aggressive combinations of minoxidil and finasteride used together, as well as other products.

Finasteride used before and after hair transplantation can improve results. "Visible increases in superior/frontal scalp hair post-transplant were recorded for 94% and 67% of patients in the finasteride and placebo groups, respectively." - 2005 Study (51)

A little known fact about some early finasteride studies is that patients were directed to wash their hair with Neutrogena T-Gel, a medicated shampoo. Other medicated shampoos containing ketaconozole and Salicylic acid have been studied and are believed to have some anti-DHT effect or assistance, and may enhance the results of finasteride and are recommended by some experts as a good adjunctive treatment that acts synergistically with finasteride.

- Studies have shown that the use of a 2% ketoconazole shampoo will reduce the sebum excretion rate (-6.54%) when used over a six-month period... Salicylic acid is a keratolytic, i.e. it loosens and breaks up clumps of keratin (dandruff), allowing them to be more easily removed from the scalp...Since the salicylic acid can remove some of the dead skin layers of the epidermis, the ketoconazole can be more effective in reducing the DHT in the scalp.

Finasteride in topical form is available from some online pharmacies. It's efficacy is debated but some experts such as Dr. Lee of Regrowth LLC, minoxidil.com, firmly believes that it works on patients and includes it in his products.

Statistics on Effectiveness: Although reports and studies vary, general figures demonstrate that one-half to two-third of the men studied REGREW hair, while 83 to 90 percent regrew hair AND/OR maintained hair (no further hair was lost).

Side Effects:

• Decreased Libido
• Decreased Ejaculate
• Impotence/Erectile Dysfunction
• Gynecomastia
• Birth Defects in Women (Not indicated for women).

Statistics on the side effects in men vary widely by source, but are generally around 2 to 4 percent.