What is Propecia?

Propecia is the brand name of the drug finasteride, also sold as
proscar. It’s the first pill approved by the FDA to treat male pattern
baldness or hair loss on the top of the head and mid-scalp areas.
Finasteride is pronounced: fin AS ter ide.

Propecia
was originally developed to treat an enlarged prostate condition called
benign prostatic hyperplasia (BPH). The FDA approved it in December 22,
1997. It’s manufactured by Merck and Company, Inc.

How does Propecia work?

Male pattern baldness is
medically called androgenetic alopecia. It accounts for 95% of all hair
loss. In women, it appears as a diffuse thinning over most of the
scalp. In men, it starts with a receding hairline that gradually
develops over the top of the head. This hair loss is called
androgenetic alopecia because the male hormones (androgens) and
hereditary factors (genetic) that determine the loss of hair.

Specifically, the enzyme 5 alpha reductase converts the male
hormone testosterone into a male hormone called Dihydrotestosterone
(DHT). The DHT is believed to cause hair loss in those who are
genetically disposed. DHT shrinks the hair follicle until it no longer
grows visible hair.

Propecia works by blocking the enzyme 5 alpha reductase that
lowers the levels of DHT in the body. This normalizes hair growth and
reverses hair loss. The advantage of Propecia is that it selectively
targets the appropriate hormone without causing undesirable changes in
other hormones.

What side effects do users of Propecia report?

98% of
men taking Propecia had no side effects. Clinical tests show PROPECIA
is very well tolerated. A small number of men (1.8%) experience some
sexual side effects. 1.3% reported erectile dysfunction.

Although not listed as a “known” side effect, some users have
reported small blackheads on forehead and increased skin oil across
face. Two report suffering from acne 6 months after stopping their
Propecia intake. One reported that acne was still present after 3
years. This is probably not a big problem but still a potential risk.

Tell your doctor if you experience
Decreased libido (1.8%)
Decreased volume of ejaculate (0.8%)
Impotence (less than one percent)
Breast tenderness or enlargement (less than one percent)

Caution: May cause birth defects in male baby’s sex organs if taken by women.

In all cases of men who reported side effects, stopping the
medication resolves the problem. In those who stopped taking it, the
benefits gradually declined and hair loss resumed.

What are the symptoms of overdose or something gone wrong?

No reports of overdose were found, but if you experience any of the following, you may be having an allergic reaction and should seek immediate medical attention.

Difficulty breathing
Closing of your throat
Swelling of your lips, tongue, or face
Hives

Storing Propecia

Store Propecia in a tightly closed
container at room temperature ( 59 - 86 degrees F or 15 - 30 degrees C
) away from heat, moisture and children.

Conditions to tell your Doctor about before taking Propecia:

If you’re going to get a blood test for PSA (Prostate Specific Antigen), the Propecia will alter the results.

Liver disease - you may need a lower dose or special monitoring during therapy.

Tell Your Doctor if you are taking any of the following medicines:

Although
no known conflicts have been reported, you should still tell your
doctor about any prescription drugs you are taking in case something
new is discovered.

General Notes on Propecia

If you miss a day, do NOT take an extra tablet. Taking more than one a day is

NOT recommended.

You may use it for 3 months or more before you notice an
increase in hair growth and/or prevention of hair loss. If you haven’t
seen results within 12 months, you probably won’t.

You have to use it continuously for maximum benefit. If you
stop taking it, you will likely lose the hair you have gained within 12
months.

Take each dose with a full glass of water (8 ounces).

Propecia has been studied in men with mild to moderate hair loss, aged 18 to 41.

Not to be used or given to anyone under the age of 18.

Not to be used by women - causes birth defects.

Women should not handle crushed or broken Propecia tablets.
It can be absorbed through the skin. Whole tablets are coated to
prevent this.

Propecia can be taken with or without food.

According to Merck Pharmaceuticals, Propecia stops the
progression of hair loss in the majority of patients (83%), and results
in hair regrowth in over 65%.

Tests were performed for semen levels in 35 men taking
PROPECIA® daily for 6 months. PROPECIA® levels were undetectable in 60%
of the samples. The highest level measured was 1.52 ng/mL and the mean
was 0.26 ng/mL. Using the highest semen level measured, a woman’s
exposure through vaginal absorption would be 750 times lower than the
exposure from the no-effect dose in Rhesus monkeys tests.

PROPECIA® helps grow natural hair not just “peach fuzz” and it’s as convenient as taking a vitamin: one pill a day.

Some studies shown Propecia to be about 80% effective in
preventing future hair loss and about 40% - 50% effective in restoring
hair growth.

Common Misspellings for Propecia

Propecia is often
misspelled, as many people hear the word verbally, write it down and
spell it incorrectly. Here are a few of the most common misspellings
for Propecia: Propesha, Propesa, Propicia, and Propeaca.

Propecia Feedback

If you’ve used Propecia, please help
others by adding your feedback. What would you tell someone considering
using this product? Please remember that we do not give medical advice.
That is for your local health care provider, who is familiar with your
medical history. You can use the form below to add your comments,
feedback or Propecia review.

Subj: Propecia

Is there a side effect noted in Propecia of mood swings,
irritability, loss of anger control? My husband is taking Propecia and
shortly after he started he started exhibiting these “symptoms”. He is
now going to a psychiatrist for this. However, I work for a
dermatologist and have noted two patients who have complained of the
same “side effects”, i.e. irritability, short tempers, moos swings.
None of these have been clinically attributed to Propecia, but I feel
there might be a link.

Valerie

Subj: propecia side affects
Date: 1/17/2003
My
name is Lynda and I have a lot to say about Propecia. My husband was
taking Propecia for 3 years. It did fill in the crown area of his head
and didn’t seem to make him sick in any way. All seemed good. The
problem started about 4 months ago when we wanted to conceive our
second child. We have a 2 year old and conceived on the first try. This
time I knew something was wrong when we wern’t getting pregnant. We
both got checked out and it was my husbands sperm count. It was lowered
to 1 million no motility at all. The doc says he is perfectly healthy,
all test came back normal. Whats differant Propecia for over 3 years.

When we had our daughter he had only been on the drug for a
couple of months. He is going for a 3 month sa in another month. We are
really worried, is this going to go back to normal? We have been in
touch with other people across the US that are going through the same
thing. I think more testing needs to be done on men taking this drug
for a long time and on men who are trying to become fathers. Do you
know anything that could help us? Have you heard about this before?
This is a very serious subject, people are spending so much money on
this drug and now are spending tons of money trying to become parents!

Lynda

Subj: Propecia alternative
Date: 2/16/2003
I
am not asking for medical advice, but I did have a question. I took
propecia for over a year, and at first I seemed to notice a stop in
hair loss, and the appearance of regrowth and was ecstatic. Then about
a year and 2 months or so after starting the treatment, I seemed to be
losing hair again.

My question is, is it possible to develop a tolerance to propecia,
or was it just in my head (over analysis etc)? Since I’ve stopped
taking it I’ve developed more rapid hair loss, but I don’t want to
spend a lot of money just to grow hair and then develop a tolerance
again.

Ian

AskDocWeb: Yes, it is possible to develop a tolerance.

Subj: Propecia feedback
Date: 4/6/2003
Propecia
was presribed to me prior to hair transplantation. I was quoted the
same comforting statistics shared by the manufacturer.

From the first week on the medication the sexual side effects
were, in a word, drastic. I literally felt as if I had lost all
sensation below my waist. This condition only improved after I refused
to take any more of the medication.

At first I believed my doctor when he suggested that I fell in
to that rare 1.8% that had a reaction - but I then found numerous
web-sites where other men had complained of the same side-effects I had
but never seemed to show up in any studies.

Speaking for myself, I would rather be as bald as Yul Brenner for life before I ever take this medication again.

Steve

AskDocWeb: You might want to try an inexpensive alternative to Propecia like finasteride

Subj: Shen Min
Date: 4/21/2003
What is you
opinion on Shen Min and it’s ability to stop hair loss. Are there any
studies on Shen Min and hair loss that the general public would have
access to? Thanks.

AskDocWeb: Part 1: We have not looked at this closely but my personal opinion is that taking vitamins will result in hair growth only when the hair loss was caused by a vitamin deficiency. At present, we don’t know what percentage of people are losing hair because of a vitamin deficiency.

Part 2: There was a study but it looks like it is no longer available to the public.

Subj: No problems (propecia)
Date: 5/5/2003
I’ve
been taking Propecia for about 2 years now. The hair has regrown on the
crown area and the hair loss/thinning has all but stopped but is still
thin. This is exactly what I expected.

I have not experienced a decrease in sex drive or any of the
potential side effects. The regrown hair has actually increased my
confidence and therefore increased my sex drive. I see a lot of
negative comments about Propecia but I feel that the issue there is
that people are apt to complain when something does not work but do not
bother to contribute when something is working great for them (I work
in customer support, so I know!). Propecia doesn’t work for everybody
and all the studies show this to be true; 80% stop hair loss and 40%
regrow hair. There’s really no way to tell unless you give it a shot.

Steve (another one)

Subj: Online Rx sites
Date: 6/18/2003
I have
heard that many of the sites that do not require a medical referral or
exam are actually just selling placebo, fake or otherwise “watered
down” versions of the drug. How do I know for sure that the Propecia I
buy on line is the real thing?

Kraig

AskDocWeb: Good question! You can start by making sure
you are dealing with a pharmacy in the United States. Then see if they
have a real address and phone number by doing .
You could also call directory assistance and ask for the phone listing
of their company name. If there is no listing, I wouldn’t do business
with them.

Subj: question about propecia
Date: 7/25/2003
Hello.
Since propecia is covered with just a thin film, does cutting the
finasteride into pieces interfere with the absorption of the drug, and
could the absorption be quicker and more efficient if the tab is placed
under the tongue. Thank you for you answer to this matter.

R

AskDocWeb: This sounds like you are trying to get
results in minutes rather than months. It just does not happen that
fast. You are just wasting your time.

Subj: sexual dysfunction after 7 months on propecia
Date: 7/30/2003
I
have recently began to experience some erectile dysfunction while
having sex. I’ll get an erection and then lose it. I have been taking
propecia for 7 months and recently began having sex with my girlfriend.
For several weeks my erections were fine, but I noticed not as hard as
they had been before taking the medicine. I also seem to have lost my
libido. Is this a common side effect after 7 months? I have been to my
family doctor and urologist and both assure me the problem is not
physical. They have suggested that I may be experiencing some
performance anxiety, but I have backed away form having sex with my
girlfriend and I do have firm erections when I kissing her and stuff,
but I still feel like something is not right. can anyone help?

Bryan

Subj: Propecia
Date: 9/10/2003
A few years ago
I had been using Rogaine and decided to try Propecia. I stopped using
Propecia after a couple of months because I noticed more hair loss in
that 2 month period than ever before. When I went back to Rogaine, it
seamed to help. I still use Rogaine, but in my opinion it only slows
hair loss and does not stop it, or re-grow hair.

Subj: Propecia
Date: 9/8/2003
Someone says taking Propecia can get cancer. Is this true?

Tim

AskDocWeb: We found nothing relating cancer with this product.

Propecia (Finasteride) and male pattern baldness (androgenetic alopecia)

What kind of baldness (alopecia) can Propecia (Finasteride) help?

Propecia is a licensed medicine for the treatment of men with male pattern baldness (androgenetic alopecia) to increase hair growth and prevent further hair loss. It is not licensed for use in women. For information on Our’s private prescription services, including our online doctor consultation service.

How many men suffer with male pattern baldness (androgenetic alopecia)?

Male pattern baldness (androgenetic alopecia) is the most common form of hair loss in men, occurring in 30% of men by the age of 30, and 50% of men by the age of 50. In the year 2000 it was estimated that 6.5 million men were losing their hair.

What are the causes of male pattern baldness (androgenetic alopecia)?

In male pattern baldness or androgenetic alopecia the way hair grows changes. The affected hairs become thinner and lighter in colour. Eventually some hairs become impossible to see making you look bald.

Some men are genetically at risk of male pattern baldness (androgenetic alopecia). In these men, hormones in the blood supply to the scalp causes each hair to grow for a shorter length of time, and this creates the thinning and light hair. Over a number of hair growth cycles, this results in the thin, pale hair that we see with male pattern baldness (androgenetic alopecia).

If left untreated, male pattern baldness (androgenetic alopecia) will tend to get worse with time.This will happen at different rates for different people.

Why does male pattern baldness (androgenetic alopecia) matter?

Despite being a very common condition male pattern baldness (androgenetic alopecia) can have a serious effect on the sufferer. Male pattern baldness (androgenetic alopecia) can be associated with a poor body image, make people feel old and unattractive and in general have low self-esteem. This leads to a greater likelihood of depression and other psychological problems. In general first impressions are very important and having male pattern baldness (androgenetic alopecia) can strongly affect whether or not a man perceives himself as attractive to others, and studies show that this perception can be correct as male pattern baldness (androgenetic alopecia) can affect men’s perceived sexual attractiveness.

Treatment of male pattern baldness (androgenetic alopecia)

Propecia (Finasteride) is the only prescription tablet in the UK for male pattern baldness (androgenetic alopecia).

How does Propecia (Finasteride) work?

Propecia (Finasteride) belongs to a group of medicines called “5 alpha reductase inhibitors”. It is a tan octagonal tablet, which is swallowed and is available in just one strength - 1mg.

Propecia (Finasteride) works by blocking the enzyme, Type II 5 alpha-reductase, and in doing so it reduces the level of the hormone in the scalp which shortens the hair growth cycle and allows hairs to revert to a normal growth cycle. This can result in stopping further hair loss and increasing new hair growth in men with male pattern baldness (androgenetic alopecia).
Continuous use once a day for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued so continuous use is recommended to sustain benefit.

Does Propecia (Finasteride) always work?

Clinical trials conducted on thousands of men have shown that after 2 years of use 66% (two thirds) of men showed increased hair growth. 30% of men showed a slight improvement, 31% moderate improvement and 5% great increase. 83% of men in the trial showed no further hair loss.

Propecia (Finasteride) side effects

When taken at the recommended dose, the possible side effects of Propecia (Finasteride) are usually mild and generally have not caused the men to stop taking the medicine.

Possible side effects that have been identified with Propecia (Finasteride) include decreased libido, erectile dysfunction, decreased volume of ejaculate, breast tenderness and enlargement; rashes, itching and swelling of the lips and face; and testicular pain.

Is Propecia (Finasteride) for everyone?

Propecia (Finasteride) should only be taken if your doctor has prescribed it for you.
Propecia (Finasteride) is only for men and should not be used by women due to serious risks in pregnancy and breast feeding.

Propecia (Finasteride) is not for use in children and adolescents.

‘Propecia’ should not be taken by men who are taking ‘Proscar’ (finasteride 5 mg) or any other 5α-reductase inhibitor for benign prostatic hyperplasia or any other condition.

How do I get Propecia (Finasteride)?

You need a prescription from your doctor to legally obtain Propecia (Finasteride). Companies offering Propecia without a valid prescription are breaking the law, and you may be putting your health at risk.

Highly convenient and embarrassment free and supply of Propecia (Finasteride)

For many men who are prescribed treatments for male pattern baldness (androgenetic alopecia), taking their prescription to the pharmacy represents an embarrassing hurdle which some may not overcome.

Our Pharmacy offers one option to avoid this hurdle. 4rx is an NHS contracted, fully registered pharmacy that specialises in national home delivery of medicines, including the common treatments for male pattern baldness (androgenetic alopecia). 4rx offers patients a professionally controlled and discreet service. All medicines are conveniently delivered in plain packaging to your chosen delivery address, so there is no need to go into a pharmacy.Medicines are dispatched by recorded delivery on the same day the prescription is received at our pharmacy

Ensure that you do not pay too much

The NHS does not pay for Propecia (Finasteride). This means your doctor will give you a private prescription that means you have to pay for the full cost of the medicine and also any dispensing fee the pharmacist chooses to charge. Big differences can exist depending on where you take your prescription to be dispensed. This means that it is important for you to find the best price available to you.

Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). It is used as a treatment in benign prostatic hyperplasia (BPH) in low doses, and prostate cancer in higher doses. It is also indicated for use in combination with doxazosin therapy to reduce the risk for symptomatic progression of BPH. Additionally, it is registered in many countries for androgenetic alopecia (male-pattern baldness).

Finasteride was approved initially in 1992 as Proscar, a treatment for prostate enlargement, but the sponsor had studied 1 mg of finasteride and demonstrated hair growth in male pattern hair loss. On December 22, 1997, the FDA approved finasteride to treat male pattern hair loss.

The Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5mg per day, as is commonly prescribed for BPH, though much higher than the 1mg generally prescribed for hair loss, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo.[1] Further, finasteride increased the specificity and selectivity of prostate cancer detection, thus, a seemly increased rate of high Gleason grade tumor.

Recognized side effects, experienced by around >1% of users, include erectile dysfunction, and less often gynecomastia (breast gland enlargement).[4] As expected from its short 6-8 hour half-life, in trial studies, side effects ceased after dosage was discontinued.
Brand names

Drug trade names include Propecia and Proscar, both products of Merck & Co. (the former is marketed for hair loss in male pattern baldness, and the latter for BPH). There is 1 mg of finasteride in Propecia and 5 mg in Proscar.

Cipla also manufactures finasteride (trade names Fincar and Finpecia), as does Dr. Reddy’s (trade names Finax and Finast), Ranbaxy (trade name Finara), Intas (trade name Finalo), and Aleppo Pharmaceutical (trade name Prosteride), who sell the drug at a significantly lower cost than Merck.

Side effects

Finasteride is not indicated for use by women. Finasteride is in the FDA pregnancy category X. This means that it is known to cause birth defects in an unborn baby. Women who are or who may become pregnant must not handle crushed or broken finasteride tablets, because the medication could be absorbed through the skin. Finasteride is known to cause birth defects in a developing male baby. Exposure to whole tablets should be avoided whenever possible, however exposure to whole tablets is not expected to be harmful as long as the tablets are not swallowed. It is not known whether finasteride passes into breast milk, and thus should not be taken by breastfeeding women. Finasteride may pass into the semen of men, but Merck states that a pregnant woman’s contact with the semen of a man taking finasteride is not an issue for concern.[2]

Finasteride has been linked with depression [3] The drug also caused reductions in allopregnanolone, a potent, endogenous positive modulator of the GABA-A receptor, in very large doses in rodent studies.[4]

Finasteride can also be used to mask steroid abuse, and many professional sports have banned finasteride use for this reason. [5]

Finasteride is under investigation by the Swedish Medical Products Agency for possibly causing irreversible sexual side effects [6].

Use as a treatment for hair loss

In a 5-year study of men with mild to moderate hair loss, 48% of those treated with Propecia (finasteride 1mg) experienced some regrowth of hair, and 42% had no further loss. Average hair count in the treatment group remained above baseline, and showed an increasing difference from hair count in the placebo group, for all five years of the study.[5]. Propecia is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy.[7] In clinical studies, Propecia, like minoxidil, was shown to work on both the crown area and the hairline,[8] but is most successful in the crown area.

Some users, in an effort to save money, buy Proscar instead of Propecia, and split the Proscar pills to approximate the Propecia dosage. Doing so is generally considered unadvisable if women of pregnancy age are in the household; this is because finasteride, even in small concentrations, can cause birth defects in a developing male fetus. The birth defects involve the development of male genitalia (no such effects have been noted in developing female fetuses). On most product inserts, it will be mentioned that the dust or crumbs from broken Propecia tablets should be kept away from pregnant women.

Propecia has been shown to be ineffective for treating hair loss in women.[citation needed] However, Propecia’s supporters respond that the study was on post-menopausal women whose hair loss was more likely related to the loss of estrogen versus a sensitivity to testosterone. Many doctors prescribe it for women, but not without either careful birth control measures or assurance that the woman cannot become pregnant.

Possible health concerns

The UC Berkeley Wellness Letter expressed concern in March 2003 about the unproven long-term safety of Propecia and recommended cutting a standard 1 milligram dose of Propecia into quarters to reduce the cost without reducing its effectiveness. This claim appears to be supported by clinical pharmacological data reviewed by the FDA during Propecia’s approval process that suggested that the advantage of taking 1 mg per day over 0.2 mg per day is statisticially small.[9] Some people have unsuccessfully petitioned the FDA to re-examine the approved dosage in light of the statistical evidence and unknown long-term risks.[10] The FDA responded and said that just because the level of DHT found in the scalp was not significantly different does not mean there is a correlation with hair loss. A study would have to show that the benefits of using 0.2 mg and 1 mg were not statistically different. According to the FDA such a study has been performed and a 1 mg dose has a greater benefit whilst remaining equally safe. The same study also concluded that doses of 0.01 mg per day were found to be ineffective in treating hair loss.[10]

In the Prostate Cancer Prevention Trial (PCPT), 25 percent fewer men taking the drug finasteride developed prostate cancer than men not taking the drug. However, men who developed prostate cancer while taking finasteride were more likely to have high-grade cancers, which can spread quickly even if the tumors are small. [11]

Propecia’s effects in detail

DHT is a derivative hormone (metabolite) of testosterone that has been shown to be critical to the initiation and progression of follicular miniaturization and eventual destruction of hair follicles in male pattern baldness. DHT is a steroid hormone just like testosterone but with greater affinity for the androgen receptor. Converting testosterone to DHT thus increases many of its effects.

While the mechanism by which DHT is involved in hair loss is not confirmed, many dermatologists and research scientists specializing in hair loss believe DHT molecules may diffuse into the interior of hair follicle cells (the cytoplasm or cytosol) and bind with androgen receptors. This complex, both the receptor and the DHT molecule, then enters the nucleus of the cell. In the nucleus of the hair follicle cell this complex could then alter the rate of protein synthesis in men who are genetically predisposed to baldness.[citation needed]

However, DHT also plays an important role in the functioning of the central nervous system (the brain), the testicles and prostate, and almost everything but muscle tissue. In muscle tissue testosterone is the dominant hormone, which is why some bodybuilders inject testosterone derivatives to aid in muscular development.

* Propecia (and other products containing finasteride) cause a rise in testosterone levels because testosterone that would normally be converted into DHT remains testosterone. Continual high levels of testosterone in the body could possibly have negative side effects.

* Artificially low levels of DHT in the body could cause some unwanted conditions. DHT is an antagonist of estrogen. Men’s bodies also produce the female hormone estrogen in the adrenal glands, although this is just one-tenth of the estrogen that premenopausal women produce in their ovaries. By reducing DHT with drugs, a man’s protection from the effects of estrogen may also be reduced. This could result in gynecomastia.

* Even though both finasteride and dutasteride were developed to combat benign prostatic hyperplasia by reducing DHT in prostate tissue, some scientists question the wisdom of using these 5-alpha reductase inhibitors in younger men who have no problem with their prostates. A research chemist, Patrick Arnold, says “Evidence is mounting that the existence of a high estrogen/androgen ratio – a condition common in older men – is highly correlated with the development of benign prostatic hyperplasia.”[citation needed] However, in apparent contradiction, individuals with 5-alpha-reductase deficiency (and thus a similar hormonal profile to users of DHT inhibitors) do not experience BPH.

Patent expiration

Merck’s patent on Finasteride (for the treatment of BPH) expired on June 19, 2006.[12] Merck was awarded a separate patent for the use of Finasteride to treat Male Pattern Baldness. According to the FDA, this patent will not expire until Nov 2013.[13]