Great blog, very informative. I am 23 years old and just started taking propecia. After reading about the drug in various forums online, I’m pretty scared about the sexual side effects. Many propecia users claim to have an irreversible loss of libido and some even say that have had trouble conceiving. With so many people reporting devastating sexual side effects, why is this drug so freely prescribed by doctors? Am I right in feeling vain for taking this risk? After all, a healthy sex life and eventually the possibility of having children are much more important than a full head of hair. Aren’t they?

1-2% experience side effects of varying degrees from Propecia. As I’ve written many times before, the loudest folks are those with complaints. You’re not going to find a large number of men rushing to web forums to talk about how great their hair medication is working, but the ones that feel cheated will be the first ones to let you know… over and over, often times under multiple usernames. I see it quite a bit in the comments to posts on this very blog (the IP address is an obvious clue).

Also keep in mind that these are unsubstantiated claims you’re referring to, with some being written by people trying to steer you from a proven FDA treatment like Propecia to an unproven “natural” supplement that they just happen to be selling online (with a convenient link right in their Propecia complaint post). There’s a lot of scams out there, and message boards are full of people eager to believe anything from an anonymous person that offers them a glimmer of hope.

As for feeling vain, you want to look and feel your best, and I don’t see why anyone should feel bad about that. Here are some related posts you might want to check out:

1. Official Word from Merck Regarding Propecia’s Effect on Sperm and Pregnancy
2. Can You Dismiss Propecia Information on the Web?
3. Propecia Causes Damage to the Penis — If It’s on the Internet, It Must Be True!
4. Propecia Info on the Internet Has Me Worried!

Hi,

I’ve written before and have another question. Do you think within the next ten years there will be a new hair loss drug that supplants Propecia as the go-to non-surgical option, or is FDA approved Dutasteride (for hair loss) the only new, clinically proven product you see on the horizon?

Thanks

Dutasteride (marketed as Avodart) is being used by many men, prescribed by some doctors to treat hair loss despite the absence of FDA clearance. In the phase 3 dutasteride study done in Korea, there was no mention of sperm or sterility. This is a concern to me, and I do not believe that this drug will be approved for treating hair loss until issues like that are studied further. That’s my opinion, and I’m sure I’ll get plenty of emails from people telling me how I’m wrong or I’m narrow minded about this medication. Ultimately, going to market is in the hands of the drug company that manufactures it. I am reluctant to prescribe dutasteride, because without clinical clearance from the FDA, I do not know the risk of sterility for those taking the drug for their MPB treatment.

As for other new hair loss drugs… I am not familiar with anything in the short term pipeline of 5 years, so it seems 10 years may be enough for us to hope and short enough for us to wait. Propecia should be off patent in the 1mg finasteride dosage in the US in a few years, so once generics are available in local pharmacies I’d imagine it would cut into their profits. I’m sure the drug companies will want to have a newer product out before then to keep their shareholders happy.

Dr farjo
i am aware that you have been doing research with Bradford university into the workings of minoxidil. i just want to ask if this research has shined any light on any potential improvements on minoxidil or even a better drug?

The following response is by UK-based physician Dr. Bessam Farjo:

Response by: Dr Bessam Farjo United Kingdom

Our research has made a big breakthrough in discovering the precise mechanism of action of minoxidil, as far as its action on hair loss is concerned. We have shown that this is done via the potassium channels in the tissue, which are sort of like on/off switches that help govern various transmission of signals and chemicals. This was previously unknown. The significance of this possibly lies in higher efficiency of minoxidil action, but more likely will result in discovering new drugs that act through these channels that may show better benefits to hair than minoxidil.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

i know that many people have written to you about how after a few years they start to see their hair thinning even though they take propecia daily..Ur response has always been that the drug doesnt prevent hair loss but only slows it down and after a period of time genetics will win out over the drug and you will start to see hair loss.. You also say that you shouldnt stop taking propecia otherwise the hair loss will be much more..i think you refer to it as catch up hair loss..

But one thing i havent seen here is people writing in to say that after using rogaine for several years they are now seeing hair loss..I get the impression that the long term effects from rogaine are much much better then the long term results from propecia. Of those people who are no longer benefiting from propecia how many of them are also using rogaine? I bet not many!

I myself use both rogaine and propecia and things are pretty stable..It may very well be that the propecia isnt working but the slack has been picked up by the rogaine..I would never know. The one basic difference between the 2 is one is something you take internally and the other is something you use externally. Could you tell me ur thoughts about this? I would imagine another reason that rogaine is probably doing a better job long term is that phizer switched from a liquid to a foam for better penetration into the scalp as well..

Yes, there’s no medication that will stop hair loss forever. And yes, if you take both Rogaine (minoxidil) and Propecia (finasteride) at the same time you may never know which medication is doing the trick, though perhaps both are doing their own unique thing to treat your hair loss. Many of my patients do use both medications together, though some only use one or the other. I don’t have any polling data that shows what percentage of Propecia users also use Rogaine, so your guess is as good as mine. Just as with Propecia though, if you stop using Rogaine you’d also be subject to the catch-up hair loss.

I suspect there’s not a wide discussion about long-term Rogaine use, because it is available without a doctor’s prescription and it is not a hot topic like Propecia. I also don’t have data on long term benefits of Rogaine compared to those of Propecia, as it either isn’t available or just isn’t something that’s been presented to me (if anyone has it, please feel free to send it my way). The drugs have more differences than just oral vs topical, as Propecia actually blocks DHT (one of the causes of hair loss), whereas the reason for Rogaine’s hair growth isn’t known.