I Have Been On Finasteride Now Six Years, Is It Still Working?

Six years ago, when I was 24, my doctor prescribed Propecia. I had some early loss in my crown and I could see through it and my frontal corners were thinning. Within a year, I saw an increased amount of hair in my crown, but still had a see through look and my frontal corners continued to disappear leaving me today with a full Frontal Class 3 pattern in the front. Should I continue with the drug or can I assume that it has done its job?

Have you considered that maybe if you did not take the drug, you would have even less hair now with a completely bald crown area? The original studies by Merck (drug company) showed that the drug may peak at 5 years showing a stabilization of hair loss. In men not on the drug (placebo group), the visible effects of progressive hair loss showed and they were more bald than those on the drug. The fact that the value of the drug over the 5 year study showed that some men actually benefited more, the more time they were on the drug. Unfortunately, the study was stopped at 5 years. From my clinical experience of prescribing the drug since it was introduced in the mid-1990s, my sense was that if men stopped it, at any time even after the 5 year period, they would develop what we have coined “catch-up hair loss” so as a result of that, we advise all of our patients to stay on the drug. The official study in the 5 year term showed that those not on the drug, became progressively more bald each and every year, suggesting that those that were treated, even if they had some progressive balding during the follow-up treated period, that it was less than if they never took the drug. We do see some men who lose hair while on the drug and I am convinced that if they were not on the drug, or stopped it after some number of years, the hair loss will eventually reflect the progressive nature of the genetic balding pattern. I am convinced that those who stay on the drug will have more hair than those who stop it. OF interest, that may not apply to all men of all ages, as men over 50, probably have less progressive hair loss than men under 30, but my general advice to most of our patients is: If you are not having symptoms or side effects from the drug and you sexual function is acceptable to you, to stay on the drug no matter what age you are. Even if you are losing hair and are on the drug, stopping it may make ‘catch-up hair loss’ a reality that you may not want to face. Also, long term use of finesteride may have a preventive impact on prostate cancer especially if you are over 50. Hopefully, you will eventually get to 50, so stick to the plan, stay on the drug.