Long Term Propecia with More Hair Loss

Please read and comment: Propecia (Finasteride) has been available since 1997 and is the first oral medication to ever be approved by the F.D.A. specifically for the prevention of hair loss. A physician’s prescription is required. The overwhelming majority of men using this drug experience some benefit from its use, sometimes dramatically. It takes a full year before the full benefits can be fully seen and appreciated. The recent 5-year research studies show that, for most patients, there is a substantial increase in the number and quality of hairs growing on the patient’s scalp for around 4 years. After that, the patient’s overall hair mass on top very gradually starts dropping ever so slightly each year, so that at the end of around 10 years, the patient is back to where he started 10 years earlier. So, in effect, for most patients it holds off the hereditary expression of hair loss for around 10 years. There also are many clinicians and investigators who believe that finasteride works nearly as well when administered in dosage amounts substantially lower (and cheaper) than that recommended by Merck.

Much of my opinion is projection and conjecture. Propecia hair loss curves show that hair loss continues, albeit slower, with the drug than without the drug after an initial gain in hair volume, but Propecia is still not the magic bullet for hair loss. After 5 years, the hair may return to the level that it was at prior to starting the drug, but that varies with patients. I had a discussion some years ago with researcher David Whitting, who told me that the Merck studies showed that Propecia was just as effective at 1mg, 5mg, 10mg and higher. The effectiveness dropped by 20% at ½ mg. So all I know is what the 7 years data shows (hair loss continues at a slower rate) and that lower doses than the recommended 1mg level are less effective. You are using generalities on what may happen at the 10 year mark. It may or may not happen. Avodart may be more effective than Propecia, but as of this moment, the data is not in my hands and the FDA has not ruled on safety and effectiveness issues.