Propecia (finasteride) is used to treat androgenic alopecia (male-pattern baldness) in men, and benign prostatic hyperplasia (enlargement of the prostate gland). It is also used to treat prostate cancer in some countries.
Around 30% of men notice hair loss by the age of 30 and 50% by the age of 50.
Male-pattern baldness in men usually starts at the temples, where the hairline on both sides gradually recedes forming a characteristic M shape. Hair thinning also occurs on the crown of the head. Partial or complete baldness may result. It is called androgenic alopecia because of its link with the androgenic hormone, dihydrotesterone, and because it is thought to be contributed to by several different genes. Environmental factors are also involved, although research has not yet shown which factors make a major contribution to the problem. It may be that a sedentary lifestyle coupled with a high calorie, high fat diet play some part.
In a 5 year clinical trial, 9 out of 10 men had visible results – either regrowth of hair or no further hair loss. 2 out of 3 men taking Propecia regrew hair as measured by hair count. All the men in the study who were not taking Propecia lost hair. However, the men had to continue taking Propecia to prevent a reversal.
In women androgenic alopecia results in a general thinning of the hair of the head. However, Propecia is contraindicated in women, children and adolescents. It appears to be ineffective in post-menopausal women and is known to cause birth defects in the foetus of pregnant women. Indeed women who are, or who may become pregnant should not even handle this drug. Some of the drug may be passed to a woman in the semen of a man and, although this is not thought to cause a problem, some doctors advise the use of a condom if the man is taking Propecia.
In one trial, individuals taking Propecia were found to be 25% less likely to develop prostate cancer. However, it should be noted that, of those who did develop prostate cancer, it tended to be an aggressive type of tumour.
Enlargement of the prostate gland in men leads to poor but frequent urinary flow and, sometimes, obstruction. Propecia reduces the size of the prostate thus relieving the symptoms. Propecia in these cases is an alternative to alpha-blockers.
How does Propecia (finasteride) work?
Propecia is an anti-androgen and acts by inhibiting the enzyme 5a-reductase. This enzyme is responsible for promoting the conversion of testosterone into dihydrotesterone (DHT), the latter being the more potent. This results in the reduction of prostate size, thus relieving the symptoms of prostatic hyperplasia.
DHT is also involved in the process of destruction of hair follicles. Therefore, as the level of DHT is reduced in individuals taking Propecia, growth of hair rather than destruction is promoted.
However, it should be noted that inhibiting 5a-reductase results in an increase in testosterone itself (because it is not being converted to DHT). This in itself can cause problems if levels of testosterone are continually raised above a normal level.
A further possible disadvantage in using Propecia is that DHT is an antagonist (i.e. works against) of oestrogen the ‘female’ hormone which is predominant in women and present in men at a level of around 10% of that in women. In extreme cases such a situation in men could lead to gynecomastia (enlargement of breasts).
Contraindications
Women of child bearing age who are or may become pregnant, should not take or handle Propecia because the risk of causing birth defects in the unborn child.
Propecia is also contraindicated in children and adolescents.
Warning
Taking Propecia may reduce the serum concentration of prostate cancer markers such as prostate-specific antigen. If you are going to the doctor about a prostate problem you need to ensure that he/she is aware that you are taking Propecia so that appropriate serum analysis are used.
You should start seeing results within about six months. However, if there is no improvement after 12 months, you may wish to stop taking Propecia.
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