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About Propecia

Effectiveness

Improved growth usually starts after about three months and is usually noticeable by 4-6 months. Maximum benefit is seen at 1-2 years. At the end of 5 years 90% of men taking Propecia/finasteride 1mg tablets have more or the same amount of hair than they started with. This compares with 25% of men not taking Propecia/finasteride 1mg.

How Propecia/finasteride 1mg works

Propecia/finasteride is a 5AR inhibitor that blocks the enzyme which converts testosterone to the hormone DHT (dihydrotestosterone). DHT in the scalp contributes to male pattern hair loss so reducing the amount of this hormone encourages hair regrowth. Improvement is normally seen within 3 months. Improvement usually continues for 2 years and in most cases there is a noticeable difference in hair thickness after 5 years of Propecia/finasteride 1mg use.

Further information on how finasteride works.

Who benefits

Men at any stage of male pattern hair loss are likely to benefit.

Propecia/finasteride 1mg is most effective for hair loss over the top of the scalp (vertex).

Propecia/finasteride 1mg has NOT been proven to:

• Reverse receding frontal hairline.
• Reverse hair loss which is ONLY in the temple regions (the area at sides of the forehead).
• Restore hair to entirely bald areas.

Clinical studies were conducted on men aged 18-41 years with mild to moderate hair loss, but not complete hair loss.

The best results of Propecia/finasteride 1mg treatment are seen after two years, at which time hair growth is likely to be at its thickest.

When not to take Propecia

You should not take Propecia if:

• Under 18 or assigned female at birth.
• Already taking another 5AR medication such as dutasteride or finasteride 5mg for another condition, e.g. prostate cancer or enlarged prostate gland.
• You have a known allergy to finasteride.

You may be able to take Propecia for hair loss but Dr Fox does not supply if you have:

• Previously suffered with sexual problems when taking finasteride or a similar 5AR medication such as dutasteride.
• Prostate cancer or have had it in the past.
• Male breast enlargement (gynaecomastia) or have had it in the past.
• A history of liver disease as the metabolism of finasteride is likely to be affected.

Cautions

• If hair loss has been rapid and recent (less than a year), or where there are symptoms of serious illness - such as unexplained weight loss, fevers, persistent diarrhoea, or excessive fatigue, or there is also loss of eyebrows or eyelashes - your GP should be consulted.
• If hair loss is patchy or irregular, or hair comes out in clumps, or there is scalp inflammation, papules, or pustules, you should consult your GP or a dermatologist.
• Blood tests carried out to detect prostate cancer (PSA) can give misleading results when Propecia/finasteride 1mg is being taken. Tell your doctor that you are taking Propecia/finasteride, if you are having a PSA test.
• If you are also having difficulty passing urine either starting the flow or with very slow flow, please consult your GP as this may be caused by your prostate gland.
• If treatment is stopped, the beneficial effects begin to reverse by 6 months and return to baseline by 9-12 months.
• Pregnant women should not come into contact with Propecia/finasteride 1mg tablets. It may affect the baby's sex organ development. For this reason tablets are film-coated and all women are advised not to handle crushed or broken tablets.

Side effects

Propecia/finasteride side effects are usually mild.

Reduced libido and erectile dysfunction are possible.

There are some case reports of diminished libido or erectile dysfunction persisting after stopping Propecia/finasteride. However sexual problems usually settle once finasteride has washed out of the system. In 2017 the NHS reviewed a new study and concluded that If sexual problems do occur, the drug can be stopped and the problem will resolve in nearly all cases. Extremely rarely, patients report symptoms linked to Post Finasteride Syndrome. An editorial in the British Medical Journal in 2019 supported this position, but suggested a need for further research.

Important: if you develop any lumps or experience pain in your breast area, or discharge from your nipples, please consult your GP. There have been rare reports of breast cancer in men who have taken finasteride.

Some men have reported episodes of depressive illness in association with the use of Propecia/finasteride 1mg for male pattern hair loss. There are also some reports of men developing suicidal thoughts. If low mood, depression, or suicidal thoughts develop, stop treatment and consult your GP straight away.

See the Propecia patient leaflet for full list of side effects. Side effects can be reported directly via the MHRA Yellow Card Scheme website or their app which can be downloaded from Google Play or Apple's App Store.

Alternative treatments

Regaine/minoxidil topical is the only other proven effective hair loss treatment. Regaine is applied to the scalp twice daily. Men can use Regaine/minoxidil and Propecia/finasteride 1mg tablets at the same time.

Dr Fox Hair Growth Spray is also available - it is a topical solution containing finasteride 0.3% and minoxidil 5%.

Dutasteride 0.5mg (brand name Avodart) is another 5AR inhibitor which works in the same way as finasteride to prevent male pattern baldness. In theory dutasteride is more potent than finasteride, and is therefore a more effective treatment. However dutasteride does not have a licence to be used to prevent hair loss and so it's prescription is off label. Dr Fox currently does not supply dutasteride.

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