Ask an Expert: Does Propecia Really Prevent Baldness?

Earlier this year, the web was atwitter about claims that Donald Trump was taking Propecia hair rejuvenation. It is a drug that lowers the conversion of testosterone to dihydrotestosterone, which in turn prevents hair from falling out (since dihydrotestosterone is a big culprit behind baldness). It would not be surprising if Trump took Propecia; That wispy, faded mop looks anything but natural. Or perhaps, like Samson the Israelite, Trump’s power is somehow tied to its fluid locks. It makes sense that I would do my best to avoid baldness. (Hey, anything that makes sense to the guy.)

This piece of gossip aside, is a big question for guys from the late twenties and early to mid-thirties: How far are you going to avoid hair loss? Are you going to move to Nova Scotia because you’ve read somewhere that the contamination causes male pattern baldness? Or will you hug him and shave his hair as close as possible?

Hormone-altering drugs like Propecia have numerous potential side effects. Many of the blog outlets about this article Trump noted that Propecia can cause mental confusion and impotence in rare cases, although most guys do not see negative side effects at all. (Trump obviously has never been impotent.)

If you are thinking of taking Propecia (alias Finasteride, its generic name), it is imperative to educate yourself about your chances of a positive outcome and potential harm. To help you sift through all the noise, we asked three dermatologists to tell us exactly what they tell their patients before prescribing anything.

1. Once you start taking it, you should continue to take it
“If Propecia is discontinued, all hair retained in that period will fall,” says Jane F. Kardashian, MD in Fresno, CA. So basically you are committing yourself to using this drug for life.

2. Finasteride is traditionally a drug that treats enlarged prostates. “Many men take this drug in much higher doses for the enlarged prostate and only use one fifth of that dose for hair loss,” says Lindsey Bordone, MD in New York Presbyterian and Assistant Professor of Dermatology at Columbia University. Your insurance may not cover a dose of 1mg of Finasteride, as this is such a low dose that it is being clearly used for aesthetic reasons. One solution is that your insurance could cover the dose of 5 mg, which is used to treat enlarged prostates. Some individuals cut these pills into fifths, good luck with that task. But seriously, do not take the whole pill. Why…

3. Particularly high doses (such as 5mg) can lead to breast cancer in men
“One side effect may be breast enlargement, and other changes in breast tissue, which could be a sign of male breast cancer,” Kardashian says. “A 10-year study published in the Journal of Urology found no link between Finasteride 1 mg and male breast cancer. However, studies of Proscar (Finasteride 5 mg) used to treat benign prostatic hypertrophy (BPH) , Showed a rare increased rate of breast cancer of 1.5 out of 20,000 patients, so this may be a dose related problem and deserves more research. ”

4. Also, you may lose your sex drive …
“Because many men want to keep their hair to attract a sexual partner, perhaps the most annoying side effect is sexual dysfunction,” Kardashian says. “3.8 percent of men reported one or more adverse sexual consequences, such as loss of libido, impotence, or failure to ejaculate.” So, small as is the risk, you are definitely throwing the dice when you take Propecia.

5. … And your libido might not come back for a while
“Symptoms may persist for a longer period of time than we previously believed, even after stopping the medication,” says Filamer Kabigting, MD, who also practices in New York Presbyterian, and is an assistant professor of Dermatology at the University of Columbia. Bordone adds that he has never had patients with this problem, and that anyone who does should see his urologist immediately.

6. Propecia may not be the best solution for your specific case
“Before taking Propecia get a complete hair evaluation by a knowledgeable health provider to determine if hair loss is caused by an underlying medical condition,” Kardashian says. “There are many causes of hair loss, many of which are reversible and include fungal infections, autoimmune disorders, tight braiding, and telogen effluvium (caused by fever, surgery, chronic disease). Out by a dermatologist who has spent time learning about hair structure, function and disease. ”

7. The nearest alternative is Rogaine
“Rogaine, or 5% minoxidil, is the most common first-line treatment,” says Kabigting. “It is simple to use and tested to work, but you have to use it regularly, twice a day, to maintain its effect. Light scalp irritation may develop in some, but this can be largely avoided by the minoxidil foam “It’s just as good as Propecia, it can take time to see results, up to six months, so be patient, otherwise it’s well tolerated and affordable: as cheap as $ 10 a month.”

8. Men who are trying to conceive might want to temporarily interrupt
“There is a risk of decreased ejaculation volume,” says Bordone. “I mention this to men who are trying to conceive and explain that if there is any delay beyond several months in their partner becoming pregnant, to consider taking a break from the medication.”

9. It actually works on the preservation and regeneration of your hair
“In the studies, 80 percent of men taking Finasteride 1 mg retained their original hair follicle counts and 64 percent experienced some regrowth after two years of continuous use,” says Kardashian. “Additional studies in one, two, and five years, respectively, showed hair loss at a rate of 58, 72, and 100 percent in male placebo groups versus 14, 17, and 35 percent male hair loss who take Propecia. ”

10. Tactics of fear aside, negative side effects are quite rare
“Overall I have no less than 300 men on this medication, and in the last few years I have not had a single patient tell me that he is discontinuing medication because of the side effects,” says Bordone. Either way, pay close attention to the response of your own body, and talk to your dermatologist immediately on any indication of a change.

In short: losing hair is not the worst thing in the world. Even energy donuts can look good when used with confidence. If you want to avoid Propecia or Rogaine, however, there are always hair transplants or micropigmentation.