Propecia

A natural hormone, DHT, speeds up the rate of hair loss. Propecia blocks the action of DHT. Hairs naturally fall out and regrow in the same place. Propecia reduces the rate at which hairs fall out and promotes new hairs to grow in their place. Propecia works at the level of hair follicles.

Propecia will only treat male pattern hair loss, where hair is receding at the front and temple region (either side of the brow) and thinning over the top of the head. Other types of hair loss, such as overall thinning over the whole scalp or patchy hair loss, will not respond to Propecia. Not all male pattern hair loss will respond to treatment. See question about effectiveness above.

If hair has already been completely lost in an area, Propecia will not make hair grow again in that area. It can prevent further hair loss.

In studies, most men with male pattern hair loss taking Propecia see an increase in hair growth in the first 2 years and after 5 years have more hair than when they started. This compares with gradual continuous hair loss in untreated men.

Propecia is a brand name for tablets containing the active ingredient finasteride. The pharmaceutical company Merck first developed finasteride and is the only company which markets finasteride 1mg under the original brand name of Propecia. Merck keeps its prices for Propecia high, but there are lower cost finasteride 1mg tablets available from other pharmaceutical companies containing exactly the same active ingredient, finasteride 1mg (also available from Dr Fox).

Propecia tablets should be swallowed whole. Each tablet contains 1mg of finasteride which is the daily amount required for the treatment of hair loss.

Improvement should be seen after three months, although optimal results are usually seen after 2 years.

There may be a benefit for men over 45. The medicine licence for Propecia relies on studies carried out on men from 18-41 years only.

There is a lot of controversy surrounding this question, particularly in online forums. The pharmaceutical company Merck gives the following advice in its patient information leaflet supplied with Propecia tablets:

Effects on fertility - Infertility has been reported in men who took finasteride for a long time and had other risk factors that may affect fertility. Normalisation or improvement of seminal quality has been reported after discontinuation of finasteride. Long-term clinical studies about the effects of finasteride on fertility in men have not been conducted.

Uncommon: may affect up to 1 in 100 people

• you may be unable to have an erection (impotence)
• you may have less desire to have sex
• you may have problems with ejaculation, for example a decrease in the amount of semen released during sex. This decrease in the amount of semen does not appear to affect normal sexual function.

These side effects above may disappear after a while if you continue taking Propecia. If these symptoms persist, they usually resolve after stopping Propecia.

Frequency unknown

• persistent difficulty having an erection after discontinuation of treatment
• persistent decrease in sex drive after discontinuation of treatment
• persistent problems with ejaculation after discontinuation of treatment
• male infertility and/or poor quality of semen

March 2017: The NHS reviewed new research and concluded If sexual problems do occur, the drug can be stopped and the problem will resolve in nearly all cases.

See also the mystery of post-finasteride syndrome.

Yes, the gains made from taking Propecia are likely to be lost in the 9-12 months after stopping treatment.

Propecia is the brand name used by Merck for tablets which contain the active ingredient finasteride 1mg. Other pharmacy companies produce 1mg finasteride tablets, usually at lower cost, and these are known as generic Propecia (also available from Dr Fox). See generic medicines FAQs page.

Propecia treats male pattern hair loss, where hair thins at the front and sides and over the top of the head. Generalised thinning of the hair, not in the typical pattern, will not respond to Propecia. Propecia will not restore hair to areas of complete baldness.

Propecia is a long-term daily tablet. Benefits are usually seen after about 2 months and continue for up to 5 years, and probably longer. Benefits are lost 9-12 months after stopping treatment.

Propecia prices tend to be high because Merck, the company which produces this brand of 1mg finasteride tablets, keeps the wholesale price to pharmacies quite high. Some pharmacies, particularly Dr Fox, keep mark-ups low and supply Propecia at lower costs than others. It is worth shopping around. Non-Merck finasteride 1mg tablets (generic Propecia) are usually cheaper, and contain the same active ingredient.

Propecia will be ineffective for hair thinning in women and there is a risk of serious side effects, particularly in women of childbearing age, who should not even handle Propecia tablets (tablets are film coated to reduce the risk).

The only other proven treatment is topical minoxidil, marketed as Regaine, and this can be used at the same time with additional benefit.