Q. I'm 22 years old and I've had thinning hair for the past couple of years. How effective is PrOpecia in reversing this? I've heard there is a risk of sexual side-effects, but how likely is this? -JS
A. For male pattern balding, finasteride (PrOpecia) has proven very effective at
slowing hair loss and moderately effective at regrowing hair.
It does not work in men who are completely bald, nor in women. When you stop taking finasteride, the hair loss resumes, meaning that you'll likely be on it for a long time.
Based on long-term studies, about 2 to 5 per cent of men taking it develop problems with erection or ejaculation, but in general it's pretty well tolerated by most. In those who do develop adverse sexual effects, these generally disappear when the medication is stopped.
Finasteride works by interfering with the production of one of the products of testosterone, DHT, resulting in lower levels in the scalp. These lower levels help keep hair follicles alive for longer.
This effect on male sex hormones also explains the biggest danger of finasteride - if pregnant women are exposed to finasteride, by taking a pill or even handling the pills with wet hands, their male fetuses can suffer sexual organ deformities.
As with all cosmetic interventions, one must ask if the benefit is worth the risk. In addition to the above mentioned drawbacks, there are extremely rare cases of male breast cancer as well as permanent cases of impotence potentially linked to finasteride use. These events are so rare, though, that a definite relationship is impossible to prove.
The safest option is to accept the balding process as natural and skip the pharmaceuticals.
The flip side is that there's not much besides finasteride that actually works for balding, so for millions of men it's become a viable option.
Gary Payinda MD is an emergency medicine consultant in Whangarei.
Have a science, health topic or question you'd like addressed? Email: drpayinda@gmail.com
(This column provides general information and is not a substitute for the medical advice of your personal doctor.)
