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What are the pros and cons of Propecia?

// July 13th, 2010 // Men's health

Propecia and the newer Proscar are brand names for the medication finasteride. The only difference between them is the dosage: Propecia is 1 milligram of finasteride, Proscar is 5. Because Propecia is expensive, some men buy Proscar and cut the pills into smaller doses — not recommended. Proscar is prescribed to treat prostate enlargement, not hair loss.

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Finasteride works by blocking the conversion of testosterone into dihydrotestosterone, or DHT. High DHT levels are associated with baldness, so by preventing testosterone from converting into DHT, finasteride allows hair follicles that have become inactive to produce hairs again. In two twenty-four-month studies of men age 18 to 41, finasteride was shown to be fairly successful in treating hair loss. About 80 percent of the men studied maintained their base hair count, and 66 percent grew new hair. It usually takes about twelve months to see results from finasteride.

There are possible side effects with this drug, the most famous being loss of libido. The irony is obvious, as most men are concerned about hair loss because they fear it makes them less attractive. (Propecia cannot be taken by women, and pregnant women shouldn't even touch the pills, because doing so may cause birth defects.) The Propecia Web site has a patient product information page that lists sexual side effects, including «less desire for sex, difficulty in achieving an erection; and, a decrease in the amount of semen.» The site goes on to say, "Each of these propecia side effects occurred in less than 2% of men. These propecia side effects went away in men who stopped taking PROPECIA. They also disappeared in most men who continued taking PROPECIA."

That reassurance was enough to persuade millions of men to take Propecia. Not all of them are convinced the side effects are rare or temporary. Their comments can be read on a number of forums, including propeciasideffects.com and askapatient.com. In February 2006, 87 men on askapatient .com described their experiences with the drug. Nearly all concluded that it grows hair superbly, but 35 of the men reported loss of sexual desire. Fifteen reported a change in their semen or erectile function, 11 reported testicular pain, and 9 reported breast enlargement. A few complained that their penis had developed a curvature. Their anguish comes through loud and clear. Wrote one man, «From looking at these forums, the 98% no side effects is a big lie. It annoys me that the FDA would approve something so destructive to our bodies.» Another offered, «As far as preventing hair loss it worked like a charm. But now I've stopped taking it for almost a year, a lot of hair has fallen out (although it turns out it still looks fine overall), but I've got little man boobs THAT WONT GO AWAY. I'm embarrassed to take my shirt off in public. Anyone up for suing Merck?»

Perhaps most disturbing, 22 of the 87 men reported experiencing depression, anxiety, and panic attacks while taking Propecia. Merck's site mentions nothing at all about propecia side effects. «I experienced my first panic attack that lasted for hours,» reported one user. «Since then I have had horrible anxiety, shortness of breath, shaking, mood swings, and loss of appetite. It did not occur to me that Propecia may be causing these problems because Propecia's web site does not list these propecia side effects. Thanks Propecia.» Several men also claimed that Propecia made it more difficult for them to concentrate. Others lamented that the side effects did not decrease after they stopped taking the drug.

However, some men were ecstatic about the results. Some had increased sexual capacity with no side effects whatsoever. A man who had been on Propecia for eight months declared, «The negative experiences people have written about on this site astound me. ... I have had great success with Propecia and now enjoy a thicker head of hair than I've had in the last two years. More than anything, it has greatly soothed my anxiety about losing my hair and allowed me to focus on the important things in my life.»

These online forums are not scientific surveys, to be sure. But if you are contemplating taking Propecia, it would be worth your while to look through the comments. You could get lucky and enjoy years of thick hair, or you could end up like the tormented soul who wrote, «I used this shit for 11 months and now, 28 months later 1 still have side effects. I wonder if I'll ever get to normal. ... I wish I could go back in time just to shave my head and avoid this poison.»