By Dr. John Frank, M.D. – IAHRS, ABHRS,ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, March 31, 2012
Propecia is highly effective if started at the first signs of alopecia
The short answer is Propecia can be highly effective if you start taking it early, at the first signs of alopecia.
If you’re young, in your early 20s, experiencing significant hair loss, and if you have a family history of baldness, it’s likely that you are suffering from androgenic alopecia, a genetic form of baldness. However, only a qualified hair loss medical specialist can make that diagnosis. Assuming that you are suffering from this type of hair loss, the best thing you can do is start to use Propecia right away.
This is because The American Hair Loss Association recommends Propecia (Finasteride) as one of the first treatments a hair loss sufferer should try, and the earlier you start, ideally as soon as you detect serious hair loss, the better off you’re going to be. The longer you wait to start Propecia, the less hair there is to save.
NIH Study: Propecia Is Most Effective at the Early Onset of Alopecia
Propecia Is Most Effective at the Early Onset of Alopecia
The above chart (curtsey of http://dailymed.nlm.nih.gov) is from a double blind, placebo-controlled, 12-month study, and it shows that Propecia is most effective if you use it at the first sign of androgenetic alopecia related hair loss.
The top line (closed triangle, label: 1/1/1/1/1 N=539) shows hair loss in men who started Propecia at the first sign of hair loss. In the first 12 months (see the left hand box), these men experienced significant hair growth. From year 1 to 2, they experienced no hair loss (see the right hand box), and after 2 years, they experienced modest hair loss.
Compare that with the bottom line (open circle, label: P/P/P/P/P N=60). This shows the hair loss for men who did nothing. They steadily lost hair over the course of 5 years.
The third line (open triangle, label: 1/P/1/1/1 N=64) shows those men who waited one year before starting Propecia. As soon as they started Propecia (see the right hand box), they too experienced hair growth, but they never had as much hair as those in the top line who started Propecia right away.
The younger you are, the more important it is that you begin treatment with Propecia as soon as possible because most men who start losing their hair in the early 20’s due to alopecia will experience significant hair loss by the time they are 30. The longer you wait, the less hair there is to save.
How Can I Know If Propecia is Working?
First, there’s no question that Propecia can stop hair. In one of the original studies designed to demonstrate the efficacy of Propecia, 83% of men using Propecia stopped their hair loss and 66% experienced some degree of hair re-growth.
Second, according to Merck, the manufacture of Propecia, you need to take it for at least 3 months before you start seeing any benefits, i.e., either a slowing or complete stoppage of hair loss or hair re-growth. However, results can take up to 1 year. After one year, if you don’t see any benefits, the drug, for whatever reason, is unlikely to be working for you.
It may be difficult for you on your own to detect a slowing or stoppage of hair loss, or new hair growth, especially at the 3-month mark. Generally, you should see a qualified hair loss specialist after you’ve been using it for 3 months to access whether it is working or not. Your doctor will do a gross and microscopic examine of the scalp and follicles. He or she may take microscopic detailed photos of the follicles for a before and after comparison.
What Happens If I Stop Taking Propecia?
According to Merck, Propecia works only while you’re taking it. You can clearly see this in the second line in the above chart (closed circle, label: 1/P/1/1/1/1 N = 64). These are men who started using Propecia as soon as they started experiencing hair loss, but they then stopped using the drug for one year and then they started to re-use it. After staying off of Propecia for a year, they had almost as much hair loss as if they never used it at all. Generally, however, you can safely stop taking Propecia for short periods, e.g., a few days to a couple of weeks.
In sum then, while there are some recent concerns about Propecia’s side effects (e.g. see Does Propecia cause or prevent prostate cancer? and What’s the latest word on Propecia (Finasteride) & Sexual Side Effects in Men?), it represents a significant advance in the fight against alopecia related balding. It is most effective in preventing hair loss if you start using it as soon as you start to experience hair loss due to alopecia, but only a qualified hair loss physician can determine if that’s the cause of your hair loss. Finally, if you have alopecia, the rate of hair loss is greater the younger you are when you start to experience symptoms, so it’s especially important to see a qualified hair loss physician as soon as possible.
© 2012, John Frank, M.D.
