By Dr. John Frank, M.D. – IAHRS, ABHRS,ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, September 22, 2011
That’s what most hair loss sufferers are asking themselves if they’ve been following recent news headlines about the side effects of Propecia and it’s relation to prostate cancer. For example:
- Large, long-term study shows dutasteride (Propecia) reduced prostate cancer risk in men at increased risk of the disease
- FDA Drug Safety Communication: 5-alpha reductase inhibitors (Propecia) may increase the risk of a more serious form of prostate cancer
It turns out the answer is an uncomfortable yes and no.
What’s Known About Propecia & Prostate Cancer
Merck & Co., Inc. first developed a drug called Finasteride, one of the 5-alpha reductase inhibitors targeted in the above “FDA Drug Safety Communication,” to treat prostate enlargement. Because Finasteride works by its inhibition of the male hormones, e.g., testosterone, it turned out to be a surprisingly effective treatment for hair loss. It was so successful, Merck converted Finasteride into a commercial product for the treatment of hair loss. They called this product Propecia.
At the same time, intense research began on 5-alpha reductase inhibitors’ possible beneficial effects on prostate cancer. Researchers found that this class of drug significantly decreased the likelihood in men of developing the disease – see:
Effect of Dutasteride on the Risk of Prostate Cancer (Dutasteride is in the same class of drugs as Propecia)
Studies Make Case for Finasteride (Propecia) to Prevent Prostate Cancer
A wrinkle, however, soon appeared. While most of the studies showed an overall reduction in the risk of developing prostate cancer, almost all the risk reduction was for less aggressive forms of the disease. Disturbingly, this same class of drugs simultaneously appeared to increase the incidence of high-grade prostate cancer.
These results prompted the U.S. Food and Drug Administration (FDA) to issue guidelines to healthcare professionals on June 9th of this year (2011) about the inclusion in the Warnings and Precautions section of the labels for the 5-alpha reductase inhibitor class of drugs, including Propecia, about the increased risk of being diagnosed with a more serious form of prostate cancer, i.e., high-grade prostate cancer.
Are You At Risk? Are You Taking or Thinking of Taking Propecia?
These studies underscore that all prescription drugs have side effects, some of them quite serious (albeit at low risk). It also underscores the importance of having a qualified, highly trained doctor as one’s hair transplant surgeon, one that can work with your primary doctor or specialist.
While Finasteride for hair growth is only a fraction of the dose used for prostate CA (1 mg vs 5 mg), it is commonly known that it retains a similar side effect profile independent of the dosage. Obviously men with prostate cancer who are taking a 5 mg dose are willing to accept the possible side effects of the decreased sexual response. A hair loss sufferer may not be willing to accept such a side effect.
A more serious side effect of the 5 mg dose is that although the total number of prostate cancers is lower, the cancers that did arise were a more aggressive type.
These results are still somewhat controversial in the research community. Plus, the studies were performed with Proscar at a 5 mg dose and not the lower 1 mg Propecia dose. Still, even with a 1 mg dose there are reports of a higher than published sexual side effect profile as well as gynecomastia (enlarged male breasts).
What’s the bottom line? Despite all the debate and uncertainty, men with hair loss are still extremely anxious to find, and try, any reasonable solution. While Propecia does have a “natural look” outcome advantage in the case of mild hair loss, hair restoration specalists and researchers are continuaully refining surgical hair transplant techniques. Today the gap between surgical hair transplant outcomes and those that can be achieved by Propecia is rapidly closing.
© 2012, John Frank, M.D.
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