Hairloss Medication Treatment

A huge amount of internet and media interest has recently focused on claims of persistent sexual side-effects long after discontinuing the use of Propecia (finasteride) hairloss medication. A study published by Irwig in 2011 suggested the occurence of a high incidence of long-term sexual side effects in some Propecia users. It should however be noted that this study wasn't a study of Propecia users in the general population, but a sample of men who already claimed to have long-term side effects. 

Whilst not wishing to cast doubt on these patient claims, I do find them somewhat surprising. In over 14 years of prescribing Propecia/Proscar, to well over 4000 of my patients, I have no reported cases of permanent sexual side-effects. Those few patients who reported these sexual side-effects recovered fully after stopping taking the medication. In most cases recovery occurred within one month, in a couple of cases it was about 2-3 months until full recovery.
A few of recently published medical studies from Japan and Italy support the previously published lower incidence of side-effects and the long term effectiveness of Propecia. The Japanese study  followed 3177 men for 3 years and the Italian study followed 113 men for 10 years. In both studies, over 80% of patients showed long-term growth and stability on the medication without any significant side-effects.

Another factor, which is largely unknown, is that the frequency of sexual side-effects depends upon the dose used. In my care, I have consistently recommended a dosing of a 1mg tablet three times per week for the last fourteen years. This is because Propecia lasts a lot longer than 1 day in your system. In fact, the enzyme is blocked for up to one month! This means that you can maintain the effectiveness of Propecia without having to use it daily. The other great benefit is that, the frequency of sexual, or other side effects, drops dramatically if you only take the tablet every 2-3 days.

I believe that the frequency of patient sexual side effects in my care is approximately 1 per 200 patients on 3 tablets per week and even less frequent on 2 tablets per week. All my patients have fully recovered after stopping therapy. Some of my patients who could not tolerate 3 tablets per week were able to be re-introduced to 2 tablets per week without any side effects.

With regards to depression whilst on Propecia, I have seen this in only a handful of patients. It occurred quickly after starting the medication and resolved quickly upon stopping the Propecia tablets.
In summary, Propecia remains a very effective and safe treatment for male pattern hair loss. Propecia has demonstrated clear superiority compared to other treatments for hair loss and side effects can be significantly reduced with adjusted or lower doses.