Help me make an informed decision on using Propecia.
July 17, 2012 1:42 PM Subscribe
After much research on side effects and talking with my doctor, I am close to trying Propecia for my male-pattern hair loss. However, I still have some reservations. Help me make an informed decision.
I am 31, and this is a decision I've been grappling with for about four years. I had been using Rogaine throughout that period, but found it became less effective over time and caused side effects of its own, so I stopped using it earlier this year. Since then, I've had a considerable amount of thinning in the front of my scalp, and from the looks of it I could be fully bald on top in the near future. I've since cropped my hair short, and on one level I am OK with losing it all, but that's not what I'm asking about here (I've read other ask mefi threads on that topic).
At first I was very hesitant to use Propecia after reading about persistent sexual side effects and gynecomastia. And fundamentally, screwing around with the body's hormones sounds like a bad idea. My dermatologist has admitted there have been reported cases of persistent sexual side effects (as the labeling now reflects), but that none of his patients have experienced it. He was still somewhat dismissive of reports to the contrary, and on some level I have difficulty fully trusting the word of doctors when it comes to medications, given that drug companies have ways of influencing them.
According to the latest FDA update:
Only a small percentage of men using these drugs have experienced a sexual adverse event. The frequency of sexual adverse events is best obtained from controlled clinical trials. Analysis of these controlled clinical trials showed that during treatment with Propecia, 36 (3.8%) of 945 men had reported one or more adverse sexual experiences as compared to 20 (2.1%) of 934 men who did not receive Propecia (received placebo).
If those numbers are to be believed, the risk is one I am willing to take.
However, the same report also states the following:
FDA reviewed 421 postmarketing reports of sexual dysfunction submitted to the Agency’s Adverse Events Reporting System (AERS) database between 1998 and 2011. Of these, 59 cases reported sexual dysfunction that lasted for at least three months following discontinuation of Propecia, and included erectile dysfunction, decreased libido, problems with ejaculation and orgasm disorders.
So, I've talked to my doctor, and I've done much research on the topic. Ultimately, responsibility for my health rests with me. At present I believe I am willing to take the risk and move forward with trying the medication.
Is there anything I'm missing? How else might I go about evaluating this decision?
I am 31, and this is a decision I've been grappling with for about four years. I had been using Rogaine throughout that period, but found it became less effective over time and caused side effects of its own, so I stopped using it earlier this year. Since then, I've had a considerable amount of thinning in the front of my scalp, and from the looks of it I could be fully bald on top in the near future. I've since cropped my hair short, and on one level I am OK with losing it all, but that's not what I'm asking about here (I've read other ask mefi threads on that topic).
At first I was very hesitant to use Propecia after reading about persistent sexual side effects and gynecomastia. And fundamentally, screwing around with the body's hormones sounds like a bad idea. My dermatologist has admitted there have been reported cases of persistent sexual side effects (as the labeling now reflects), but that none of his patients have experienced it. He was still somewhat dismissive of reports to the contrary, and on some level I have difficulty fully trusting the word of doctors when it comes to medications, given that drug companies have ways of influencing them.
According to the latest FDA update:
Only a small percentage of men using these drugs have experienced a sexual adverse event. The frequency of sexual adverse events is best obtained from controlled clinical trials. Analysis of these controlled clinical trials showed that during treatment with Propecia, 36 (3.8%) of 945 men had reported one or more adverse sexual experiences as compared to 20 (2.1%) of 934 men who did not receive Propecia (received placebo).
If those numbers are to be believed, the risk is one I am willing to take.
However, the same report also states the following:
FDA reviewed 421 postmarketing reports of sexual dysfunction submitted to the Agency’s Adverse Events Reporting System (AERS) database between 1998 and 2011. Of these, 59 cases reported sexual dysfunction that lasted for at least three months following discontinuation of Propecia, and included erectile dysfunction, decreased libido, problems with ejaculation and orgasm disorders.
So, I've talked to my doctor, and I've done much research on the topic. Ultimately, responsibility for my health rests with me. At present I believe I am willing to take the risk and move forward with trying the medication.
Is there anything I'm missing? How else might I go about evaluating this decision?
...just to make sure you're not making a Faustian bargain.
posted by griphus at 1:50 PM on July 17, 2012
posted by griphus at 1:50 PM on July 17, 2012
Is it possible to talk with a urologist about their experience with this issue, and their recommendations?
posted by Sidhedevil at 1:54 PM on July 17, 2012
posted by Sidhedevil at 1:54 PM on July 17, 2012
Anecdata: I've been taking Propecia (finasteride) for 10 years with zero, absolutely zero, issues. Started when I was 25. My dad was completely bald at 35, whereas I have all my hair.
1mg of finasteride, which is what you'll take for hair loss, is a really low dose. The dosing for enlarged prostate is 5mg, and even at that dose, most people tolerate it well and have no side effects.
posted by killdevil at 1:58 PM on July 17, 2012
1mg of finasteride, which is what you'll take for hair loss, is a really low dose. The dosing for enlarged prostate is 5mg, and even at that dose, most people tolerate it well and have no side effects.
posted by killdevil at 1:58 PM on July 17, 2012
As an aside, if you want to save money, ask your doctor to prescribe Proscar, the finasteride formulation for prostate issues. It's on the $4 generic list whereas Propecia has no generic in the United States and costs like $80 a month. You can then just break the tablets into pieces for a smaller dose.
posted by killdevil at 2:00 PM on July 17, 2012 [3 favorites]
posted by killdevil at 2:00 PM on July 17, 2012 [3 favorites]
Only a small percentage of men using these drugs have experienced a sexual adverse event...
...However, the same report also states the following...
...FDA reviewed 421 postmarketing reports of sexual dysfunction submitted to the Agency’s Adverse Events Reporting System (AERS) database between 1998 and 2011.
I'm not sure I see a contradiction here. Presumably many thousands of men used the drug during those years, and a "small percentage of them" experienced a sexual side effect. Frankly, I'd be suspicious of any self-reporting of sexual side-effects, as men are both hyper-sensitive to changes in that department, which might lead to some psychosomatic false positives, but are also often embarrassed about those types of problems, leading to under-reporting.
I'm losing my hair too, but I wouldn't trade a full head of hair for even a teeny risk of persistent sexual dysfunction.
posted by Rock Steady at 2:02 PM on July 17, 2012 [1 favorite]
...However, the same report also states the following...
...FDA reviewed 421 postmarketing reports of sexual dysfunction submitted to the Agency’s Adverse Events Reporting System (AERS) database between 1998 and 2011.
I'm not sure I see a contradiction here. Presumably many thousands of men used the drug during those years, and a "small percentage of them" experienced a sexual side effect. Frankly, I'd be suspicious of any self-reporting of sexual side-effects, as men are both hyper-sensitive to changes in that department, which might lead to some psychosomatic false positives, but are also often embarrassed about those types of problems, leading to under-reporting.
I'm losing my hair too, but I wouldn't trade a full head of hair for even a teeny risk of persistent sexual dysfunction.
posted by Rock Steady at 2:02 PM on July 17, 2012 [1 favorite]
Just wanted to say I'll be watching this thread closely because I'm working through the exact same decision. I've had the buzz cut at various times in my life but never thought it looked nearly as good on me as a full head of hair, especially as I get older. I also dye my hair (going gray) and I think that's harder to maintain if I go the stubble route on top. I'm not very far down the bald path yet, but over the past few months I've noticed much more thinning and recession and see the handwriting on the wall.
One observation occurred to me in reading all the stuff on forums. . .I think a lot of guys encounter declines in their sex drive as they get older. I wonder how many people who report those side effects attribute them to the drug instead of normal fluctuations in their sex drive?
posted by minorcadence at 2:14 PM on July 17, 2012 [1 favorite]
One observation occurred to me in reading all the stuff on forums. . .I think a lot of guys encounter declines in their sex drive as they get older. I wonder how many people who report those side effects attribute them to the drug instead of normal fluctuations in their sex drive?
posted by minorcadence at 2:14 PM on July 17, 2012 [1 favorite]
For me, even a 4 percent risk of sexual side effects would be too much. My hair is (slowly) disappearing and I guess it just doesn't bother me that much, other than being easy to get a scalp sunburn if I don't wear a hat. I guess for me the bottom line is that hair does not seem to be a deal breaker for most people, but sexual dysfunction definitely is, which makes that a bad bargain.
posted by Forktine at 2:29 PM on July 17, 2012 [1 favorite]
posted by Forktine at 2:29 PM on July 17, 2012 [1 favorite]
I found out about Post-Finasteride Syndrome by reading a Reddit Ask Me Anything post by a young man who had the rare and permanent side effect that is now being reported by the manufacturer/FDA (Reddit AMeA). I would not trade permanent loss of my libido and sexual function for hair. This syndrome is scary because, although it is rare, it seems to be permanent and currently untreatable.
posted by quince at 2:40 PM on July 17, 2012
posted by quince at 2:40 PM on July 17, 2012
Fuhgedaboudit. God made only a few perfect heads. The rest He covered with hair.
posted by KRS at 6:42 AM on July 18, 2012 [1 favorite]
posted by KRS at 6:42 AM on July 18, 2012 [1 favorite]
Propecia is pretty effective at halting the hair loss, although you are quite unlikely to grow any new hair. You will have to take it for life if you want to keep the hair.
I'm 36. I yutzed around with Rogaine and Propecia for a while in the late 20s and early 30s, telling myself that I'd shave it all off one day. This went on for a while until I decided that "one day" wasn't going to get here on its own, so I bought a pair of clippers on the way home from work and shaved my head that day. That was four years ago last week and I haven't looked back.
Shave your head and give it 30 days to see how you like it. If not, what hair you have will grow back.
posted by Tanizaki at 9:13 AM on July 18, 2012 [1 favorite]
I'm 36. I yutzed around with Rogaine and Propecia for a while in the late 20s and early 30s, telling myself that I'd shave it all off one day. This went on for a while until I decided that "one day" wasn't going to get here on its own, so I bought a pair of clippers on the way home from work and shaved my head that day. That was four years ago last week and I haven't looked back.
Shave your head and give it 30 days to see how you like it. If not, what hair you have will grow back.
posted by Tanizaki at 9:13 AM on July 18, 2012 [1 favorite]
As a bald guy, I just want to chime in that bald works (and works well), unless you have some kind of crazy shaped head (and that does happen, for sure). I went from 18" locks, to shortly shorn, to Bic-tastic, in about 18 months.
I don't have any experience with Propecia, but I would also chime in that I'd rather be cueball-bald, as I am now, than chance permanent sexual dysfunction. It's just hair, man.
As Tanizaki said, you're not going to grow back new hair; unless you've managed to halt the loss at a reasonable place, are you really doing yourself much good? I personally love being where I'm at, hair-wise, now (and I loved having long hair). Low maintenance, and one less thing to worry about for current styles.
posted by liquado at 10:22 PM on July 18, 2012 [1 favorite]
I don't have any experience with Propecia, but I would also chime in that I'd rather be cueball-bald, as I am now, than chance permanent sexual dysfunction. It's just hair, man.
As Tanizaki said, you're not going to grow back new hair; unless you've managed to halt the loss at a reasonable place, are you really doing yourself much good? I personally love being where I'm at, hair-wise, now (and I loved having long hair). Low maintenance, and one less thing to worry about for current styles.
posted by liquado at 10:22 PM on July 18, 2012 [1 favorite]
Response by poster: For anyone still reading: thanks for the insightful responses.
Regarding the comments that Propecia will not result in new hair growth, I would point out that this is contrary to many clinical studies and anecdotal reports. For the sake of time, I'll quote the Wikipedia page on Finasteride:
In a 5-year study of men with mild to moderate hair loss, 2 out of 3 of the men who took 1 mg of finasteride daily regrew some hair, as measured by hair counts. In contrast, all of the men in the study who were not taking finasteride lost hair. In the same study, based on photographs that were reviewed by an independent panel of dermatologists, 48% of those treated with finasteride experienced visible regrowth of hair, and a further 42% had no further loss.
I spoke with my dermatologist on this point, and he said he has seen new growth from Propecia in a number of his patients but it is largely dependent on patient age and stage of hair loss.
In any case, to liquado's point, I would still be happy keeping the hair I have left versus losing it. Since posting, I have started a regimen of finasteride 1.25mg every other day. If anyone is curious about my progress, feel free to PM me.
posted by iamisaid at 2:16 PM on July 23, 2012 [1 favorite]
Regarding the comments that Propecia will not result in new hair growth, I would point out that this is contrary to many clinical studies and anecdotal reports. For the sake of time, I'll quote the Wikipedia page on Finasteride:
In a 5-year study of men with mild to moderate hair loss, 2 out of 3 of the men who took 1 mg of finasteride daily regrew some hair, as measured by hair counts. In contrast, all of the men in the study who were not taking finasteride lost hair. In the same study, based on photographs that were reviewed by an independent panel of dermatologists, 48% of those treated with finasteride experienced visible regrowth of hair, and a further 42% had no further loss.
I spoke with my dermatologist on this point, and he said he has seen new growth from Propecia in a number of his patients but it is largely dependent on patient age and stage of hair loss.
In any case, to liquado's point, I would still be happy keeping the hair I have left versus losing it. Since posting, I have started a regimen of finasteride 1.25mg every other day. If anyone is curious about my progress, feel free to PM me.
posted by iamisaid at 2:16 PM on July 23, 2012 [1 favorite]
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posted by griphus at 1:50 PM on July 17, 2012