Hair Transplant Blog - The Knudsen Clinic

Category: Propecia (Finasteride)

Hair Loss Treatment with Generics?

Posted on 03 Mar, 2015

Are generic prescription drugs as effective for the treatment of hair loss as the original ones?

 

In recent years generic versions of finasteride and minoxidil have come into the marketplace. Generics appear when the patent period (typically 15 years) expires for the original company that process/markets a new drug. They are often made in the same facility as the original drug but are generally made by a respected manufacturer in a certified facility. It is worth noting that purchasing generics from overseas manufacturers does not always offer this protection.

 

The attractive feature of generics is their price as it is usually significantly lower. This reflects the fact that they did not do the original research which is very expensive. Generally speaking, the generics are well produced with equivalent effectiveness compared to the original. Compounding chemists also make variations on original products but the addition of other ingredients is not necessarily helpful.

 

Many minoxidil hair loss treatment lotions add ingredients such as azelaic acid and retinoic acid. There is NO evidence this increases the effectiveness of minoxidil. Indeed, there is NO evidence that any strength of minoxidil greater than 5% adds to effectiveness.

Hair Loss Treatment Confusion

Posted on 10 Nov, 2014

Much confusion surrounds the difference between topical hair loss products (applied directly to the scalp) and internal products (taken by mouth). They both can be effective in managing hair loss but are NOT equivalent when trying to block the male hormone DHT.

 

DHT is produced in both hair follicle and the liver. If a topical product is aimed at the scalp hair follicle it will likely be less effective than oral blocking as the liver supplies DHT directly to the follicle via the blood. This is why finasteride needs to be taken orally to give the best effect.

 

In men with male pattern balding the oral use of blockers (e.g. finasteride) has proven to be far superior to the use of topical stimulants (e.g. minoxidil or laser). That said they can be successfully used together to produce even better results as they act in different areas.

 

For male pattern balding, effective therapy begins with a medical doctor

Finasteride and Prostate Cancer

Posted on 09 Sep, 2013

A long-running study of men in the USA with enlarged non-cancerous prostates (benign prostatic hyperplasia – BPH) using finasteride previously reported a 25% reduction in overall numbers of patients developing prostate cancer. However, there was some debate about whether the prostate cancers detected in users of finasteride were of the more aggressive variety. A recent analysis of this study showed that finasteride users had lower levels of the prostate cancer screening test PSA (prostate specific antigen) which led to more accurate diagnosis of those patients actually suffering cancer rather than just an enlarged prostate. In addition, the smaller prostates made tumour detection easier by biopsy.

 

Overall, men taking finasteride were 30% less likely to be diagnosed with prostate cancer and 43% less likely to get a diagnosis of low-grade cancer (slow growing). In addition, survival rates were not changed in patients taking finasteride compared to those not on finasteride.This is very reassuring news to patients taking finasteride for hair loss as these prostate effects are beneficial rather than harmful and will likely result in less unnecessary surgical treatment of prostate enlargement in future. We can reassure patients talking finasteride that there are no harmful long-term effects on the prostate from treating their hair loss.

The ongoing Finasteride debate

Posted on 03 Dec, 2012

Recently an international conference heard an in-depth panel discussion about Finasteride and sexual side-effects. It was again emphasized that Finasteride is a safe medication, side-effects were largely dose-related and disappeared upon stopping the medication. It was felt that recently media reports about the incidence and severity of side-effects was significantly overstated and that it remained the medication of choice for treating male pattern hair loss. In my hands, side effects are quite uncommon and only a small intermittent dose of Finasteride is required to achieve long-term stability of the hair loss in most balding men.

New Medication to treat pattern hair loss

Posted on 26 Nov, 2012

The recent Annual meeting of the International Society of Hair restoration Surgery saw discussion of upcoming medications to treat male pattern hair loss. In particular we were intrigued to understand that different versions of prostaglandins (chemicals involved in inflammation) have opposite effects on hair growth! Some prostaglandins have recently been shown to inhibit hair growth, whereas others are well known to stimulate hair growth. Perhaps the most exciting part of the research is that some medications currently being developed to treat asthma via inhibiting specific prostaglandins could have an unexpected benefit in stimulating hair regrowth in balding males. These new compounds are still a couple of years away but may turn out to be the next generation of medicines that positively affect balding.

Hairloss Treatment Medication

Posted on 16 Mar, 2012

A large 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 occurrence a high incidence of long-term sexual side effects in some Propecia users. It should however be noted that this study was not a study of Propecia users in the general population, but a sample of men already claiming to have long-term side effects.

While 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 case of permanent sexual side-effects. Those few patients who reported these side-effects recovered fully after stopping taking the medication. In most cases recovery occurred within 4 weeks, in a couple of cases it was about 2-3 months until full recovery. A couple 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 by Sato followed 3177 men for 3 years and the Italian study by Rossi followed 113 men for 10 years. In both studies, over 80% of patients show long-term growth and stability on the medication without any significant side-effects.

Another factor,  largely unknown, is that the frequency of sexual side-effects depends upon the dose used. In my hands, I have consistently recommended a dosing of a 1 mg tablet three times a week for the last fourteen years. This is because Propecia lasts much longer than 1 day in your system. In fact, the enzyme is blocked for up to 1 month! This means that you can maintain the effectiveness of Propecia without having to use it every day. 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 my frequency of patient sexual side effects 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 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 altered mood (depression) whilst on Propecia, I have seen this in a handful of patients. It occurred quickly after starting the medication and resolved quickly on stopping the Propecia tablets. In summary, Propecia remains a very effective and also very safe treatment for male pattern hairloss. It has demonstrated clear superiority compared to other treatments for hairloss and side effects can be significantly reduced with adjusted or lower doses.