Finasteride in Action

The Bald Truth: The First Complete Guide To Preventing And Treating Hair Loss
by Spencer David Kobren

(Page 2 of 3)

When I discovered that Merck was studying their prostate drug Proscar (finasteride) for its baldness prevention and treatment potential, the 1 mg. dose of the drug they would name Propecia was in the second phase of its FDA study. It was 1994, and with the third-phase human trials for efficacy still to come, FDA approval for finasteride's use as Propecia, a drug to prevent and treat hair loss, would be years away.

Although minoxidil had bought me some time (about two years), I was not the best candidate for the drug, so I needed to explore other options, including finasteride, as soon as possible.

I wanted to take finasteride now. But until its approval by the FDA specifically for hair loss, men could only get the drug marketed as Proscar, a 5 mg. pill, for prostate treatment. And if a man didn't have any prostate trouble, he'd have to convince a doctor to prescribe Proscar for him anyway.

I called my hair specialist very excitedly and asked him if he knew about Proscar and its hairsaving side effect. He said that he knew about the drug. When I asked what he thought about it, he told me that if I took the drug at my age (I was almost twenty-nine), I would likely become impotent and eventually take on female characteristics, such as breast enlargement and curvaceous hips. (I discovered later that many physicians were under this misconception and were causing unnecessary worry. It wasn't Proscar but a previous generation of prostate drugs that had these unfortunate "feminizing" side effects among many of the men who took them.)

He affirmed that he provided the only safe and effective antibaldness treatment in the world and that I should stick to his concoction.

Since I enjoyed sex and had no desire to develop a girlish figure, I took his advice. I stuck to his treatment for a few more months. I was still losing my hair. I began to notice that when I went to his office to get my supply of "product" at $90 a pop, there was more and more anti-Proscar literature in his waiting room, photocopied sheets noting only its adverse side effects.

I read some of these and noticed that all of the men who were studied in the original Proscar FDA trials for approval as a prostate drug were over the age of forty. All had enlarged prostates. Chances are that many of them suffered from impotence for reasons having nothing to do with Proscar.

These photocopied sheets listed the possible side effects, and there were only five, including possible lowering of libido, partial impotence, and smaller volume of ejaculant. In about 60 percent of the very few men with these side effects, these symptoms were transient and went away during the course of treatment. (Also, the 5 mg. Proscar pill used in these studies contained five times the amount of finasteride Merck planned to use in its I mg. Propecia pill for the treatment of baldness.) Nothing about the side effects of Proscar mentioned anything about turning into a woman.

The doctor was definitely threatened by the possibility that people could save their hair by popping a pill for far less than the cost of his virtually useless concoction. I stopped using his product and started to research Proscar.

Finasteride is a synthetic compound that specifically inhibits Type II 5-alpha-reductase, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Finasteride, when marketed as a I mg. pill to treat baldness under the brand name Propecia, can decrease DHT concentrations by approximately 60 percent (Proscar's 5 mg. dose decreases DHT by 70 percent).

Contrary to what my hair specialist told me, I discovered that research has shown that in patients being treated with a 5 mg. dose of Proscar during a 12-week period, the hypothalamic pituitary-testicular axis was not affected. In other words, if the patient reacted normally to the drug, he experienced no adverse sexual side effects. Because a balding man now regaining his hair was likely to feel better about his appearance, men taking finasteride might even experience an increase in their libido.

The possibility of experiencing any of the five possible side effects was rare. The antidepressant that my hair specialist wanted me to take (he apparently thought that those not happy about losing their hair should cheer up about it) has sixty-one possible adverse side effects including impotence, ejaculation problems, abnormal bleeding, and, ironically, hair loss. More than 15 percent of the patients treated with this antidepressant drug experienced these adverse side effects. Only 3.7 percent of those taking the 5 mg. Proscar pill experienced any side effects — and sixty percent of those 3.7 percent experienced the side effects only temporarily, and in time they subsided completely. Aspirin has more documented adverse side effects than Proscar. Aspirin's list of side effects includes nausea, loss of blood in the stool, stomach ulcers and bleeding, hives, liver damage, and visual difficulties.

I couldn't understand why so many medical professionals were so anti-Proscar. Their propaganda also raised the fear of possible birth defects in male fetuses if finasteride was passed through sperm, but according to the research the chances of that were practically nil. And a man could always temporarily stop using the drug if he were inclined to impregnate someone, or he could wear a condom to help prevent pregnancy. Women can also rely on their array of birth control methods to prevent pregnancy if their partner is taking finasteride. The bottom line is that these hair specialists knew that a drug as affordable, effective, and low risk as Proscar would take some of the lining out of their pockets. It wouldn't be the first time that professionals in health care — or any other industry — would be resistant to advances that would jeopardize the economic status quo.

I wanted to start treatment with Proscar. I was not about to let someone else control my destiny. I wanted to keep my hair, and I was willing to do anything that I felt was safe.

I called every hair specialist in the nation, trying to get a prescription for Proscar, and almost everyone thought that I was out of my mind. One well-known hair specialist in New York did say that he was supplying some of his patients with the drug. He told me that he had seen some very impressive results. The catch was that he'd only allow his patients to use it in conjunction with his minoxidil concoction. I only wanted the Proscar. But he wouldn't provide it for me unless I used it his way, which would cost around $200 per month for the Proscar pill-minoxidil topical lotion package.

Finally, I asked a physician friend what he thought about prescribing Proscar for male pattern baldness. He looked it up in his Physician's Desk Reference and said that it was worth trying as long as I had some blood tests done and was willing to be tested a few times a year. I agreed, and he gave me a prescription for Proscar.

As one of the very few men outside of Merck's FDA studies to take finasteride to treat hair loss, I felt like some kind of pioneer when I popped that first pill in December 1994. I had a very strong feeling that this was going to help me, and I knew that when it did I would share this information, as well as everything else I was learning about hair loss, with anyone and everyone who needed it.

By early 1995, within two months of starting Proscar, my excessive hair fall-out had ceased. I had no adverse side effects, sexual or otherwise. I had been literally counting hairs and saving them in plastic bags and labeling them to compare weekly counts (C'mon, we've all been there, right?), so I was very aware of what was happening on my head. Before the third month began, the hair count had not only stabilized — I only lost a little each day, just like someone who isn't balding — but hair was growing back, too.

The hair on the sides of my head had become very thin over the years, and I had some recession as well. That hair had now begun to grow back.

Within twelve months, ninety-five percent of my hair was actually growing again. It was still a little thinner than it had been before the onset of male pattern baldness, but I was no longer concerned with losing my hair and the unwanted change in my appearance.

My male pattern baldness had not progressed since I began taking finasteride.

In August 1996, I started the Web site "Major Hair Loss News" (http: Urnernbers. aol. com/ hairman96) in order to share reliable information about the biology of hair loss, treatment options, and other information that consumers may need to stay informed and to protect themselves when dealing with the unregulated hair-loss industry.

The response to the Web site has been both overwhelming and gratifying: During the first year alone, nearly 10,000 men and women contacted me for help, and I supplied them with an information package that included details on finasteride, diet, herbal treatments, hair-transplant surgery, an update on physicians, and other research and practical information, charging only $5.95 to cover printing and postage. I soon realized that this Web site was giving real hope to people who had all but thrown in the towel. I have received calls, letters, and E-mail from people all over the world, and I consult with leading hair-loss experts and researchers.

What began as a personal quest ended up as my life's work: consumer advocacy for the "hair impaired."

I knew what they had been through and were still dealing with. I had been there myself.

Randy from Kansas wrote: "The information that you provided regarding DHT and the substances that can counter it was the first substantive data I've ever received on hair loss and hair growth. I've got to believe that countless other guys around the country, even the world, would benefit greatly from what you have to offer."

I was determined to see to it that those battling hair loss wouldn't have to have that problem compounded by unreliable information, greedy marketers of useless products and damaging procedures, and other abuses.

"My brother is twenty-four years old and has full receding baldness. He is extremely handsome regardless, and yet he has been covering his head with a cap for more than three years," wrote one woman in an E-mail that is representative of the pain and frustration of thousands of others with whom I've been in contact. "He feels so terrible, he doesn't feel like looking at anyone and barely keeps his job because he prefers to miss meetings — so many people would see his head. We love him, but he tries to evade facial contact. I love him, hair or not. I am worried and sad. I've heard on the Net that you have helped a great many people. Can you please help my brother, he is really suffering. I've been in contact with hundreds of men and women who say that the treatments you recommend are the only thing that's helped them. Please help my brother."

I can identify with the pain every time I read a plea like that. I was relieved that I had helped myself, and in turn had been able to help others, but when some of the E-mails and letters began referring to me as the "Hair Messiah," and when the praise for my information and efforts began pouring in along with reports of success with the treatments I'd recommended, I felt a bit strange.

Andres from Argentina wrote: "I am taking finasteride and I am seeing very encouraging results. I think that what you are doing is very important for people who suffer from this problem."

Ken wrote that he hoped my work would "revolutionize the hair industry and take out all the scams and quacks."

Tony kept me posted about his battle with hair loss. After receiving my information package, which included information on finasteride, he said, "I immediately called my doctor. Luckily, she had been my physician for many years, because at first she was rather hesitant to give me a prescription. After thumbing through her [drug] book, she decided that it probably wouldn't hurt to give it a try. She prescribed 5 mg. Proscar with the stipulation that I return for checkups. I am happy to report that I have had NO side effects or adverse reactions as a result of taking Proscar. This sounds kind of over the top, but I would have to say that life has really changed for me. In the past, because of my hair loss, time was my enemy. Every day marked the gradual decline in my looks. As a result of Proscar, I now look forward to the next day, and the day after. After three months I already noticed hair regrowth. The word tomorrow has a much more promising ring to it."

Kevin wrote: "Knowing you're losing your hair is frustrating and heartbreaking. Especially for me because I'm only twenty-three. I noticed my loss when I was about twenty and I thought that there was no way this could be happening to me this young. I used to have nice, thick, wavy hair that I used to think was troublesome. I wish I still had hair like I did back then. I guess you really don't appreciate what you're blessed with until it gradually disappears. Being so young, and still in college, looks are important to me. Unfortunately, I believe my hair loss is affecting my looks and it hurts me very much. I probably wouldn't care if I was sixty years old, but I'm only one-third of that age. I think I've spent way too much time worrying about my condition."

Letters and E-mails like these continue to pour in. You'll read about more of these in our discussion of herbal treatments in Chapter Three.

But before we continue with finasteride's road to FDA approval for marketing as Propecia, here's the story of Brian, whose own road led him to finasteride and herbal treatments after he'd seen my Web site.

"After reading the information you sent me, I wondered how you dealt with the stress over all those years of trying everything. It can really get to you. Now that I'm taking Proscar I have hope," he wrote. "My story started about nine years ago. I know this because I found an old prescription bottle of lotion from my dermatologist. My hair was very slowly thinning, so slowly that I didn't notice it too much."

Brian's doctor had given him this lotion to help treat the tingling and itching he often felt as his hair loss gradually progressed. Of course, it did nothing to stop the hair loss.

"About a year and a half ago, I noticed it looked a little thinner again and I decided to try Rogaine. It was over-the-counter now, so what the heck. Seven months later, it hadn't done much of anything at all for me. I stopped the Rogaine," he continued. "Then my seven-year-old daughter was sitting across the living room from me and said, 'I can see right through your head.' I knew what she meant. If I sit in the car and look in the rear-view mirror, looking at the front of my head, I can see light through the back! I stood in front of the mirror one day and put another mirror in the back of my head. What I saw was the typical upside-down horeshoe pattern starting. The only way I can describe that kind of shock is to imagine being asleep in the middle of the night and waking up and seeing a stranger at the foot of your bed. Kind of like watching a horror movie or something. The shock just hits you. You start to notice people talking to you, but looking at your head."

After learning about finasteride, Brian went back to his dermatologist.

"I asked him what kind of treatments were new since I saw him years ago, and he said I should try Rogaine. I told him, 'That won't work for me and my level of hair loss. How about Proscar?' He said he would be going to a conference in the fall and would let me know let me know what he thought after that. But what if I waited that few months, and then he still wouldn't let me try it? Then I've wasted a few more months. Doctors don't look at this as a real medical problem. They shrug it off. That is, of course, the ones who aren't making money off of it. I recently got an E-mail from one of the Rogaine/Retin-A doctors. He strongly suggests not using Proscar. Of course he does. He's trying to sell his product. So many people just take this problem for granted and accept it. I don't accept things easily. I am amazed at all the sites on the Internet that sell hair-promoting shampoos, vitamins, herbal liquids, and they aren't cheap. I've used some really bad-smelling brown herbal liquid stuff on my head that came in a small, cheap, plastic bottle with a label glued to it made on a copy machine. I've paid for information telling me about Thymu-Skin. I've seen videos advertised on the Internet for two hundred bucks that will teach you how to massage your head back to healthy hair. Of course, in my search, I read a lot about 5-alpha-reductase and DHT, and so I started to research this more because it made sense. I finally came to your Web site, which was describing what I was going through. After getting all of your information, and talking to you on the phone, I realized that I had found someone out there who really wants to help."

Now taking finasteride and herbs, Brian is experiencing less hair fall-out and gradual hair regrowth.

Copyright © 1998 by Spencer David Kobren

About the Author

Spencer David Kobren is the country's most prominent and effective hair loss consumer/patient advocate, and the Founder and Director of The Bald Truth Foundation, the only organization dedicated to consumer advocacy, education and funding research regarding hair loss.