A little more on the top; baldness pills; Evaluation
September, 1998
How much hair can a baldness pill grow if a baldness pill can grow hair?
About nine months have passed since Propecia, the first and only pill created to treat male pattern baldness, was approved for sale in the United States. High time, we thought, to find out just how much hair the drug is actually capable of germinating.
The short answer, we discovered, is...some. If you've already lost a significant amount of hair, Propecia won't cause any pressing need to go out and buy a blow-dryer. Even in ideal circumstances, it can't transform a Bruce Willis dome into a Michael Douglas mane. If, however, you're only beginning to go bald, the drug is very likely to halt, or significantly slow, your hair loss, say dermatologists who have been prescribing Propecia. "About 90 percent of my patients on Propecia have stopped losing their hair," says Ken Washenik, M.D., Ph.D., director of dermato-pharmacology at the New York University medical center. The drug's maker, Merck, found similar results in its tests.
In case you haven't been following the Propecia story (in which case you probably have a full head of hair, you lucky dog), the pill is a 1 milligram version of finasteride. Merck has sold the drug since 1992 as Proscar, to treat enlarged prostates. Finasteride decreases the body's amount of dihydrotestosterone (DHT), a male hormone that apparently encourages prostate tissue growth and baldness. Without a steady supply of DHT, your hair follicles stop dying, and a few may even resume sprouting hair.
So far, indications are that about two-thirds of the men who take Propecia regrow some hair. It's not much; the photo at right shows typical regrowth.
"My results have been almost too slight to notice," says Bob, 46, an Anthony Edwards look-alike who's been taking Proscar since mid-1997. "My wife noticed that my bald spot was filling in slightly, mostly in the form of peach fuzz. But I assume the drug is preventing further loss, and I want to hold on to what I have until the real cure comes along."
That seems to be the right way to approach taking Propecia. "If your goal is to regrow your hair, you'll probably be disappointed," says George Cotsarelis, PAGE 3 Men's Health September, 1998
M.D., director of the hair and scalp clinic at the University of Pennsylvania. Like Rogaine (the nonprescription minoxidil spray), Propecia works best on younger, newly balding men who still have a lot of hair to save. But even many of them aren't completely satisfied.
"Honestly, I expected better results," says Jeff, a 22-year-old from Baltimore who's been using Propecia for eight months. "But if knowing that I'm doing something instead of just complaining about it makes it worthwhile."
At this point, there's no way to predict what Propecia will do for you, but you'll know fairly soon after you start taking it. "If you're going to see any regrowth of hair at all, it'll happen within a year," says Dr. Washenik. "Men who stop using Propecia before that point may be giving up prematurely." If Propecia doesn't regrow any hair after a year, he adds, "you have to ask yourself if keeping your hair is worth $ 50 per month."
Another shortcoming shared by both Propecia and Rogaine is that while they may slightly thicken your front tuft, they work best on bald spots at the back of the head.
If you're losing hair at the temples, the odds of either drug producing noticeable results are slight. Why? Your frontal hairline responds to male hormones differently, explains Dr. Washenik.
These hairs often fall out rather quickly; the hair on your crown and the center of your scalp usually takes years to thin. "Every man still has a certain number of salvageable hairs in these areas," says Dr. Washenik. "But the hair at the temples and forehead is usually not salvageable. We don't know why."
To keep their edge in the hair-loss marketplace, the makers of Rogaine recently introduced an "extra-strength" version of the spray, which contains more than twice the concentration of minoxidil of the original and costs about the same--$ 30 or so for a month's supply. The company's studies on 825 men have shown that the stronger solution produces 45 percent more hair growth and works a bit faster than the 2 percent solution.
"The 5 percent minoxidil solution is definitely more effective than the 2 percent, and I've seen it foster more frontal hair growth," says John Romano, M.D., dermatologist at the Cornell Medical Center in New York. The photos above show "moderate regrowth" after four months, a result Rogaine's makers claim one in three men can achieve. It took Karl Malone six months to grow the new hair he sports in the Rogaine ads, but only about 5 percent of men can hope for even his success, says Dr. Cotsarelis.
The most effective--if not cheapest--strategy may be to use Rogaine and Propecia simultaneously. Because one reduces baldness hormones and the other stimulates hair follicles, these drugs seem to complement each other well.
"The combination appears to work better than using either Propecia or Rogaine alone," agrees Ronald Savin, M.D., clinical professor of dermatology at Yale University. "Instead of seeing moderate regrowth in one-third of my Propecia users, I believe that adding Rogaine is pushing the success rate to two-thirds. It's my own subjective opinion, but it's a strong one." PAGE 4 Men's Health September, 1998.
There's no clinical proof, though, since no dual studies of the two drugs have taken place. Like stubborn competitors unwilling to share the market, both companies say no such research is planned.
If you start using Rogaine, you my lose more hair during the first month, says Dr. Washenik. Minoxidil purges hairs that are naturally preparing to fall out, exposing more scalp and no doubt scaring the hell out of lots of users. The accelerated shedding is temporary, and usually stops in a few weeks, he explains. "Take it as a sign that the minoxidil is working."
Some men may be staying away from Propecia because they've read about two side effects that arose in Merck's studies: Finasteride caused erection problems in 1.3 percent of subjects, and it caused birth defects when given to pregnant animals. Male fetuses need DHT to develop genitals, so some doctors warned men to stop using Propecia for three months before trying to conceive a child, and the Propecia label warns that pregnant women shouldn't even touch the pills.
Take a closer look, however, and there may not be much to worry about. The erection problems also occurred in 0.7 percent of the placebo group, "so you're talking about a minuscule difference," says Marry Sawaya, M.D., Ph.D., principal investigator at Aratec, a Florida foundation that conducts hair research. "In my practice, I've never had a patient on Propecia complain about this."
Also, several dermatologists acknowledge that the birth-defect cautions are probably worded a bit strongly. According to Dr. Sawaya, your wife would have to be exposed to a large number of crushed tablets every day to absorb enough finasteride through her skin to harm your unborn child. And you'd have to ejaculate "several buckets' worth" of semen--regularly--to endanger his development. If you can do that, don't complain about losing your hair.
One little-known side effect does concern some doctors. There's no doubt that Propecia can slightly decrease your PSA results during a prostate-cancer test. Since skewed results may mask a possible problem, men should always remind their testing doctor that they're taking it.
Other than these rare problems, taking a daily milligram of Propecia seems relatively harmless. "The 10-year data on finasteride show it's very safe," says Dr. Cotsarelis. The prospect of a man taking Propecia "forever" is unsettling to him, but that's not likely. "My hope is, there will be a better treatment soon."
And indeed, at least 70 new baldness drugs are being researched right now, says Dr. Sawaya, and half of the big medical firms are working on hair-growing potions. (After all, the potential market is huge; there are at least 25 million balding men in the United States alone.) If the clinical trials are successful, several new drugs may surface in the next few years. They'll fit into two categories: follicle-stimulators like minoxidil, and hormone-inhibitors like finasteride.
Currently the most promising candidate is a DHT-blocking pill being researched at Glaxo-Wellcome. Early reports are that it blocks 99 percent of the hormone in men, versus about 66 percent for Propecia. Glaxo-Wellcome is keeping the drug research low-key, possibly so they don't irk the FDA by creating false hopes--or so they don't receive a phone assault from desperate, balding men. PAGE 5 Men's Health September, 1998
"This drug may not work better than Propecia," cautions Dr. Romano. "Blocking all of the DHT might not be necessary to reverse balding." The mystery pill is currently in Phase II studies in sites around the country, says Dr. Sawaya. If it's proven safe, it may be available in about five years. We'll keep you posted.
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