Follicle Five

Posted by Sarah Sweetz Akhza On 3:23 AM 0 comments
Check out the Dateline episode featuring The Follicle Five. Surgeonofnalts (Dr. Alan Bauman) makes an appearance, and you can see the difference it made for his patient.

I'd heard buzz about sexual side effects of Propecia (finasteride) and Avodart (both are Rx medications to treat male pattern hairloss), but now a study about the link is getting some serious news (see USAToday).

Reports USAToday: The drugs — prescribed to treat a common urological condition called benign prostatic hyperplasia (BPH) and baldness — work by blocking androgen. In the case of BPH, this helps reduce the enlarged prostate, making urination easier.

But there's a downside. "We need androgen for erectile function, libido and ejaculation, and for just feeling good," said Abdulmaged M. Traish, a professor of biochemistry and urology at Boston University School of Medicine.

No response from Merck (see Propecia FAQ or Merck news), but it takes a while to respond to studies like this. I wouldn't be surprised if there was no response, and GSK's Avodart isn't even indicated for male-pattern hairloss.

The prescribing information on Propecia indicates slightly increased sexual issues relative to placebo (see chart). But, says the PI, "Resolution occurred in men who discontinued therapy with
PROPECIA due to these side effects and in most of those who continued therapy."

Here's the study from "The Journal of Sexual Medicine" (via, and here's an abstract that seems less sensational than the news reports: "Although the adverse side effects of these agents are thought to be minimal, the magnitude of adverse effects on sexual function, gynecomastia, depression, and quality of life remains ill-defined."

The significant update is not the relationship between sexual adverse events, but the longer term impact (after people stop taking the medication). This also is addressed in Proscar's prescribing information (see link), which is finasteride in a 5mg dose to treat prostate.
"Prolonged adverse effects on sexual function such as erectile dysfunction and diminished libido are reported by a subset of men, raising the possibility of a causal relationship."
There's a guy who has devoted a website to this issue, and it's the first Google result if you search Propecia side effects:

Bottom line: every approved drug has benefits that the FDA concludes (at launch) outweigh the risks (or they wouldn't approve it). Some guys care deeply about hair, and are willing to take a chance on the possibility of sexual side effects... which seems rare but possible.

So it's a personal decision of risk versus reward. Hopefully people realize that no hairloss medication radically grows back hair... Rogaine, Propecia and some of the lotions/potions can help hair grow slightly and maybe thicker. However a significant change in appearance is, today, only possible through a hair transplant (in my informed opinion).

Since hair transplant surgeons encourage using Propecia to preserve the patient's hair after a transplant (and it may even help the newly transplanted hair), this will be the group of physicians to watch. If they start shying away from the medications it will be an important cue.

That said, a hair transplant surgeon is not without bias... some sell Propecia and rely on it to cultivate longer term relationships with patients. And then there's this age-old debate: a patient losing more hair is a potential repeat customer. On the other hand, a transplant recipient untreated with Propecia may continue to lose hair. That could look silly: a fortified "front line" and continued male-pattern hairloss behind it) and reflect poorly on the physician. Dr. Rassman has some strong opinions on these matters, and is usually quick to play "devil's advocate" on his "Balding Blog."

Note that while I once marketed Propecia, I'm far from a medical professional... and have no dealings with Merck. These are just my observations reading the same information you can find online.