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What are the pros and cons of finasteride (sold as Propecia) and minoxidil (sold as Rogaine) for hair loss?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Any consumer looking on the Internet for a treatment for hair loss is exposed to a multitude of remedies.” However, we only have good evidence for efficacy for the FDA-approved drugs: finasteride, sold as Propecia, and minoxidil, sold as Rogaine. It’s considered a myth that all the patented hair-loss supplements on the market will increase hair growth. And they may actually be more expensive, with over-the-counter supplement regimens costing up to more than $1,000 a year, whereas the drugs may cost only $100 to $300 a year. The drugs can help, but can cause side effects. The Propecia can diminish libido and cause sexual disfunction, while the topical Minoxidil can cause itching. (Though I believe this a typo for scaling—much better than scalping.)

Here’s a more comprehensive list of the more common side effects. To understand why there are so many hormonal side effects for Propecia, like impotence, testicular pain, and breast enlargement, you have to understand how the drug works.

Androgens––male hormones like testosterone––are the principal drivers of hair growth in both men and women. We know this from studies a half century ago that show that castration of men stopped hair loss. Why exactly were they being castrated? It was due to eugenics laws in the United States, when mentally handicapped persons were castrated or had their tubes tied against their will. So-called retarded persons were routinely sterilized without their consent or knowledge and we, the United States of America, were the first country to introduce eugenic laws, which were later upheld by the U.S. Supreme Court. In the 1930s, a vocal proponent complained that “The Germans are beating us at our own game.”

Anyway, testosterone is the primary androgen circulating in the blood, and can be converted to dihydrotestosterone, which is even more powerful by an enzyme called 5-alpha reductase. That’s the enzyme that is blocked by Propecia, so it inhibits the souping up of testosterone. That’s why women are not supposed to take it––since it could feminize male fetuses, whereas for men, it has the sexual side effects like erectile dysfunction, which can affect men for years. It’s something the drug companies had to disclose for the last decade: “a difficulty in achieving an erection that continues after stopping the medication”––side effects that may even be permanent. Up to 20 percent of subjects reporting persistent sexual dysfunction for six or more years after stopping the drug, suggesting the possibility that it may never go away.

What we think might be happening is that the drug may actually structurally change the part of your brain responsible for sexual function. And indeed, though blood levels of hormones in users with persistent effects appear normal, if you do a spinal tap and look at the cerebrospinal fluid surrounding their brains, neurosteroid levels do appear to end up being altered. So, “[i]t is recommended that prescribers of finasteride, as well as potential users, be aware of the potential serious long-term risks of a medication used for a cosmetic purpose.”

To date, no new interventions are used routinely in the treatment of male or female pattern baldness. Given the side effects of the current drug options, there is a need for alternative treatments. So, what about foods? Things we could eat to combat hair loss. That’s exactly what we’re going to explore next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Any consumer looking on the Internet for a treatment for hair loss is exposed to a multitude of remedies.” However, we only have good evidence for efficacy for the FDA-approved drugs: finasteride, sold as Propecia, and minoxidil, sold as Rogaine. It’s considered a myth that all the patented hair-loss supplements on the market will increase hair growth. And they may actually be more expensive, with over-the-counter supplement regimens costing up to more than $1,000 a year, whereas the drugs may cost only $100 to $300 a year. The drugs can help, but can cause side effects. The Propecia can diminish libido and cause sexual disfunction, while the topical Minoxidil can cause itching. (Though I believe this a typo for scaling—much better than scalping.)

Here’s a more comprehensive list of the more common side effects. To understand why there are so many hormonal side effects for Propecia, like impotence, testicular pain, and breast enlargement, you have to understand how the drug works.

Androgens––male hormones like testosterone––are the principal drivers of hair growth in both men and women. We know this from studies a half century ago that show that castration of men stopped hair loss. Why exactly were they being castrated? It was due to eugenics laws in the United States, when mentally handicapped persons were castrated or had their tubes tied against their will. So-called retarded persons were routinely sterilized without their consent or knowledge and we, the United States of America, were the first country to introduce eugenic laws, which were later upheld by the U.S. Supreme Court. In the 1930s, a vocal proponent complained that “The Germans are beating us at our own game.”

Anyway, testosterone is the primary androgen circulating in the blood, and can be converted to dihydrotestosterone, which is even more powerful by an enzyme called 5-alpha reductase. That’s the enzyme that is blocked by Propecia, so it inhibits the souping up of testosterone. That’s why women are not supposed to take it––since it could feminize male fetuses, whereas for men, it has the sexual side effects like erectile dysfunction, which can affect men for years. It’s something the drug companies had to disclose for the last decade: “a difficulty in achieving an erection that continues after stopping the medication”––side effects that may even be permanent. Up to 20 percent of subjects reporting persistent sexual dysfunction for six or more years after stopping the drug, suggesting the possibility that it may never go away.

What we think might be happening is that the drug may actually structurally change the part of your brain responsible for sexual function. And indeed, though blood levels of hormones in users with persistent effects appear normal, if you do a spinal tap and look at the cerebrospinal fluid surrounding their brains, neurosteroid levels do appear to end up being altered. So, “[i]t is recommended that prescribers of finasteride, as well as potential users, be aware of the potential serious long-term risks of a medication used for a cosmetic purpose.”

To date, no new interventions are used routinely in the treatment of male or female pattern baldness. Given the side effects of the current drug options, there is a need for alternative treatments. So, what about foods? Things we could eat to combat hair loss. That’s exactly what we’re going to explore next.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

This is the second in a three-part series on hair loss and growth. Supplements for Hair Growth is the first video, in case you missed it.

Antidepressants like Prozac can also cause sexual dysfunction, but there is something that may help. See Best Food for Antidepressant-Induced Sexual Dysfunction.

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