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Hair Loss and Balding

How Do I Treat Male Pattern Baldness?

I treat patients with Propecia (I have also been treating myself with Propecia for the last seven years. And my brother. And my father….)
DISCLAIMER: Propecia is made by Merck. We have no relationship with this company or with this product, financial or otherwise.

What Is Propecia?

Propecia (or the generic name “finasteride”) is a 5-alpha reductase inhibitor. In other words, it blocks the conversion of testosterone to DHT (dihydrotestosterone). If you do not have dihydrotestosterone (DHT), you do not go bald.

Why Do Some Men Lose Their Hair?

Men who lose their hair do so because they are genetically programmed to lose their hair.  Somewhere in their genes it says something like “at age 25 you will start to lose your hair” and DHT carries out the order.  If there is no DHT then you do not go bald.  An extreme example:  eunichs (boys who have had their testicles removed before puberty) do not go bald, even with a strong family history.  Without testicles there is no testosterone and therefore no DHT.  If you give DHT to a eunich  (and they have the “bald gene”), then they will start to bald at their pre-programmed age.

How We Bald:

Balding seems to occur in stages. Hair follicles don’t just disappear, first they miniaturize under the influence of DHT. These miniature hair follicles produce miniature hairs that are invisible to your naked eye. A few years like this and the follicle will eventually die. But if you interrupt the DHT with Propecia, the miniature follicles can become normal follicles again and grow normal hair. So there is a “window of opportunity”. A drug like Propecia can bring back some of the hair you lost over the last few years, but it will not bring back hair you lost 5 or 10 years ago.

What Can I Expect for Results?

Propecia must be taken for at least six months to see results. Most men who take Propecia are successful and at the very least stop the hair loss. Most men also reverse some of the balding, because recently lost hair grows back (see “how we bald” above). Propecia seems to be more effective at filling in your “bald spot” then it is at reversing your receding hair line.

What Happens if I Stop Taking Propecia?

Like any other medicine, Propecia only works when you take it. Many patients are worried that if they stop taking Propecia, then they will end up worse than if they never took it in the first place. This is simply not the case. If you stop taking Propecia, then you may lose some of the hair that Propecia “created”.
As a side note, I have personally observed many patients who stopped using Propecia after many years, and did NOT seem to lose their hair.

What About Side Effects?

Every man is worried about the sexual side effects mentioned in Propecia ads. Finasteride can cause sexual side effects (especially erectile dysfunction) at the 5mg dose, but at the 1mg Propecia dose, the rate of this side effect is the same as placebo. I have treated men for years with Propecia, and none have reported erectile dysfunction. I have had a few men report decreased libido.

Why Propecia Over Rogaine®?

The short answer is “Propecia is easier”. Rogaine is a liquid that must be applied to your scalp morning and night and it is kind of greasy (although the new Rogaine foam is not greasy). But if you are really losing hair rapidly, it is not a bad idea to use both Rogaine and Propecia.

What About Other Products?

Propecia and Rogaine both have test data to show that they actually work. No other products that make claims to grow hair have data like this.


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