In response to anecdotal evidence of sexual side effects continuing after stopping Propecia (finasteride 1mg), the International Society of Hair Restoration Surgery (ISHRS) has published a press release for the hair restoration community about the safety and efficacy of the drug.

The release notes that scientific data gathered from extensive testing finds no correlation between persistent sexual dysfunction and Propecia:

The ISHRS reports that there is no evidence-based data substantiating the link between finasteride and persistent sexual side effects after discontinued use of the drug in numerous, double blinded, placebo controlled studies conducted evaluating the use of Propecia 1mg for hair loss.

The ISHRS statement also touches on the fact that the exact cause of sexual dysfunction can be difficult to diagnose:

Sexual dysfunction is a complex disorder, and Dr. Martinick noted that it often can be hard to pinpoint the exact cause – particularly when multiple factors such as nicotine, alcohol, prescription medications, stress, anxiety, fatigue and depression can contribute to erectile dysfunction (ED).

In the interest of hair loss patients around the world, the ISHRS has formed a task force to examine the anecdotal reports of persistent sexual dysfunction by Propecia users. It has also called on medical communities from a variety of disciplines — dermatologists, hair loss physicians, urologists, endocrinologists and sexual medicine specialists — to share data and experiences.

Visit our section on Propecia to learn more about the medication, its use, and side effects.

Read the full ISHRS press release here.

 

Q: I am taking finasteride as you prescribed. You also suggested using minoxidil liberally over the entire front and top of my scalp once a day. During our meeting I think that you said that once I start using this I would not be able to stop it, and, if I did, it might lead to further hair loss. Hence, I decided to use the laser comb three times a week in addition to the finasteride. Having said that, if you still feel I should start using minoxidil daily, I will start doing so.

A: Stopping therapy doesn’t lead to further hair loss in that it doesn’t accelerate it; you just continue on the path that you would have been without the treatment. When you stop, there may be an initial shedding as you quickly lose any benefits that you had from the treatment.

The following applies to all three treatments: finasteride, minoxidil, and laser therapy:

1. Only work when you use it
2. Reversion to where you would have been when you stop (but not worse)

However, the important issue is efficacy:

Finasteride >> minoxidil > laser therapy (dubious value)

This is the reason I recommended finasteride and minoxidil.

 

Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future?

A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.

It has been argued, that one should have a hair transplant early, before the donor area can thin. This is not a reasonable argument, since doing a hair transplant early, does not make the donor hair more permanent. If the donor area is not stable, the transplanted hair will continue to thin after it has been moved to the new location. This will cause the hair transplant to gradually disappear and also risk the donor scar from becoming visible as the hair covering it continues to thin. This problem can affect patients undergoing both FUT and FUE procedures.

Age itself is another factor to consider. The donor area in young people almost always appears adequate. However, the older a person is, the more likely he/she will show donor changes. Therefore, the older a person is, the more confident we are of donor area measurements being accurate. In very general terms, it is very difficult to assess the permanency of one’s donor area in patients under 25 year of age.

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