Finasteride

Treatments for Thinning Hair: Do They Work?

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So you’re never going to have a thick, lush head of hair again. But at least you’d like to hang on to what you’ve got. Short of a transplant, is there anything you can do to stop thinning hair?

Yes. With some treatments, you can slow down or stop hair thinning — and maybe even grow back some hair you thought was gone forever. Read on to see what works and what doesn’t.

Minoxidil

This is the only over-the-counter medication for hair loss approved by the FDA for use by both men and women. It won’t rescue a receding hairline. It does stimulate hair growth, although scientists aren’t quite sure how it works.

Minoxidil is available as Rogaine or Theroxidil, or in generic form. It’s sold as a liquid or foam and in two strengths: 2% and 5%.

  • Effectiveness: Minoxidil works for about 2 out of 3 men. It’s most effective if you’re under age 40 and have only recently started to lose your hair.
  • How to use it: Twice a day, when your hair is dry, apply minoxidil on your scalp where the hair has started to thin. Then be patient. You may not notice changes for 4 months or more.
  • What it doesn’t do: Minoxidil does not cure baldness. If you stop using it, you will start losing hair again. Your hair may fall out faster than before.
  • Side effects:You may have redness, itching, dryness, flaking, or other scalp irritation, though this is uncommon. It’s more likely if you use the stronger 5% solution.

 

Finasteride

This medication stops your body from making the hormone at the root of male pattern baldness, DHT (dihydrotestosterone). It is available under the brand name Propecia.

  • Effectiveness: Finasteride is very effective. It slows or stops hair loss in nearly 90% of men. About two-thirds of these men also regrow some hair.
  • How to use it: Finasteride is a pill. Usually, you take it once a day. Your dermatologist may recommend using it in combination with minoxidil.
  • What it doesn’t do: Like minoxidil, it doesn’t cure hair loss. If you stop taking it, you will lose hair again.
  • Side effects: Finasteride can cause erectile dysfunction and other sexual side effects, though this is unusual. If it happens to you, it will likely clear up once you stop taking finasteride. But for some men, that can take 3 months or more.

Biotin and Low Level Laser Therapy (LLLT)

Biotin is a B vitamin that is essential for your health. You most likely get plenty of it in your diet in egg yolks, yeast, liver, and other foods. That’s good news because too little biotin can cause hair loss. Does that mean that taking mega-doses of it will give you more hair? Probably not. No scientific studies have shown biotin to prevent or treat hair loss.

You may have heard that laser combs, brushes, hoods, and caps can help halt hair loss. The theory is that when hair follicles absorb laser light at a certain level, it stimulates hair to grow. But there’s not enough evidence that any of these devices restore hair or prevent balding.

When to See a Doctor for Hair Loss

If you lose hair suddenly, see your doctor. It may be caused by illnesses, medicine, or your diet.

Finasteride Safety Questionable in Androgenic Alopecia

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Pooled data do not prove the safety of finasteride for androgenic alopecia (AGA), with sexual side effects in particular not adequately evaluated, according to a new meta-analysis.

“The methods matter,” Dr. Steven M. Belknap told Reuters Health by email. “If you don’t take a temperature, you won’t find a fever. If investigators use flawed methods they may miss important adverse drug effects.”
In an April 1st online paper in JAMA Dermatology, Dr. Belknap of Northwestern University Feinberg School of Medicine, Chicago and colleagues noted that clinical use of finasteride “was prompted by the observation that male pseudohermaphrodites do not develop prostatic hyperplasia or AGA.”

Male pseudohermaphrodites have a mutation of the gene encoding 5-alpha reductase. Finasteride, a 5-alpha-reductase inhibitor, can induce a strikingly similar sex steroid profile.

Finasteride was approved in 1992 for treating benign prostatic hyperplasia and in 1997 for AGA. In an editorial, Dr. Thomas J. Moore says, “It was clear, or should have been, from the start that inhibition of a key metabolic pathway for the conversion of testosterone to other steroids was going to have many effects, not all of them necessarily desirable.”

For the current study, the researchers examined data from 34 controlled clinical trials. None, they say, had adequate safety reporting. In 19, safety reporting was partially adequate, in 12 it was inadequate, and three reported no adverse events.

No reports assessed adequacy of blinding, 18 (53%) disclosed conflicts of interest, and 19 (56%) received funding from the manufacturer. Duration of drug safety evaluation was one year or less for 26 of 34 trials (76%).
Overall, the investigators conclude, “Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.”

Moreover, they point out, funnel plots were asymmetric, with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic underdetection.

“The researchers that did these studies,” continued Dr. Belknap, “either knew or should have known that sexual dysfunction might occur in some men exposed to finasteride.” The trials “should have been designed to detect sexual dysfunction and the published reports of these RCTs should have included the results.”

Commenting by email, Dr. Moore, the editorialist, told Reuters Health, “There is clear evidence that finasteride can cause male sexual impairment, and that in some cases the effects are persistent.”

Dr. Moore, of the Institute for Safe Medication Practices in Alexandria, Virginia, added that the study “also illustrates that clinical trials do much better at measuring benefits than assessing harms.”

18-Year Study Finds Drug Cut Prostate Cancer Risk.

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A drug used to treat enlarged prostateand male pattern baldness also reduces a man’s risk of prostate cancer by nearly a third, according to a large new study.

The findings on nearly 19,000 men also overturn earlier concerns that treatment withfinasteride – the agent in the prostate drugProscar and the hair-loss drug Propecia – might promote the development of more virulent prostate cancers in men who contract the disease, researchers said.

Finasteride did not affect overall survival rates or survival rates after diagnosis with prostate cancer for men who did and did not receive the drug, said study lead author Dr. Ian Thompson, a urologist and professor at the University of Texas Health Science Center.

“If indeed the more high-grade cancers in the men taking finasteride were real, we would expect to find a higher death rate,” Thompson said. “The survival of these men was exactly the same.”

Published in the Aug. 15 issue of the New England Journal of Medicine, the study is an 18-year follow-up on the Prostate Cancer Prevention Trial, which took place in the late 1990s. Back then, the trial found that finasteride could reduce overall risk of prostate cancer by 25 percent – but that it increased by 27 percent the risk of high-grade prostate cancer in those men who did wind up with the disease.

The concern over the high-grade cancer findings led officials back then to decline recommending finasteride as a prostate cancer prevention tool. “Basically, this potential home-run prostate cancer intervention never happened,” Thompson said.

When checking back with the men involved in the earlier trial, researchers behind the new study found that the drug actually worked better than earlier reported in reducing prostate cancer risk.

They also found that detection of high-grade cancers occurred in 3.5 percent of prostate cancer patients who took finasteride and 3 percent of patients given a placebo. There was no difference between the finasteride and placebo groups regarding overall long-term survival or survival following a prostate cancer diagnosis.

“It shows that the higher proportion of high-grade disease doesn’t really matter, because it doesn’t affect the risk of death,” said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

Brawley said the increased diagnosis of high-grade prostate cancer likely occurs due to finasteride’s effectiveness in shrinking enlarged prostates.

“You take Proscar for six months to a year and it halves the size of your prostate, but the cancer inside your prostate does not shrink,” Brawley said. “If I’m performing a biopsy on a smaller prostate, I’m more likely to hit that cancer than if I am sticking into a larger prostate. This drug wasn’t causing more prostate cancer. It’s causing more prostate cancer to be diagnosed.”

Since finasteride does not affect survival rates, its true value may lie in reducing the diagnosis of minor prostate cancers that should not be treated, Thompson and Brawley said.

Prostate cancer is the most commonly detected form of cancer in men, found in one in six men during their lifetimes, Thompson said. Prostate cancer kills only 3 percent to 5 percent of men, however.

Most men “will get away with it, dying of causes other than prostate cancer,” Thompson said.

Because of this, prostate cancer has become an overtreated disease, with men suffering side effects such as impotence and incontinence because they received treatment for a cancer that wasn’t likely to lead to their deaths, Brawley said.

“It does not affect a man’s risk of death at all to take finasteride, but if he takes finasteride it will lower his risk of being diagnosed with prostate cancer,” Brawley said. “Half to 60 percent of men who were diagnosed with localized prostate cancer, if it was never diagnosed, it would never have bothered them in their lifetimes. We cure some people who never need to be cured.”

Source: Drugs.com

New Sexual Adverse Effects Added to Finasteride Labels.

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The labels of the alopecia drug Propecia (finasteride 1 mg) and the benign prostatic hyperplasia drug Proscar (finasteride 5 mg) are being updated with an expanded list of adverse sexual effects, the FDA has announced.

The updates:

  • The Propecia label will include libido, ejaculation, and orgasm disorders that persist after treatment ends.
  • The Proscar label will include decreased libido that persists posttreatment.
  • Both labels will note reports of male infertility or poor semen quality that improved after drug discontinuation.

The FDA said: “Despite the fact that clear causal links between finasteride … and sexual adverse events have NOT been established, the cases suggest a broader range of adverse effects than previously reported.”

When these drugs were approved in the 1990s, their labels noted sexual side effects that normalized after treatment ended. In 2011, the FDA updated the labels to warn of persistent, posttreatment erectile dysfunction.

Source: FDA drug safety information.

Big science zooms in on a new cure for baldness.

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In mice and men, baldness is a scourge that cries out for a cure. Fortunately, a far-flung group of American researchers is on it — and on Wednesday reported progress on this front in the very sober journal Science Translational Medicine.

Plucking hair follicles from the pates of 22 men with male-pattern baldness and an army of mice, researchers detected a key difference between patches where hair was growing and patches where it was thinning or bald: In humans, a prostaglandin called PGD2 was far more plentiful in areas of the pate that were bald than in patches where hair continued to grow; and in mice, the same prostaglandin was in large supply when they were in the shedding phase of their normal hair follicle cycle.

The team was led by dermatologist Luis Garza (then of the University of Pennsylvania, now at Johns Hopkins University) and by Penn dermatologist George Cotsarelis. The discovery that prostaglandins might be the catalyst that sets baldness in motion, was a surprise to the researachers, who “hadn’t thought about prostaglandins in relation to hair loss,” said Cotsarelis.

From there, researchers were able to identify the receptor — the cellular landing dock — for D2, called GPR44. Find a way to block that receptor, or somehow thwart PGD2’s path to it, and, voila! —baldness doesn’t happen. That, say the researchers, will be their next effort — to try topical treatments that block the GPR44 receptor. They hope the same approach might help find treatments that prevent hair thinning in women.

Male pattern baldness strikes 80% of men younger than 70, causing hair growth to thin in a distinctive pattern. Currently, just two medications, Monoxidil (marketed as Rogaine) andFinasteride (marketed as Propecia or Proscar), are available to combat hair loss.

Source:  Los Angeles Times