Oral Medication Will Help Fight Male Hair Loss
Patients with androgenetic alopecia will soon have a treatment option for their hair loss with 1 mg oral finasteride (Propecia, Merck Co).
While not a cure, Propecia promises results similar to those of minoxidil (Rogaine), said Wilma F. Bergfeld, head of clinical research, department of dermatology, Cleveland (Ohio) Clinic Foundation.
One feature of finasteride that is bound to be popular is that it is administered once a day in pill form. Following recent approval by the FDA, the drug is the first oral treatment for hair loss.
More than 8 years ago, the FDA approved finasteride in higher doses to treat enlarged prostates in men. Researchers have studied finasteride as it relates to hair growth for about 4 years.
“The data coming from the Merck Co’s large multicenter trials this year [1997] show that [finasteride] is equal to or slightly better than minoxidil,” Dr. Bergfeld said.
In one of two clinical trials, 1,553 men presented with thinning hair predominantly at the vertex. The use of once-a-day finasteride for 1 year resulted in 86% of the subjects maintaining their hair or having new hair grow on the vertex. This compared with 42% of the men in the placebo group having similar results. Hair counts of the subjects in the vertex trials showed 1496 of the men in the finasteride group continued to lose hair, while 58% of those receiving the placebo continued to lose hair.
Another phase of the trial involved 326 men between 21 and 40 years of age with mild to moderate frontal hair thinning. These subjects were also given finasteride once a day and had higher rates of maintenance and new hair growth than did the placebo group. However, the new hair growth was more modest than in the vertex group.
“Researchers saw hair growth at 3 months with special magnification and photography,” Dr. Bergfeld said. “The patient doesn’t appreciate the growth until they are at 6 months or so into his treatment. However, the shedding of hair is decreased at 2 months.”
Dr. Bergfeld said hair growth can be seen and cosmetically improved within 6 to 12 months after beginning treatment with finasteride. She added that continuation studies show that even after 3 years some subjects’ hair shows improvement.
However, like minoxidil, if finasteride is stopped, the hair that was promoted will be lost over time. Therefore, users must take finasteride indefinitely to maintain and to grow new hair, Dr. Bergfeld said.
With specific, targeted activity, finasteride interferes with the conversion of testosterone to dihydrotestosterone, a hormone known to cause male-pattern baldness by shrinking hair follicles in genetically prone men.
The side effects in males are minimal hut include enlarged breasts, impotency, and decreased semen and sperm counts. “These are seen in about 1% of all patients treated with either the placebo or or [finasteride],” she said. “The side effects are reversible whether the patient is on or off of the drug, so it is not a [serious] problem.”
Finasteride is not indicated for women and children. The drug is contraindicated in women who are pregnant because of the risk of hypospadias in their children. Dr. Bergfeld is conducting a postmenopausal study in 20 to 30 females, since they would probably not be affected. Her study is part of a national trial of 800 postmenopausal women. The results are not yet known.
The combination of finasteride with other hair-loss treatments has not yet been studied in people.
“I am aware of only one study of the combination of minoxidil and finasteride in an animal model,” she said. In the species of monkey used in these studies both sexes start to bald at age 3. Dr. Bergfeld said, in the monkey model, the combination treatment was more effective than with individual drugs. There are no human studies now under way.
The future of hair growth therapy is bright, according to Dr. Bergfeld. Research is more targeted and is improving physicians’ understanding of the role genetics play in androgenetic alopecia. “Hopefully, in the future, gene therapy will be used so we won’t need chronic drug administration and hair growth will be permanent,” Dr. Bergfeld said.
Dr. Bergfeld has no financial interest in Propecia.
Tags: Hair Loss