Last year we reported about a poorly conducted study regarding the side effects of Propecia. The same researchers have now published a follow up study, where the interpretation of the results remains questionable.

The study reassessed 54 individuals with a mean age of 31 years that did not present with any other medical conditions. The patients were sent a follow up questionnaire called ASEX via email. In total 81% responded and of those 89% met the definition for sexual dysfunction.  The length of use of the medication, as well as duration of the side effects appeared to be unrelated. However, the majority of individuals in the study had experienced the side effects for 1-2 years. Based on this, the authors concluded that there is a possibility for the side effects to be long lasting or potentially permanent and therefore urged for caution when prescribing Propecia.

To a large extent, the recruitment of participants depended on the same sample they used in the previous study. Yet, this was one of the main flaws of the initial study. By recruiting participants that already exhibited sexual side effects, the authors made it challenging to generalise the findings to all individuals who take Propecia. Although they specified that their sample did not take any other medications or have any other conditions that may have affected the outcome, there was no mention of corroborating this with medical records.

Although we understand the need to research side effects of any medication, we also feel that it is important that more rigorous studies are made before suggesting that the side effects may be permanent. We also agree that caution should be taken when prescribing any medication and as such fail to see the value of the conclusion of this badly constructed study.

The Food and Drug Administration (FDA) in the USA has now ordered that packets of Propecia be accompanied by health warnings regarding problems with ejaculation, orgasm and libido that are said to occur even after patients stop taking the hair loss treatment.

Propecia already carries a warning on its label regarding a decrease in libido but now the other warnings will also be added to it. Along with sexual side effects, the label warnings will include side effects such as a decrease in semen quality and infertility however these are two side effects that are said to disappear once treatment ceases.

Despite this move, no evidence is available to establish a direct link between Finasteride, the active ingredient in Propecia and Proscar, with these symptoms. The cases investigated have been reported voluntarily and the number of actual reports was very small given the prescribed population, thus making it difficult to draw any reliable conclusions or establish any causal link between the drug and these symptoms.

Drug companies are obliged to advertise such warnings since cases have been reported. However, we assure patients that there is no concrete evidence to prove that Finasteride has these effects on patients and very few of our patients report any side effects whatsoever so Propecia appears to be well tolerated on the whole and we are not aware of any label changes in the UK.

The Food and Drug Administration (FDA) is addressing the fact that there is a growing fear surrounding Propecia’s supposed effects on sexual function. Men have been reporting permanent sexual dysfunction having taken the hair loss treatment.

Until investigations have been carried out, both the FDA and the manufacturers, Merck, are staying silent on the topic. The FDA will carry out a review with a view to updating the drug’s safety data if necessary. This might include a warning regarding the potential for certain individuals to experience certain side effects to a more severe degree than others.

This review probably signals a swathe of complaints about the side effects in question however, no formal evidence has been presented as of yet and until there is sufficient support for these complaints, patients should not be alarmed by any reports that they read online.

The Online Clinic has been prescribing Propecia online for around 7 years and we have not had a single patient who has suffered irreversible sexual side effects. We do take the view that the sexual side effects have a higher incidence than the figures from the original clinical trials but the percentage does not quite reach double figures according to our patient follow-up responses.

Merck, the manufacturers of popular hair loss treatment, Propecia (Finasteride) has been faced with a lot of bad press recently. It has always been suspected that Finasteride caused sexual dysfunction in men with side effects including:lower libido; erectile dysfunction; and problems with ejaculation but we were always told that if side effects were to be experienced by a patient, they would soon disappear once treatment ceased.

Researchers at the George Washington University carried out a study on 76 men between the ages of 21 and 46 and found that these men were experiencing problems with sexual dysfunction such as erectile dysfunction (ED) and premature ejaculation from 3 weeks to 10 years after they had stopped taking the drug. The study is published in The Journal of Sexual Medicine.

94% of participants who had taken the drug for a number of days noted that they had low levels of sexual desire, a similar number reported difficulty with sexual arousal and ED and 69% had problems with achieving orgasm. Those who had taken Finasteride for 28 months reported that they had experienced sexual problems for a duration of 40 months on average from when they stopped taking the treatment to the time the reports were made. 20% of men were experiencing side effects 6 years later.

What is interesting is that in order to be considered eligible to participate in this study, men had to have experienced problems with sexual dysfunction for at least three months after they had stopped taking Finasteride. It seems to me that the study’s authors had a pretty clear indication of the outcome they wanted to see before they even began! Furthermore, in order to participate in this study, men had to include the results of two hormone and fertility tests with their application. These tests were to be spaced one month apart. There was no mention of these results and their effect on sexual dysfunction in the report, only the influence of Finasteride. This report is based on a very small and biased sample and quite simply, it is bad science.

The fact remains that Propecia does benefit those suffering from hair loss and it may cause sexual dysfunction in certain patients but as yet there is no reliable evidence to suggest that any side effects are widespread and long lasting.

The latest episode of My Face, My Body on Sky has focused on the top aesthetic worries of men in the UK. Top of the list (somewhat unsurprisingly) is the fear of going bald. A large percentage of men start losing their hair by the time that they reach 30 and most believe that there is nothing that they can do about it other than the extreme (and not always successful) hair transplant.

The fact is that men can do something about their hair loss and it does not need to include the drastic option of a hair transplant. There is an over the counter remedy called Regaine that can be purchased from most pharmacies. Regaine does work but it is not the most successful product on the market and it is a topical solution so it can be a bit messy. Propecia is a daily pill with a much higher success rate than Regaine. Around 89% of men taking Propecia experience a cessation of hair loss and around 65% experience re-growth.

The show featured the Gladiator star, Warren Furman who had a hair transplant. This is the nuclear option but for some men it is the only realistic option if they let their hair loss go too far. If Propecia or Regaine are to be successful, a reasonably early intervention is normally advantageous. Once a man has gone completely bald, it is unlikely that Propecia or Regaine will be of much use.

A new report for a consumer magazine has shown that the hair loss treatment Propecia is one of the few remedies for the condition that consumers find actually works.

Consumer Reports surveyed over 8,000 men and women struggling with hair loss to ask them about how they dealt with the condition, whether they used any products to slow down the process and whether they found those products to be effective.

Nearly 40% of women and 27% of men said that they had tried some kind of treatment to reverse their hairloss. A large section of the men, over half, said that they believed that many remedies for baldness overstated how effective they are. Most opted for remedies available over the counter, but 20% got prescriptions from their doctor for Propecia.

27% of the men who used the medication described it as ‘very’ effective. Minoxidil, sold as Rogaine over the counter, was deemed considerably less successful, with only 4% of the men who used it describing it as very effective. 43% of those who tried it said it made no difference to their hair loss. 6% of those polled thought taking herbal and dietary supplements made a big difference to their hair loss.

Only 2% of the men opted for the fairly expensive option of hair transplant surgery, but nearly half of those were either very or totally satisfied with the results.

A spokesperson for Merke, who manufacture Propecia, said that the survey supported the findings of clinical trials indicating the medication is the most effective treatment on the market. She added that those suffering from hairloss should speak to their doctor, so they can get reputable advice as to how they can separate fact from fiction.  

Americans believe stress is a leading cause of hair loss, according to a survey commissioned by hair-loss treatment makers Regaine, an over-the-counter preparation.

The firm asked Wakefield Research to survey Americans to see what their attitudes to hair loss were. 57% of those questioned said they were not attracted to people with thinning hair, while 40% of married respondents said they would prefer their partner to be overweight rather than bald.

The survey asked 1,001 adults how much they knew about hair loss. 75% said that stress was a leading cause of the condition – incorrectly – while 35% believed that wearing a hat frequenty could cause hair to thin. 24% said that overstyling hair could lead to hair loss. This last belief is partly true, as hair treatments such as hair extensions can put stress on hair and cause it to thin.

Dr. Robert Leonard, a member of the board of governers for the International Society of Hair Restoration Surgery and a leading hair transplant surgeon, said that the survey showed that people were unaware that hereditary hair loss accounts for 95% of all hair loss. He warned that diet, vitamins and thickening shampoos and conditioners were not effective treatments for hair loss.

The survey shows how little the general public really know about hair loss, suggesting that many people suffering from the condition will turn to untested or pointless treatments to cure the problem. There are lots of shampoos and serums that claim to ameliorate the condition, but as hereditary hair loss is a medical condition with specific causes, they are not going to make a difference.

There are only two products which have been clinically proven to combat hair loss. The first is Regaine, the commissioners of the survey, which uses the active ingredient minoxidil to combat heridatary hair loss. It is believed that it encourages blood to flow to the hair follicles, encouraging regrowth.

While Regaine is available over the counter, the other option, Propecia, is only available with a doctor’s prescription. It is only suitable for men and contains finasteride, which stops the production of dihydratestosterone, responsible for attacking the hair follicles in the scalp.

During his trip to New Zealand, Prince William has got a lot of positive coverage. Newspapers around the world have published pictures of him cooking steak during a barbeque with New Zealand Prime Minister John Key as well as the future king exchanging the traditional nose-to-nose greeting with the head of a Maori tribe.

There has also been a fair bit of attention paid to a less statemanly aspect of his trip – photos that show the Prince is not just struggling with a receeding hairline but is clearly experiencing fairly severe male-pattern hairloss.

Local journalists were overhead discussing his exposed pate, with one female reporter quoted by the Daily Mail as saying to a colleague, “Oh my god, he looks really bald. But he is still handsome.”

William has clearly inherited a condition predominant in his family, male-pattern baldness. Often sons are more likely to see their hairline receed if their father also experienced the same thing. Prince Charles’ hair started thinning when he was aged 28 (Prince William is 27) while Prince Edward started losing his hair aged 21.

Male-pattern hair loss is caused by hormonal changes where the hormone testosterone is converted into another hormone called dihydrotestosterone. The hair follicles become more sensitive to this hormone and it causes the hair follicles on the head to shrink.

There are some treatments to halt the progress of male pattern baldness, such as Propecia or Regaine. Some men even resort to hair transplants. It all really depends on how the man in question feels about the hairloss.

The Maori women certainly weren’t put off by the glimpses of pink pate showing through – one women yelled, ‘We love you William!’ as he exchanged greetings with a group of Maori elders.

A new study from a British hair loss clinic, the Belgravia Centre, has indicated that British men are more likely to be concerned about hair loss in their earlier life, with most deciding to take action aged 30.

Figures released by the clinic showed that there was a significant rise in the number of men seeking treatment for hair loss who were under 30, but then there tended to be a decline in patient numbers.

Out of all the 10,660 men the Belgravia Clinic is treating for hair loss, young men make up a significant proportion of the customers.  The senior hair loss specialist, Leonora Doclis, said that statistics show that men are first noticing hair loss at a younger and younger age and the number of people affected is growing.

Ms. Doclis said that various aspects of life for men in their 20s – career expectations, exam stress, frequent moving – could be triggers for early onset male-pattern baldness.She added that while there was a fair amount of scepticism about hair loss treatments, younger men were more likely to be better informed about the medical developments, such as the creation of Propecia, that have taken place over the last decade.

Earlier this week, a massive trial into the sales of counterfeit Viagra, Cialis and Propecia came to a close as the last three members of a seven-strong criminal gang were jailed at Kingston Crown Court.

The Medicines and Heathcare Products Regulatory Agency's investigation, codenamed Operation Stormgrand, saw the gang receive prison sentences totalling 17.5 years and confiscation orders for £3,074,242. The operation, begun in 2005, was the largest ever discovery by the MHRA of counterfeit drugs, with over £1.5 m worth of counterfeit medication seized.

The gang formed the UK arm of a worldwide ring which was operating in China, India, Pakistan, the Caribbean and the USA. In 2002 HM Customs officials seized large quantities of Viagra at Stanstead Airport, followed by the seizure of a variety of other drugs disguised as harmless supplements with names such as Samples of Mineral Supplements for Dogs” and “Calcium for Kids.”

The last person to be sentenced was Alpesh Patel, who was convicted for masterminding thea conspiracy on an industrial scale to supply counterfeit medication. He was handed out a 12 month suspended sentence.

The sentence follows that of his fellow gang member Dr. George Patino, who after pleading guilty was given a three year jail term for supplying counterfeit Viagra.

New guidelines issued by American urologists have suggested that the drug finasteride, commonly used to fight hair loss in men under the name Propecia,is also effective in combating prostate cancer. The American Society of Clinical Oncology and the American Urological Association have said that after a phase III randomised trial, the evidence was that finasteride reduced the chances of someone contracting prostate cancer by 25%.

The results are based on data gathered from the Prostate Cancer Prevention Trial, which studied 18,882 healthy men aged over 55. In a strange paradox, the results showed that while men who did not have the cancer dramatically reduced their chances of getting it, amongst men who did or had already developed the cancer, the tumours were more likely to be high-grade.

However during a year of analysis of the results, the researchers discovered that the medication was not making the tumours high-grade, but was rather making them easier to detect by shrinking the prostate. The researchers said they believed the myth that finasteride caused the cancer had now been debunked.

The lead researcher on the study Barnett Kramer said not enough research had yet been done to see how cost effective it would be to take finasteride as preventative measure. He said it would depend on whether American health care insurance providers would cover the cost. He also said that more needed to be discovered about whether a low dose of the medication would also be effective and whether the drug impacts on prostate cancer mortality.

The News of the World this week reported that England football star Wayne Rooney is planning to start taking the prescription-only hair loss medication Propecia after he got sick of teasing about his balding pate from teammates. Rooney, who is paid £100,000 a week to play as a striker for Manchester United, has apparently already has a consultation to begin the treatment.

Previously, footballers were unable to take Propecia. The active ingredient finasteride was banned in the sport, as regulators were afraid it could mask steroid use. Now it has been made legal and apparently Rooney, 23, is hopeful it could help with his early-onset hair loss and is intending to combine the pills with a topical lotion he will rub into his scalp.

Rooney is expecting his first child with his wife Coleen and the baby is due later in the year. If the couple were trying for a child, this would have prevented Rooney from starting the medication immediately as finasteride can cause problems in the development of unborn male children. His wife’s pregnancy may still lead him to decide to only begin the medication after the baby is born, as it is recommended that the pregnant women do not come into contact with the tablets at all.

According to an American gossip website the American rocker Jon Bon Jovi is worried that he is starting to suffer from male-pattern baldness. The singer and sometime actor is justly famed for his luscious locks and many women (and men) have felt their hearts flutter at the sight of his sandy tresses curling gently onto his shoulders in such epic works as Sex and the City, The Leading Man and of course all his wildly sexy music videos.

However, the 1985 Kerrang “Sex Object of the Year” is quoted as saying,"Oh, let me tell you, I am so worried (about my hair). I look at guys like Sting and think, 'Well, he's cool about it,' but I'm already losing it a bit and I'm so aware of it". This new fear has been held responsible for the new, shorter hairstyle he has been sporting in recent months.

The star has even been pursuing strange regimes recommended to him by friends and acquaintances. He said, “Someone told me that you have to regularly massage your scalp, so I do that all the time. You look like a jerk, but it's got to be worth a shot, right?"

There is a certain pleasure in seeing celebrities succumbing to the perils of age, but personally I think that Bon Jovi could be bald as a coot and he’d still be yummy. Considerably more yummy than John Cleese, who after telling Richard and Judy rather bravely about his painful hair implant treatment then followed the classic mid-life crisis route by having an affair with an aged blonde who improbably claimed she was 27.

What we need is a celebrity who admits he is losing his hair, does something proactive about it, and then doesn’t undermine all his good work by going off to buy a red Porche and some pretty girls to ride in it. Jon Bon Jovi, who does lots of political stuff for the Democrats, seems to fit the bill admirably...maybe now Obama is safe he can take on a new challenge as Propecia spokesman....?

We often get questions about whether or not the hair loss product that we prescribe actually works.  It is really extraordinary because nobody ever questions the other treatments.  Maybe it is because treatments for erectile dysfunction have had so much positive publicity and the ability to lose weight is something that we know is perfectly possible?  With hair loss, most men, whilst being distressed about the process, are resigned to the fact as they believe that there is nothing that can be done.  It is bizarre that the market leading treatment, Propecia, has not had more editorial publicity in the UK (it is not allowed to be advertised here as it is prescription only and the marketing of these types of drugs is heavily regulated in the UK.)

I first heard about Propecia on a trip to the United States when I saw a television advert for the product.  This was a prescription medication which the manufacturer claimed could reverse hair loss.

Propecia, like a lot of other drugs, was discovered by accident.  Finasteride, the active ingredient contained in Propecia, was originally developed to treat benign prostatic hyperplasia (enlarged prostate.)  Patients being treated with Finasteride began to notice that they we re-growing hair that was lost years before.  Further trials confirmed the original anecdotal evidence.

Male pattern baldness is caused by a naturally occurring hormone called dihydratestosterone (DHT) which attacks the hair follicles in the scalp, causing hair production to slow down and in some cases, cease altogether.  Bizarrely, DHT can actually encourage hair growth on other parts of the body such as the chest, back and nostrils.  Propecia inhibits the production of DHT and can lead to the re-growth of scalp hair.

So, in summary, yes, the hair loss product works and it works well.  I have personally been taking it ever since I saw it advertised on that trip to the US!