Dr. Poswal, do your patients see success with Propecia?

Hair Transplant
1

Hi Dr. Poswal,

I am of East Indian origin and am wondering if your patients see any success with Propecia/Proscar/Finpecia/Fincar? I think there could be a genetic difference in its level of efficacy. Can you share any photos of people who had good results only from Finasteride?

Dr. Bernstein has such as page on his site and it is amazing.

Thanks.

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» Hi Dr. Poswal,
»
» I am of East Indian origin and am wondering if your patients see any
» success with Propecia/Proscar/Finpecia/Fincar? I think there could be a
» genetic difference in its level of efficacy. Can you share any photos of
» people who had good results only from Finasteride?
»
» Dr. Bernstein has such as page on his site and it is amazing.
»
» Thanks.

Dear tembo,
I would love to have a page showcasing beautiful results of various medications.
Unfortunately, I have seen limited results in a very small subset of patients. At best.
If a person has a headache, I would confidently and safely prescribe him paracetamol (?Tylenol) assuming it would work 99% of the time and relieve the person of his headache.
I know of no medicine that would work the same way for people suffering from hairloss. Therefore, I educate the patients about the possible benefits and risks of these medications as explained on the websites of the pharmaceautical companies that make these medications and let them make their own decisions.

Those that want to try the medications are best advised to take monthly clear pictures of their hair status so they can evaluate the benefits or lack thereof.
There are patients who, had they not taken the pictures would have thought they got no benefit, when they indeed got some.
In conclusion, its like looking at grass grow. If you want to see whether medicines help you, easiest way is to keep a accurate pictorial record for an year on your camera.
More expensive ways are to go to a nearby clinic and get hair volume measurements.
But maintaining a personal webpage on my website of a few patients getting good results from any medication (without stating the %age who would routinely benefit from the consumption of the same)! Sorry, I would not do that.
Regards,
Dr. A

3

Thanks Dr. Poswal. So I assume in Indian patients the success rate is less than this from a probably caucasian patient study:

“In a 5-year study of men with mild to moderate hair loss, 2 out of 3 of the men who took Propecia (finasteride 1 mg) daily regrew hair, as measured by hair counts. In contrast, all of the men in the study who were not taking finasteride lost hair. In the same study, based on photographs that were reviewed by an independent panel of dermatologists, 48% of those treated with Propecia experienced visible regrowth of hair, and a further 42% had no further loss.”

4

» Thanks Dr. Poswal. So I assume in Indian patients the success rate is less
» than this from a probably caucasian patient study:
»
» “In a 5-year study of men with mild to moderate hair loss, 2 out of 3 of
» the men who took Propecia (finasteride 1 mg) daily regrew hair, as measured
» by hair counts. In contrast, all of the men in the study who were not
» taking finasteride lost hair. In the same study, based on photographs that
» were reviewed by an independent panel of dermatologists, 48% of those
» treated with Propecia experienced visible regrowth of hair, and a further
» 42% had no further loss.”
»
» Finasteride - Wikipedia

Dear tembo,
Thank you for the link.
At a time, I personally wanted to try finasteride when I noted hair thinning myself. However, I was not convinced of the benefits and the risks seemed too much for me. That is why I prefer to educate patients on the risk and benefits and let them make the choice personally. I do not advise finasteride as a must treatment for hairloss sufferers.

The link you supplied is indeed eye opening.
Some quotes from there

  1. "In December 2008, the Swedish Medical Products agency concluded a safety investigation of Propecia and subsequently advised that the use of Propecia may result in irreversible sexual dysfunction. The Agency’s updated safety information lists difficulty in obtaining an erection that persists indefinitely, even after the discontinuation of Propecia, as a possible side effect of the drug.[12]

The UK’s Medical and Healthcare Products Regulatory Agency (MHRA) say that erectile dysfunction that persists once use of Propecia has stopped has been reported to them.[13]"

  1. “In December 2009, the Medicines and Healthcare products Regulatory Agency in the UK announced new drug safety advice on finasteride and the potential risk of male breast cancer. The agency concluded that, although overall incidence of male breast cancer in clinical trials for finasteride 5 mg was not significantly increased, a higher risk of male breast cancer with finasteride use cannot be excluded.”

  2. “Finasteride is in the FDA pregnancy category X. This means that it is known to cause birth defects in an unborn baby. Women who are or who may become pregnant must not handle crushed or broken finasteride tablets, because the medication could be absorbed through the skin. Finasteride is known to cause birth defects in a developing male baby.”

When comparing these adverse effects to the fact that the benefits were “2 out of 3 of the men who took Propecia (finasteride 1 mg) daily regrew hair” I am not convinced. It does not mention that the regrowing hair were terminal, thick calibre hair that would provide coverage v/s flimsy vellus hair.

I am sorry not to share your enthusiasm for the medication. Maybe, you may consider me cynical in that I try to read in between lines when someone tries to claim extraordinary results. I would also be interested to know who conducted the study and whether it was a double blind, peer reviewed study or one financed by the pharma company.

Personally, I would not recommend finasteride as a mandatory treatment for my patients. And, having seen patients from most parts of the world, I do not think it has anything to do with Caucasian v/s Indian patients.
Regards,
Dr. A

5

Hello again Dr. Poswal,

I am not an eager proponent of Propecia and am also concerned at the potential side effects. However, having read through a number of studies and HT surgeon blogs, it seems like the side effects of 1 mg are minimal and occur in less than 5 percent of patients, so I decided to risk it. I only take 1 mg ever 2 days too.

Regarding the breast cancer issue, it seems like the patients took 5 mg and the study results are not clear cut.

6

Even i had used Finasteride from year 2003-2008 Approx …and i had not seen any positive response…

I also applied Mintop from 2% to 5% during this span…But not got positive response…

Many peoples to whom i known using these things ,but after that they are not getting benefit or little benefit… At last they leave all these things…

   Does homeopathy medicine works for androgenetic alopecia ????.Because i have seen many times  Add of of Dr Batra (homeopathy) in newspaper and these adds are very attractive.....
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Propecia does work. I studied it in great detail (medical literature, charts, graphs… etc)

It greatly slowed down the rate of my hair loss and I’ve been on it since 2005. I wish I had got on it at the first sign of baldness. I have no side effects from its use and neither do most men.

Statistically most patients lose hair at damn near the natural rate of hair loss (2% per year) on propecia. That is as close to a miracle drug as it gets.

Unfortunately variation in genetics and genes causing baldness probably affect some patients more than other on the drug.