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Hair Loss Experts Discuss Finasteride 1mg (Propecia)

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What are your views on finasteride 1mg as a hair loss treatment and based on your own experience from prescribing it, is finasteride a safe drug?

Christina Chikaher - Belgravia Centre Hair Loss Clinic Superintendent PharmacistChristina Chikaher BSc MRPharmS – Superintendent Pharmacist at The Belgravia Centre

“Finasteride is the only drug approved and licensed to treat male pattern hair loss by both the MHRA and the FDA. It is a type 2-selective 5 alpha reductase inhibitor and acts mainly by preventing the formation of dihydrotestosterone (DHT) from testosterone, which is the main androgen causing Male Pattern Baldness (MPB).

Apart from the obvious physical changes to the hair, male pattern hair loss can also cause severe anguish to those affected by it. In fact, research has found that baldness causes at least as much suffering in men as a serious skin condition, such as psoriasis, even though obviously hair loss is not an illness per se. In turn, this can lead to a loss of confidence and a variety of associated problems.

Finasteride is not a new drug; it has been available for more than 20 years, having originally been licensed in 1992 to treat benign prostatic hyperplasia (BPH), using a higher dose of 5mg. In 1997 it was further developed to treat hair loss in men at a smaller dose of 1mg per day.

I have been the Superintendent Pharmacist of the Belgravia Centre pharmacy since 2002 and during this time we have dispensed tens of thousands of prescriptions for men with genetic hair loss. I have found finasteride is well tolerated and leads to improvement in hair growth in men with MPB, alongside our other hair loss treatments. Finasteride slows the progression of hair loss that would have otherwise have occurred without treatment. Men successfully treated with finasteride 1mg also tend to have a more positive approach to their condition.

Experience of the higher 5mg dose used to treat men with BPH for several years advocates long term safety of the drug. However, although finasteride is a very safe drug, as with any other drugs, side effects are possible. The most commonly reported are loss of libido and sexual potency, and to a lesser extent side effects of a psychological nature. These affect under 2% of users. As far as I am aware, and from my experience gained over the years, any reported side effects have been eventually reversible and the great majority of users who have experienced side effects report that they wear off very soon after stopping treatment. I think that the positive effects and success of treatment far outweigh any possible side effects.”

Dr Bessam Farjo - Hair Restoration Specialist and Belgravia Centre Hair Transplant PartnerDr Bessam Farjo MB ChB BAO LRCPSI – World Renowned Hair Restoration Surgeon

“Finasteride, in my opinion, is by far and away the best currently available treatment for Male Pattern Hair Loss.

On average it gives a 90 per cent chance of halting the hair loss process and a 30 per cent chance of seeing significant thickening of the hair in the crown, compared to 10-15 per cent at the front. Some men report a decrease in body hair but I have not seen this.

The figures claim a cumulatively improving degree of benefit up to two years of use and then a plateau, and my experience supports this. In my practice, unless there is a reason not to, then it is the first line of action for prevention, followed by minoxidil and then LLLT or a combination thereof.

Side effects are reported to be up to two per cent in incidence but I tell people two to five per cent. These are usually reversible either through cessation or through persevering for a few weeks. If not, then I recommend stopping the medication until the side effects go and then trying again on a very low dose and working your way up to 1mg per day until hair loss stops without the side effects.

There are unofficial reports of long term persistence of the side effects, but none have been proven in any of the clinical trials – even the ones which were not organised by the manufacturer. Unless we analyse the people affected for anything else – taking into account each individual’s full medical history – then it is very difficult to make any conclusions. I have seen a few cases where the side effects took a lot longer to resolve, but I have not seen any where they didn’t resolve eventually.”

Meet the panel of hair loss experts

Dr Bessam Farjo - Hair Restoration Specialist and Belgravia Centre Hair Transplant Partner

Dr Bessam Farjo

Hair Restoration Specialist – Co-founder of the Farjo Hair Institute, Dr Farjo has extensive experience in the hair restoration field and has held numerous positions in a variety of global organisations, including President of the International Society of Hair Restoration Surgery, Founder Member and President of the British Association of Hair Restoration Surgery and Medical Director of the Institute of Trichologists.

Christina Chikaher - Belgravia Centre Hair Loss Clinic Superintendent Pharmacist

Christina Chikaher BSc MRPharmS

Belgravia Superintendent Pharmacist – A member of the Royal Pharmaceutical Society and in charge of The Belgravia Pharmacy – the UK’s only dedicated hair loss pharmacy. Christina is based at our Central London clinic near Victoria, and has been with The Belgravia Centre since 2002.

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