In my practice I am seeing many men in their twenties asking for medications to prevent baldness (“alopecia”).  Some have a family history to contend with, others are simply seeing more hair coming out on their combs, or showing up on the shower floor.  The drug industry, naturally, spends big money to advertise this treatment, showing a young man looking at the back of his head in the mirror, then advising the reader to “ask your doctor” if oral drug therapy is “right for you”.  We are also seeing female models urging women to also check their scalps.  No drug is named, but that is because there is only one oral drug to ask your doctor about : Propecia (finasteride). 

Before we even get to the side effects, one feature of this seems especially mean-spirited.  Propecia comes in 1 mg tablets, and is sold for the same price as the 5 mg Proscar (for prostate disease) tablet.  Same drug, same manufacturer, same factory.  They changed the name from Proscar to Propecia to make it sound like a separate drug.  Major 500% mark-up!  So for those who do chose to take this drug, I write a prescription for the 5mg tab, and advise the patient to divide it into 5, using a kitchen knife and cutting board.  Many will break it into 4, for a slightly higher dose, but easier to subdivide.  An easy way to save hundreds of dollars.  A few patients who have free drug coverage will ask for the 1 mg size, to avoid the nuisance. 

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If you talk to dermatologists, many seem to favor using this drug, and have done so for years.  But a better source to ask would be the hair transplant doctors.    These are the specialists who want to help their patients keep their remaining hair the most, both to preserve areas to harvest, and to maximize the post-transplant coverage.  But new evidence has come to light, and most of the hair doctors are now backing off Propecia, concerned about the side effects. 

The side effects relate to the drug’s blockage of the testosterone production pathway.  Erectile problems and loss of libido have been reported, and sometimes these surface long after the drug has been discontinued.   But an even more serious risk is that of male breast cancer.  While small, these risks are worth discussing, especially when the drug is being prescribed for a non-life threatening condition. 

Instead,  hair transplant specialists  are now suggesting just topical medication, Rogaine.  The 2% formulation is commonly seen on shelves in the drug store, but they recommend the 5% form instead. 

Purchase either the spray or the foam versions for twice-daily application.  You will also see recommended shampoo and other options.  Also, remember to not be washing your hair daily, as it dries out the natural oils.  Rinse daily, but don’t use shampoo more than a couple of times a week. Be careful when pulling the hair through the brush or comb. Gentle fingertip scalp massage can also help, keeping the skin loose.

Action tip:

Some people get dry dandruff from the Rogaine, so an additional use of an oil-based product such as coconut oil is often helpful.  Just a small scoop of it into your palm, wait for it to melt, then gently rub it in to the scalp.  It quickly absorbs, and allows one to tolerate the Rogaine-induced dandruff problem.  Maybe that’s why a coconut keeps its own hair!

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