Hair Loss/propecia long term
QUESTION: Hello dr.Panagotacos I've recently read a 10 year finasteride study done on 118 men.At the end of this study around 85% of men had no further visible hairloss compared to the baseline pictures and the drug's effectiveness is not reduced after this time.Do you think from your experience that this is true?Can the majority of patients keep the same amount of hair for 10 years or more?I also would like to ask you if you have any patients who were balding in their 20s and are on drug for 10 or more years.Can you tell me how they are doing?
ANSWER: Yes, I think it is true that nearly 85% of men stop losing their hair as measured at the 10 year mark. I have seen about the same results in my practice and I've been prescribing 1mg finasteride since 1983 ( 5 years before it came out as Propecia). There is a gradual attrition and the way you word the conclusion of 85% look as good as when they started doesn't take into account that some of those men had a lot more hair one year after starting Propecia and gradually lost it over the next 9 years. The majority of men keep what hair they started with after ten years.
I have many men who started Propecia in their 20s and have been on it for the past 10 to 15 years and most of them are doing well with the therapy. A few graduated to taking Avodart either four times a week or daily to keep from losing more hair.
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QUESTION: i would also like to ask something about minoxidil. So we know that minoxidil doesn't do anything to stop baldness but only giving hair a boost for unknown reasons. That means that if i'm using minoxidil on my leg hair they will start growing thicker for as long i'm using it.So in theory as long as i use minoxidil and my aga has stopped completely i wont loose minoxidil benefits as long as i'm using it right? i would like to see a study with minoxidil used on hair that are not affected by aga to see how long can the benefits last.In theory it should work for ever.Can you confirm this from your practice?
Minoxidil was originally used as an oral medication (Loniten)for high blood pressure and one of the side effects was that it grew hair all over the body. I would not say the mechanism when it works will work forever. A good summary which answers your questions is found here:
"Minoxidil needs to be applied once or the recommended twice daily, and may be used indefinitely for continued support of existing hair follicles and the maintenance of any experienced hair regrowth. To achieve maximum effect, the solution should be in contact with the scalp for at least 4 hours before allowing hair to get wet. Minoxidil stimulates hair follicles and growth, but does not reduce DHT or the enzyme responsible for its accumulation around the hair follicle, 5-alpha reductase, which is the primary mediator of male pattern baldness in genetically susceptible individuals. Therefore, when treatment is stopped, the DHT has its expected effect of shrinking and ultimately destroying the genetically predisposed hair follicles."