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For men or those assigned male at birth, hair loss is very common. In fact, according to the National Library of Medicine, more than 50 percent over age 50 will be affected by male pattern baldness, or androgenic alopecia, in one way or another.

It’s no wonder, then, that there are so many products and treatments designed to help with male hair loss. One of the most popular and effective medications is Propecia (the brand name of the drug finasteride).

Propecia is a brand name for the generic drug finasteride, which is a prescription-only oral tablet taken daily to slow down hair loss in men. It’s important to know that the drug cannot prevent male pattern hair loss, and it cannot regrow hair that has been permanently lost — instead, it stops hair loss in its tracks.

In 1997, the Food and Drug Administration (FDA) approved finasteride to treat male pattern hair loss. Though research suggests it’s an effective treatment, there are people who are unable to overcome some of the drug’s side effects, such as lower libido, erectile dysfunction, and decreased volume of semen.

Since June 2022, the FDA has also required a disclosure that the drug could increase the risk of depression or suicidal behavior.

Pros

  • It’s efficient: People who have consistently used the medication found that it slowed down hair loss and thickened thinning hair.
  • Some have noticed more hair on top of their head: This is due to rejuvenation of dormant follicles.
  • Works well for slowing down male pattern baldness: While it can impact any place you have hair, it’s been well studied for this type of hair loss.
  • Should notice a benefit starting after 3 months: You’ll start seeing it working as long as you take it consistently, once a day, as directed by your doctor.

Cons

  • There may be sexual side effects: These include diminished sex drive, erectile dysfunction, and a decreased semen volume.
  • It requires consistent use: Once you start taking the pill daily, you have to continue taking it to see results.
  • There may also be mood side effects: Some users have reported depression as a common side effect. It can also increase the risk of suicidal ideation.
  • Not safe for people who are pregnant or children: According to the drug’s prescribing information, the drug is not intended for use in women and children.

Using the enzyme 5-alpha reductase, which is the enzyme involved in steroid metabolism, Propecia blocks the conversion of testosterone to the androgen dihydrotestosterone (DHT).

Testosterone is a hormone that’s present in both men and women, though men typically have more testosterone present in their bodies. According to the Society for Endocrinology, about 10 percent of testosterone in all adults is converted to DHT. Testosterone contributes to growth of body hair.

Propecia is FDA approved as a hair loss treatment in men only. It’s best used for men experiencing crown thinning or baldness.

Propecia can — and sometimes should — be used along with other preventive hair loss treatments, such as shampoos and other topical treatments.

This drug is not recommended for women of childbearing capacity because of the potential for fetal birth irregularities.

It’s important to note that, according to limited research, women who experienced hair loss after menopause have found success in using Propecia.

Propecia and all finasteride tablets are prescription only, which means you cannot buy the drug over the counter like a minoxidil treatment such as Rogaine. Unlike Propecia, which is taken orally, Rogaine is a topical treatment that dilates blood vessels in the scalp to synchronize the hair for an active growing phase.

Finasteride can also be compounded into a topical preparation for those who are unable or unwilling to take it orally.

If you’re interested in taking Propecia as a hair loss treatment, you’ll need to talk with your doctor to see if it’s the right treatment plan for you. If you’re looking for an online prescription, you can get generic finasteride via Hims and other telehealth platforms, which require virtual consultations.

Propecia is not usually covered by insurance and can cost around $70 a month, according to GoodRx. However, if you’re looking to save, you can pick up finasteride, which could be covered by insurance and costs as little as $10 a month.

A 2020 report points out that a finasteride patient noticed mood swings and sexual dysfunction, including low libido, difficulty achieving an orgasm, and overall loss of interest in sex. But the study also points out that overall, the drug is generally well tolerated.

While these sexual side effects will most likely stop once you stop taking the drug, the 2020 report also notes that long-term side effects include depression and anxiety, and they can occur even after a person stops taking it.

Post-finasteride syndrome (PFS) has also been reported in some users. It occurs in men who have taken finasteride orally and is often characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after finasteride treatment has ended.

Reviews for Propecia are generally mixed. Reviewers who give the drug a lower rating described negative side effects, including weight gain, brain fog, and low libido. Those who rate Propecia on the higher end instead noted the lack of side effects and wrote about how impressed they were with its effectiveness.

Some reviewers gave the drug a 50 percent rating. They typically discussed negative side effects, but it’s important to note that these side effects did not outweigh the improvement in the thickness of their hair.

Additionally, many people who took Propecia ended up switching to generic finasteride since it was typically had a lower price point.

Both Rogaine and Propecia target hair loss in men. Rogaine is a brand name for minoxidil. Both Rogaine and Propecia work in different ways to produce the same results.

Propecia is an oral tablet that blocks the conversion of testosterone, while Rogaine is a topical treatment that dilates blood vessels near hair follicles. In turn, this increases the blood flow and brings oxygen and nutrients to the hairs, allowing them to grow stronger, faster, and thicker. Essentially, the process creates a more nurturing hair growth environment.

Lastly, Rogaine can be bought over the counter (OTC), typically costing about $45 for a 3-month supply, while Propecia requires a prescription.

In addition to taking medication like Propecia, there are some things you can do to try to minimize hair loss, including:

  1. Be gentle with your hair: Generally, your hair can handle you tying it up out of your face, but if you consistently tie it into tight braids or use heat-styling tools like curling irons or straighteners every day, you’re going to start damaging it — and this can lead to hair loss.
  2. Get a good brush: Using a soft brush can help condition your hair cuticles, which ultimately can strengthen each strand, reducing the chance of breakage.
  3. Eat a nutrient-rich diet: Eat raw vegetables and fresh herbs like parsley, basil, or salad leaves, as well as foods rich in proteins (think: nuts, fish, white meat, and eggs) and vitamin A like spinach and sweet potatoes.
  4. Use mild shampoo: Try to avoid shampoos with harsh ingredients like sulfates, which can dry out or damage your hair. Instead, look for ingredients like coconut oil, which can strengthen your hair.
  5. Do not over-wash your hair: It can harm your hair and can eventually contribute to hair loss.
  6. Avoid bleaching your hair: These harsh chemicals can damage your hair over time, splitting the keratin molecules.
  7. Consider low-level light therapy: Low-level light therapy can help boost cell growth and repair.

It’s important to know that factors like thyroid issues, aging, and genetics can also cause hair loss.

Does Propecia work for hair loss?

Overall, yes. Doctors agree and studies support the claims that Propecia works to slow down hair loss. But it cannot regrow hair that has already been permanently lost.

Can women take Propecia?

No, women should not take Propecia, since it’s only FDA approved to treat hair loss in men.

However, Propecia has been given to postmenopausal women off-label, but there is limited evidence regarding its efficacy (effectiveness), and more research is required to further study this off-label use.

Anyone considering taking Propecia should consult a healthcare professional first.

The potential, though uncommon, sexual side effects like diminished sexual drive, decrease in erections, and a decrease in semen volume can be concerning deterrents for some people. Due to these possible adverse outcomes, some people may decide not to take Propecia or any other medication in this drug class.

But research and anecdotal responses suggest that Propecia has the ability to effectively slow the progression of hair loss and increase the likelihood of fuller, thicker hair growth over time.

Emily Rekstis is a New York City-based beauty and lifestyle writer who writes for many publications, including Greatist, Racked, and Self. If she’s not writing at her computer, you can probably find her watching a mob movie, eating a burger, or reading an NYC history book. See more of her work on her website, or follow her on Twitter.