For men, hair loss is very common. In fact, according to the U.S. National Library of Medicine (NLM), more than 50 percent of all men over the age of 50 will be affected by male pattern baldness in one way or another.
It’s no wonder why there are a plethora of products and treatments designed to help with male hair loss. One of the most popular medications is Propecia (otherwise known as finasteride).
FDA-approved in 1997, Propecia is a prescription medicine that treats male pattern hair loss. Though it has been proven to be an effective treatment, there are patients who are unable to overcome some of the drug’s side effects, such as lower libido, erectile dysfunction, and decreased volume of semen.
Propecia is a brand name for the generic version of finasteride, which is a prescription-only oral tablet taken daily to slow down the loss of hair in men. It’s important to note that the drug cannot prevent male pattern hair loss and it cannot regrow hair that has been permanently lost but instead stops hair loss in its tracks.
“It does a great job of preserving and even thickening up existing hair,” San Francisco-based double board-certified plastic and reconstructive surgeon, Dr. Sieber says. “It protects the native hair and does a great job of slowing down the thinning and falling out process.”
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. About 10 percent of testosterone in all adults is converted to DHT. However, testosterone is what contributes to growth in body hair.
“DHT is a derivative of the male hormone testosterone, which signals to the hair follicle to undergo miniaturization,” hair transplant surgeon at Ziering Medical, Dr. Rae Lynne Kinler, explains. “Over time, this leads to a finer, thinner, lighter hair shaft, which progressively gets smaller until the follicle no longer produces a hair shaft.”
Propecia and all finasteride tablets are prescription only, which means you can’t just pick it up over the counter like a minoxidil treatment such as Rogaine. Unlike taking Propecia orally, Rogaine is a topical treatment that dilates blood vessels in the scalp to synchronize the hair to be in 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 are interested in taking Propecia to treat hair loss, you’ll need to talk to 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. However, if you’re looking to save, you can pick up finasteride, which could be covered by insurance, and cost as little as $10 a month.
FDA-approved for men only, Propecia is best used for men experiencing crown thinning or baldness. Dr. Matthew Lopresti of Leonard Hair Transplant Associates explains that Propecia is, “typically the first-line therapy in nearly all men with crown thinning or baldness.” He specifically notes that Propecia doesn’t necessarily target the frontal areas, so those with a receding hairline may not see results.
Propecia can, and sometimes should be used in tandem with other preventative hair loss treatments, such as shampoos and other topical treatments.
Meanwhile, it is not recommended for women of childbearing capacity because of the potential for fetal birth defects. “It is absolutely not recommended for any woman of childbearing age, whether she plans to be pregnant or not,” Dr. Sieber says. “The drug does cause fetal malformations or abnormalities and can cause loss of a fetus, so it is recommended to be avoided completely in any woman of childbearing age.”
However, women who experienced hair loss after menopause has found success in using Propecia.
A 2020 report says a finasteride patient noticed mood swings and sexual dysfunction, including low libido, difficulty achieving an orgasm, and overall loss of interest in sex. However, the study also points out that overall, the drug is generally well tolerated.
“The side effects are relatively infrequent, but they can occur, so [they] are worth monitoring for when taking the drug,” Dr. Sieber seconds.
While these sexual side effects will most likely stop once you stop taking the drug, the 2020 report also notes long-term side effects include depression and anxiety can occur even after a patient stops taking it.
Post-finasteride syndrome (PFS) has also been reported for 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.
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. While Propecia is an oral tablet that blocks the conversion of testosterone, 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, it creates a healthier hair growth environment.
Does Propecia work for hair loss?
Can women take Propecia?
No, women should not take Propecia, since it’s only FDA-approved for men.
“There can be the potential of birth defects if a woman of childbearing age takes Propecia,” Dr. Lopresti states. However, all 3 doctors note that it is possible for post-menopausal women to be given it off-label, but there is limited evidence in efficacy. Anyone looking to take Propecia should consult their doctor prior to seeking a prescription for it.
How long does it take Propecia to work?
Dr. Lopresti notes that “Propecia must be used daily for at least 18 months to clinically assess the results of treatment.” With that being said, patients can start seeing results as early as 3 or 4 months.
From there, Dr. Sieber says that the effects build up around 12 months before they begin to plateau. “The hair is still being protected, but increased hair thickness may level out around 12 months or so,” he says.
Reviews for Propecia are generally mixed. Those who write low-rated reviews focus on the negative side effects, including weight gain, brain fog, and low libido. Those who rate Propecia on the higher end noted the lack of side effects and instead wrote about how impressed they were with its effectiveness.
Some patients gave it a 50 percent rating. They typically notice negative side effects, but these side effects didn’t outweigh the improvement in the thickness of their hair.
Additionally, many people who took Propecia ended up switching to generic finasteride since it’s a more affordable option.
The potential, though uncommon, sexual side effects, such as diminished sexual drive, decrease in erections, and a decrease in the volume of semen is a major deterrent for some people. Due to these ramifications, some people gave up on the drug altogether.
“It is important to be educated about possible side effects before starting the drug. Talking to your doctor is the best way to make sure you are a good candidate to start taking Propecia,” Dr. Sieber says.
However, there seems to be no denying Propecia’s ability to effectively slow down the progression of hair loss for years of fuller, thicker hair for men.
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.