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Q: effectiveness of propecia in stopping a receding hairline ( Answered 5 out of 5 stars,   0 Comments )
Question  
Subject: effectiveness of propecia in stopping a receding hairline
Category: Health
Asked by: gremlin-ga
List Price: $2.00
Posted: 05 May 2003 16:59 PDT
Expires: 04 Jun 2003 16:59 PDT
Question ID: 199915
I saw the following statistic online: "In clinical trials, the drug
was shown to stop hair loss in 83% of men, and 66% reported increased
hair growth" However, that was from a site that was selling hair care
products, so it's likely they picked the most optimistic study they
could find. Can you find an unbiased source (say, a government health
site, or some other site that looks authoritative and isn't trying to
sell propecia) that can either confirm or refute these statistics?
Answer  
Subject: Re: effectiveness of propecia in stopping a receding hairline
Answered By: tehuti-ga on 05 May 2003 18:15 PDT
Rated:5 out of 5 stars
 
Hello gremlin,

When I want relatively objective information on a drug or other
medical topic, I always go to the journal literature as indexed in the
Medline database at the National Library of Medicine.  This is because
journal articles are peer reviewed, so it is less easy for unreliable
information to be submitted.

First, I found on Medical Web that the generic name of Propecia is
Finasteride http://www.medicalweb.com/drug_list.cfm
I used the following search strategy on Medline:
("Finasteride"[MeSH]OR propecia) AND "Alopecia"[MeSH]  I used
“alopecia” because that, rather than “baldness” or “hair loss” is the
term used by Medline indexers, so using it guarantees pulling out all
the relevant records.  I limited the search to articles about human
males.

Altogether, there were 95 articles.  I then limited the search to
clinical trials and obtained 16 articles. From these I eliminated some
which were not about effects on hair loss, and a couple for which no
summary was available, as well as one for which the summary was
uninformative, and ended up with the following 9 reports.  The URLs
lead to the summary in each case, and I have also summarized or cited
the pertinent information from each.

1:  Khandpur S, Suman M, Reddy BS. 
Comparative efficacy of various treatment regimens for androgenetic
alopecia in men.
J Dermatol. 2002 Aug;29(8):489-98.
“One hundred male patients…  were enrolled in an open, randomized,
parallel-group study, designed to evaluate and compare the efficacy of
oral finasteride (1 mg per day), topical 2% minoxidil solution and
topical 2% ketoconazole shampoo alone and in combination…. At the end
of one year, hair growth was observed in all the groups with best
results recorded with a combination of finasteride and minoxidil …
Subjects receiving finasteride alone or in combination with minoxidil
or ketoconazole showed statistically significant improvement (p<0.05)
over minoxidil only recipients.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12227482&dopt=Abstract

2:  Price VH, Menefee E, Sanchez M, Ruane P, Kaufman KD. 
Changes in hair weight and hair count in men with androgenetic
alopecia after treatment with finasteride, 1 mg, daily.
J Am Acad Dermatol. 2002 Apr;46(4):517-23.
Placebo controlled study of 66 men. “finasteride, 1 mg, increased hair
weight… Hair weight increased to a larger extent than hair count,
implying that factors other than the number of hairs, such as
increased growth rate (length) and thickness of hairs, contribute to
the beneficial effects of finasteride”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11907500&dopt=Abstract


3:  [No authors listed] 
 Long-term (5-year) multinational experience with finasteride 1 mg in
the treatment of men with androgenetic alopecia.
Eur J Dermatol. 2002 Jan-Feb;12(1):38-49.
This is a multicenter trial called Finasteride Male Pattern Hair Loss
Study Group. “1,553 men… were randomized to receive finasteride 1
mg/day or placebo, and 1,215 men continued in up to four 1-year,
placebo-controlled extension studies… Treatment with finasteride led
to durable improvements in scalp hair over five years… while treatment
with placebo led to progressive hair loss. Finasteride was generally
well tolerated and no new safety concerns were identified during
long-term use. CONCLUSIONS… long-term treatment with finasteride 1
mg/day over five years was well tolerated, led to durable improvements
in scalp hair growth, and slowed the further progression of hair loss
that occurred without treatment.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11809594&dopt=Abstract

4:  Stough DB, Rao NA, Kaufman KD, Mitchell C. Finasteride improves
male pattern hair loss in a randomized study in identical twins.
Eur J Dermatol. 2002 Jan-Feb;12(1):32-7.
“nine pairs of male identical twins… one twin from each identical twin
pair received finasteride 1 mg/day for one year while the other
received placebo… Finasteride significantly improved hair growth at
one year compared to placebo… based on analysis of photographs of the
vertex and superior-frontal scalp. These results were consistent with
the hair count change measured in the finasteride group, which was
superior… to the change measured in the placebo group. Patient
self-assessment demonstrated that treatment with finasteride, in
comparison to placebo, led to improvements in scalp hair growth and
patients' satisfaction with appearance of hair.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11809593&dopt=Abstract
 
5:  Trueb RM, Itin P. 
 [Photographic documentation of the effectiveness of 1 mg. oral
finasteride in treatment of androgenic alopecia in the man in routine
general practice in Switzerland]
Schweiz Rundsch Med Prax. 2001 Nov 29;90(48):2087-93. German.
Study in 265 men “54% of patients showed improvement of hair growth at
6 months of treatment in the vertex region, and 48.7% in the frontal
area. No progression of hair loss was found in an additional 38%
(vertex) and 47% (frontal region), respectively.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11770252&dopt=Abstract

6:  Van Neste D, Fuh V, Sanchez-Pedreno P, Lopez-Bran E, Wolff H,
Whiting D, Roberts J, Kopera D, Stene JJ, Calvieri S, Tosti A, Prens
E, Guarrera M, Kanojia P, He W, Kaufman KD.
 Finasteride increases anagen hair in men with androgenetic alopecia.
Br J Dermatol. 2000 Oct;143(4):804-10.
“Two hundred and twelve men, age 18-40 years… finasteride 1 mg daily
or placebo for 48 weeks… treatment with finasteride 1 mg day(-1) for
48 weeks increased both total and anagen hair counts, and improved the
anagen to telogen ratio. CONCLUSIONS: These data provide direct
evidence that finasteride 1 mg daily promotes the conversion of hairs
into the anagen phase. These data support that finasteride treatment
results in favourable effects on hair quality that contribute to the
visible improvements in hair growth observed in treated patients.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11069460&dopt=Abstract

7:  Roberts JL, Fiedler V, Imperato-McGinley J, Whiting D, Olsen E,
Shupack J, Stough D, DeVillez R, Rietschel R, Savin R, Bergfeld W,
Swinehart J, Funicella T, Hordinsky M, Lowe N, Katz I, Lucky A, Drake
L, Price VH, Weiss D, Whitmore E, Millikan L, Muller S, Gencheff C, et
al.
 Clinical dose ranging studies with finasteride, a type 2
5alpha-reductase inhibitor, in men with male pattern hair loss.
J Am Acad Dermatol. 1999 Oct;41(4):555-63.
“Two separate clinical studies were conducted to establish the optimal
dose of finasteride in men with this condition.” (The numbers of
subjects are not reported) “Men from 18 to 36 years of age with
moderate vertex male pattern hair loss received finasteride 5, 1, 0.2,
or 0.01 mg/day or placebo…  Efficacy was demonstrated for all end
points for finasteride at doses of 0.2 mg/day or higher, with 1 and 5
mg demonstrating similar efficacy that was superior to lower doses.
Efficacy of the 0.01 mg dose was similar to placebo…  CONCLUSION:
Finasteride 1 mg/day is the optimal dose for the treatment of men with
male pattern hair loss”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10495375&dopt=Abstract

8:  Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D,
Kraus S, Baldwin H, Shalita A, Draelos Z, Markou M, Thiboutot D,
Rapaport M, Kang S, Kelly T, Pariser D, Webster G, Hordinsky M,
Rietschel R, Katz HI, Terranella L, Best S, Round E, Waldstreicher J.
 Finasteride in the treatment of men with frontal male pattern hair
loss.
J Am Acad Dermatol. 1999 Jun;40(6 Pt 1):930-7.
“This was a 1-year, double-blind, placebo-controlled study followed by
a 1-year open extension.”  Although numbers of patients are not
reported, the study is described by Medline as being multi-center,
which implies a large number of subjects. “There was a significant
increase in hair count in the frontal scalp of finasteride-treated
patients (P < .001), as well as significant improvements in patient,
investigator, and global photographic assessments. Efficacy was
maintained or improved throughout the second year of the study.
Finasteride was generally well tolerated. CONCLUSION: In men with hair
loss in the anterior/mid area of the scalp, finasteride 1 mg/day
slowed hair loss and increased hair growth.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10365924&dopt=Abstract

9:  Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W,
Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz
B, Gormley GJ.
 Finasteride in the treatment of men with androgenetic alopecia.
Finasteride Male Pattern Hair Loss Study Group.
J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89.
 “In two 1-year trials, 1553 men (18 to 41 years of age) with male
pattern hair loss received oral finasteride 1 mg/d or placebo, and
1215 men continued in blinded extension studies for a second year….
Treatment with placebo resulted in progressive hair loss. Patients'
self-assessment demonstrated that finasteride treatment slowed hair
loss, increased hair growth, and improved appearance of hair. These
improvements were corroborated by investigator assessments and
assessments of photographs. Adverse effects were minimal. CONCLUSION:
In men with male pattern hair loss, finasteride 1 mg/d slowed the
progression of hair loss and increased hair growth in clinical trials
over 2 years”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9777765&dopt=Abstract

While I was unable to find exactly the statistics you quoted, the
general conclusion of several studies, some large, is that Propecia is
indeed beneficial in stopping hair loss and promoting hair growth. 
The statistics you found could well relate to one of the above
studies, since the summaries frequently do not give all the
quantitative data.  You could always contact the web site where you
found the data and ask the company to provide you with a bibliographic
citation to the relevant study.

Clarification of Answer by tehuti-ga on 05 May 2003 18:59 PDT
I also found an article on Male Pattern Baldness from the American
Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ6Q72SWAC&sub_cat=300

Among other things, it says "Finasteride works by inhibiting the
conversion of testosterone to DHT, decreasing the levels of DHT in the
blood and scalp. In this way, finasteride helps to block
androgen-dependent degradation of hair follicles. In a recent study,
nearly half of the men who took finasteride grew hair on the scalp,
and the drug was even more effective at halting hair loss. A
significant percentage did, however, continue to report hair loss."
gremlin-ga rated this answer:5 out of 5 stars

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