The internal method tries to control the main culprit, which is di-hydro-testosterone (DHT). The testes produce testosterone. This on its own doesn’t do the damage: it’s when the conversion into DHT occurs that can be the problem. DHT can cause many of the miniaturizing changes in the hair shaft, and takes place in the presence of 5-alpha-reductase.
The latest drug to help counter this is Propecia (Finasteride). Finasteride was originally used to treat benign prostrate enlargement. It blocks the enzyme 5-alpha-reductase and helps to reduce the conversion rate and therefore the miniaturizing effect on the hair follicles.
Theoretically, all well and good. And it sounds a wonderful way to stop (and they claim reverse) male hair thinning. ‘They’ are Merck Sharpe & Dohme, a pharmaceutical company.
I met with some of their Research and Development and Sales people in 2001 after they had sent me details of clinical trials. The trials’ results were as thick as a book and as intriguing as a good novel. The recommended dose to treat benign prostrate enlargement is 5mg a day. This dosage may reduce volume of ejaculation by 25 per cent, reduces the size of the prostrate by about 20 per cent and lowers
PSA (prostate specific antigen), the measurement of which indicates the degree of the prostate problem, by approximately 50 per cent.
At a dosage of 1mg a day for the treatment of male hair loss, none of these reductions occurred, although a small percentage noticed sexually adverse signs. It is interesting to note that in large long-term studies, 3.8 per cent of men taking Finasteride at 1mg a day noticed ‘erectile dysfunction’, but 2 per cent of those on placebo did, too! This indicates the psychological effects. In addition, the men on Finasteride noticed a considerable improvement in their hair after a year: 70 per cent reported no further hair loss and 37 per cent reported extra thickness. However, those on placebo also noticed an improvement, but less so: 44 per cent no further loss and 7 per cent extra hair. This was the front hair line and behind.
The crown area showed that 83 per cent on Propecia and 28 per cent on placebo had no further loss. Extra growth in the area was noticed in the Propecia users, and less so, but still significantly, in the placebo group. This also tends to indicate the ‘mind over matter’ aspect, but it does cast a certain amount of doubt on the methodology of the researchers. It’s not possible for a placebo to help over such a long period of time.
Theoretically, Propecia should help. Yet there is a further problem: there are two types of 5-alpha-reductase – Type I and Type II. It helps to block Type II but not Type I. So men with Type I of the enzyme may be unlucky.
Because I also believe that Propecia could be helpful, I have instigated a study in my clinic along with Dr Jeremy Gilkes, a dermatologist. It has recently started and will continue for at least another year or so. It is too early to judge, but the results so far are not as good as those given by Merck. As a form of treatment, I am certainly not against it, and those of you who wish to try it should do so – it may help and could help, but I don’t think to the extent that it’s claimed.