The Hair Piece: Are Rogaine and Propecia the Answers to Balding Woes?

Blame it on the media, VCRs at weddings, even the comb-over falling out of favor. Any way you look at it, balding (or hair loss, if you prefer) is getting a lot of exposure these days. One major cause is that after years of products heralded as hair-savers -- but in reality being little more than money wasters -- there are finally two treatments available that work, to some extent, in some people. Yes, Rogaine (minoxidil) and Propecia (finasteride) now provide hope for the approximately 50 million Americans (20 million of them women) who are losing their hair and up until this point have had few viable options beyond toupees, transplants, and sucking it up and shaving off the last few strands. While the cause of male and female pattern baldness (androgenetic alopecia) is unknown, 95 percent of cases are blamed on genetics, according to Arthur Jacknowitz, Pharm. D., chairman of the department of clinical pharmacy at West Virginia University. And you get to blame both parents for this one, contrary to popular myth that only the mother's genes are responsible for whether you look like a well-fed Chia pet or a cue ball. Because the mechanism that triggers balding remains unclear, finding treatments for the problem have been difficult. The two being used now were found to work by accident.Rogaine, an over-the-counter topical cream applied twice daily to the scalp, was actually developed in the 70s to treat high blood pressure and has been approved to treat hair loss since 1988. Propecia, a prescription pill, was first marketed to treat enlarged prostates and has been available at one-fifth the dosage to treat hair loss since 1998. Though neither drug is a cure for baldness, they've both been shown to slow or stop hair loss in up to 80 percent of cases, and to stimulate hair growth in more than half the people taking them, according to Wilma Bergfeld, M.D., head of clinical research for the department of dermatology at the Cleveland Clinic in Ohio. However, in many instances the hair that is regrown is fine, white hair, referred to as fleece, and a weak substitute for normal hair. Exactly how the drugs fights hair loss remains somewhat of a mystery. Gary S. Hitzig, M.D., a New York hair transplant surgeon and author of the book "Help and Hope for Hair Loss," says Rogaine works by awakening follicles that are "resting" and not currently producing hair. "It takes lazy ones and kicks them a bit," he says, "making more follicles active."Rogaine is available in two- and five-percent strengths. While the five percent works more quickly, some people find its consistency too greasy and prefer to stick with the two percent. (Attention women: Don't be fooled by the pink box containing two-percent solution. It's a marketing ploy. The five percent is safe for you too.) Hitzig believes Rogaine is actually more effective in women than men because it works best on hair that is thinning overall, as women's hair tends to do, rather than on bald patches, which is how men generally lose hair.Propecia works by lowering the production of dihydrotestosterone, a male hormone thought to cause hair loss. The drug is not an option for women as it can cause birth defects in their offspring and has been found to be ineffective in postmenopausal women. There are no studies to back up the safety or efficacy of using the two drugs in combination, but Bergeld says such treatment has been shown to enhance hair growth in men who have tried it.While these treatments have been lifesavers (or at least hair savers) for many, they're not effective for everyone. In general, the younger someone is and the less hair they've lost the better candidate they are. People between 25 and 35 who've been losing hair for less than five years and have only small bald patches have the best shot. It's important to be aware that both drugs can cause hair loss, or shedding, when treatment is first begun. This usually stops after a couple months but can be alarming. In addition, Rogaine's most common side effect is scalp irritation, experienced by fewer than two percent of users. Propecia's most known side effect is not as innocuous. The drug's impotence-inducing ability has received almost as much air time as Monica Lewinsky's pursuits. Studies have shown impotence to be a problem for just two percent of the drug's users, but Spencer David Kobren, author of "The Bald Truth" and host of a radio program by the same name, places the figure closer to five or six percent based on word-of-mouth.A Propecia-popper himself, he says he's never experienced the side effect (wink wink) and thinks a placebo effect may be taking place."I know guys who just get the prescription and they can't get it up," he says. But beyond that, a larger question looms. Is it worth it to take medications for a purely cosmetic reason when their potential long-term side effects remain unknown?While both drugs have received fairly clean bills of health for the short term, once started they must be taken indefinitely (or all benefits will be lost), and right now there's no way to know what could result from decades of use. Kobren doesn't see it that way. He says that when a person starts losing their hair their entire life changes."Instead of looking at the hair on their head they look at the space in between their hair. It becomes magnified."He says he hears from many people, particularly women and young men, who feel so helpless and upset by their hair loss they've considered suicide and therefore he sees this as a quality-of-life issue, not a cosmetic one. But just because the drugs are relatively easy to get your hands on doesn't mean it's an open invitation to do whatever it takes to regrow hair. Hitzig recommends being monitored by a doctor even in the case of Rogaine, a precaution he says is not an attempt to help doctors earn some extra cash. "I think the worst thing that ever happened was Rogaine becoming over the counter. When people are under a doctor's care they're not going to start freebasing, so to speak," he says, referring to one patient who was using mega-doses of a seven percent version of Rogaine she got overseas. Like many people, the woman had no idea that Rogaine could theoretically cause heart, liver and kidney damage if it entered the body in high doses. While the medication is used topically, it's possible for it to be absorbed by the body. Propecia too has the remote possibility to cause liver damage, though so far none has been reported in the drug's users. In the end it's up to the individual to decide whether the expense (treatment can run from $20 to $50 a month), trouble and potential long-term risks outweigh the possible benefits of treatment.It may be a decision that gets even more complicated, but also more promising, in the near future. Thanks to the accidental findings that Rogaine and Propecia can work, scientists are now working on treatment approaches tailored specifically to hair loss. Everything from higher-strength Rogaine to enzyme-blocking drugs, shampoos that increase and thicken hair and cloning techniques are in the works and may be available in the near future. "Within five years it's all going to be over," Kobren predicts of the plight of baldness, though notes it may take longer for new treatments to reach the U.S.But while the technology to keep hair on people's heads may eventually be within reach, it seems unrealistic to assume that everyone will be able to, or even choose to take advantage of it.

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