From the standpoint of wanting to do everything you can to stem the tide of your hair loss, upon first glance it seems obvious that you should use Propecia or one of its cousins — Proscar (cut up into quarter to get 1.25mg), or Finpecia (a generic Propecia), all of which have the same active ingredient: Finasteride. It seems obvious because of the mounds of clinical data and studies that clearly show that for the majority of men Propecia stops their hair loss, and for some men it regrows some of their hair.
There is only one other that carries an equivalent amount of documented clinical clout and that’s topical Minoxidil. But that’s another story for another day. But is there any reason to not use Propecia if you’re losing your hair? Well, for starters, if you’re a woman that wants to bear children or is planning to do so then you certainly should not use Propecia because it can cause birth defects in the genitilia of developing fetuses. If you’re a man it becomes a bit more complicated for several reasons.
First, there are the documented sexual side-effects. In a very small percentage of men Propecia can cause decreased libido and/or decreased ejaculate volume. If you happen to be one of the unlucky few who experience this side-effect however, it goes away when you stop using Propecia. But for most men it’s a frightening thought anyway (to say the least). But since the risk is small and since the side-effects go away immediately upon discontinuing the use of Propecia, it’s my opinion that this particular problem should not stop you from trying it. Obviously if you have the side-effect then you should discontinue it immediately. But we still have other things to consider.
For instance, there are topical alternatives to Propecia. Some are easy to get and have good science behind them, such as topical Spironolactone (Dr. Lee’s from www.minoxidil.com is good one) or Revivogen (a combination treatment, see www.revivogen.com). Others are not so easy to come by, such as pure linoleic or gamma-linoleic acid. The topical alternatives are, for the most part, good alternatives if you are concerned about potential long-term side-effects, or if you don’t want to use something that is systemic (meaning it effects the whole body as opposed to in the case of hair loss, the scalp). For the past year I have focused my own regimen primarily on topical treatments, with Revivogen acting as my topical dht-inhibitor/anti-androgen or my Propecia replacement as it were. Only recently have I considered adding Propecia to my regimen again, because I was concerned that although the topicals are good, I only apply them once a day so I don’t get the coverage I would get from using a systemic treatment.
There is also another consideration with regards Propecia and prostate cancer, namely that it reduces the risk of getting prostate cancer, but those people that took Propecia and did get prostate cancer had an increased risk of being diagnosed with a particularly aggressive form of the cancer that has a high likelihood of being fatal. What this means is that less people that use Propecia get prostate cancer, than people that don’t use Propecia, but of those who do get prostate cancer who are using Propecia, there is a higher risk that it is a worse form of prostate cancer.
My personal take on things now is, in order to keep things as simple and effective as possible, for most men it makes sense to use Propecia in conjunction with a good growth stimulator like topical Minoxidil (or Xandrox15, which is 15% Minoxidil, 5% azeleic acid) to get the best chances of keeping your hair and regrowing some of the hair you have lost. I think when you weigh all the risks the science so far shows it to be a fairly safe drug. Don’t go actively looking for whether you are experiencing side-effects because you may trigger a placebo effect for yourself. Even some of the people in the placebo group (sugar pill group) in the clinical studies reported sexual side-effects! You’ll know if you experience any side-effects from Propecia, in which case you should stop.