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Not willing to accept time's inevitable
march, Wixom last year began taking a once-a-day experimental drug that has restored
not only his hair but his self-esteem as well. It's the same drug that made international
headlines in January when it was approved by the US Food and Drug Adminstration as
the first pill used to treat male pattern baldness.
Propecia, also known as finasteride, was tested on more than 1500 men, ages
19 to 41, in a yearlong study that showed the drug help about half grow varing amounts
of hair, according to the FDA. Manufacutred by New Jersey based Merck & Co Inc,
the drug costs an estimated $45-$50 per month.
Until Propecia's approval, the only alternatives for the nation's 40 million
balding men were toupes, costly transplantsor Rogaine, a nonprescription slather-on-the
-scalp remedy sold on the shampoo aisle. Propecia is no quick fix. Most might
have to take it for six months to a year before they can tell if it works for them.
And if they stop taking the drug, they'll lose the hair they've regrown.
Propecia works by suppressing a hormone that shrinks hair follicles, causing
hair loss. Studies show it helps regrow hair in follicles that remain alive after
the hair has fallen out and prevents further hair loss. The baldness pill is a lower
dose form of a widely used drug called Proscar, which millions of older men have
taken for years to ease enlarged prostates. But because younger men are expected
to pop the new baldness pill for many years, FDA scientists looked closely at side
effects.
One Small Hitch
They found one small hitch. A small percentage
of men experienced sexual side effects such as decreased desire, difficulty in achieving
erection and a drop in the amount of semen produced. That fact, although reported
in only 2 percent of participants- about 30 of the more than 1500 men- played a large
role in the media coverage of Propecia. It was perhaps a detail too intriguing
to downlplay: A pill that helps men grow their hair also could steal their ability
to "perform."
"There is an irony there," Merck spokesman Christopher Allman said. "You
have a drug that treats male pattern hair loss, but a side effect can be loss of
libido." The focus on the potential side effects angered one Santa Monica physician.
Elliot Felman has been prescribing Propecia for more than two years to about 300
patients. He said the majority of his patients report little or no sexual dysfunction.
And since he's been prescribing the drug for quite awhile, Felman believes his numbers
are more accurate-and says they are more impressive- than the FDA's. About 70 percent
of Felman' s patients showed varing hair growth, with 1 percent to 1.5 percent reporting
decreased sexual function.
"This is a remarkable drub. I haven't seen any evidence that indicates people
can't take it for an indefinite period," Felman said.
Allman said sales figures for Propecia since FDA approval are not yet available,
but he believes the potential side effects will not dampen the drug's popularity.
"There's definitely been a lot of consumer interest," he said. Beverly
Hills dermatologist Marvin Rapaport, a clinical professor at UCLA, was among the
physicians who participated in nationwide clinical trials for Merck & Co. Rapaport
who considers himself conservative when it comes to cosmetic drugs, gave Propeica
a strong endorsement. "The results are quite good." said Rapaport, who
monitored the progress of 20 study participants over several years.
Doctor Urges Caution
Santa Monica's Dr. Michael McGuire, however,
urges caution. "The Phen-fen tragdies shoudl have made everybody aware of the
potential problems with any drug taken long term that hasn't been adequately studied,"
said McGuire, chief of plastic surgery at St. John's Health Center in Santa Monica
and an associate clinical professor at UCLA.
McGuire recommends surgery. Although more expensive, it has no side effects. "
This drug was designed to treat prostate enlargement," he said. "Dealing
with baldness can be a lifetime thing, and the drug will be used in a younger population
over a longer period of time. The undesirable side effects could pose a much greater
threat to a man's ego and masculinity than any amount of hair loss."
Peter Pangotacos, 58, a San Francisco dermatologist specializing in hair transpolants,
doesn't believe there will be long-term side effects. He's so confident, he has been
taking Propecia for his own thinning hair for four years. "It's the only
thing we have right now to prevent aging of the hair follicle," he said. "I
try to get every one of my patients on it." The alternatives are expensive or
ineffective, he contends.
Rogaine, for example, stimulates hair to grow in an artificial manner, producing
fluffy strands more like that found on a woman's arms than the thicker version that
grows on a man's head, Propecia advocates said. The latest technology in hair
transplantation, called micro grafts, provides a more natural look than the so-call
plug technique used previously, Panagotacos said. But the cost can be prohibative,
with a single treatment costing as much as $10,000.
It's his contention that the side effects, in men who suffer them, are fleeting and
disappear within six months to a year of taking Propecia. Felman agrees, saying
only two of his 300 patients stopped taking the drug because of decreased sexual
function. Because Propecia is a lower dose version of Proscar, Felman was
able to prescribe it it 1 milligram pills before FDA approval.
90% of Hair Returns
Wixom was among those patients. He's been
taking Propecia for more than a year and says 90 percent of the hair he lost
has grown back. He has experienced no sexual problems. "I didn't consider this
a gamble," Wixom says. "I thought about it for maybe two seconds and decided
a little loss of my sexual drive in a Faustian swap for a chance at getting my hair
back was OK."
Before-and-after-pictures of Wixom show a dramatic change in his hair growth. A photo
taken in November of 1996 shows moderate to heavy loss on the top of his head with
the hairline receding on both sides, typical of male pattern baldness. A December
1997 photo shows no balding on top and no further recession of the hairline.
Although he figured he'd lose his hair one day- his maternal grandfather is bald-
Wixom didn't think it would bother him. He was wrong. "It affects you,"
he said. "You look at yourself differently."
Baldness can be even more brutal in an image-obsessed town such as LA, said Brentwood
psychologist Yvonne Thomas, who specializes in body image. "Good looks are so
highly valued by our society, and losing one's hair is something you can't easily
cover up," she said. "It can create a lot of feelings. Some men feel less
valuable, less special. Others feel depression and a sense of grieving over the loss."
Taking a pill to grow hair may not be a blam for underlying feelings of worthlessness,
but for those experiencing what would be considered a normal reaction to hair loss,
Propecia could be valuable, Thomas said.
"If someone is willing to take certain steps to better themselves, that's one
thing," she said. "If they're desperately trying to cling to being young,
that may show a deeper problem. Until a person can learn to accept themselves as
they are, it's going to be difficult for them to feel valuable."
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