The facts about Proscar, Propecia and other hair loss treatments

Is it a troll doll? Is it a guinea pig? No, it's Donald Trump's hair.

We discovered this month that it's not, in fact, a toupee but his real hair, according to Trump's personal physician Dr. Harold N. Bornstein, who himself has an almost unfeasibly long flowing mane. This is relevant because they both credit the same wonder-drug pill for their remarkable hirsuteness: Propecia.

The accidental wonder drug

Propecia is a repackaged prostate cancer drug that has been hailed a miracle cure for male pattern baldness. It started life as a drug branded 'Proscar.' Both contain the same active ingredient: Finasteride, which reduces the conversion of testosterone to dihydrotestosterone. In plain talk, in the case of the original drug, Proscar, Finasteride shrinks enlarged prostates. A curious side effect was that men stopped losing their hair and in 65 per cent of cases, hair thickened and grew back. A pharmaceutical giant, Merck, smelt a money-making opportunity, and re-marketed the drug at a much higher price.

Save money and save your hair

The difference between Proscar and Propecia is the amount of active ingredient, Finasteride, they contain: Propecia has five times less. This means there's a cheaper way to take the drug: buy Proscar (or cheaper still, generic Finasteride) and use a pill cutter to chop each pill into five. I introduced my own doctor to this trick in 2011 and persuaded her to prescribe me one fifth of a tablet daily. For the three previous years, I'd paid $1,200 annually for Propecia. With my new prescription for one fifth of Proscar, the cost went down to $50 a year.

Libido

But for every reasonable price, there's a cost. Here, it could be your sex drive. Cutting the small pill into five is fiddly and you risk overdosing and tampering with your testosterone to the point of killing your libido. Even taking a regular dose of Propecia could result in this: between 3.4 percent and 15.8 percent of men using the product report sexual dysfunction, such as erectile dysfunction and decreased libido, or even a decrease in the volume of ejaculate. Not something you really like to think about when it comes to Donald Trump.

That said, some men actually claim Propecia increased their libido, as journalist Patrick Strudwick reported when footballer Wayne Rooney hit the headlines for taking it and appearing, well, hairier.

I approached a spokesperson for Merck Sharp & Dohme Australia, who manufacture Propecia and gave them the opportunity to refute or dilute widespread reports that the drug kills men's sex drive. Their response: "Propecia and the generic forms of the medicine (finasteride) are prescription only medicines. Patients should discuss use of this medication with their relevant healthcare professional."

Stigma

Two men I approached for this piece told me Propecia had killed their sex life altogether, but didn't want to go on the record. Even taking other hair loss treatments caused embarrassment: all interviewees requested either anonymity or first name only, and no facial pictures. Like Trump, it seems men will go to any lengths to convince the outside world it's all real and all natural.

Other side effects

Propecia can have other worrying effects, too. Since 2011, at least 1,245 lawsuits have been filed against Propecia's manufacturer, Merck, alleging that the company didn't sufficiently warn users of sexual and cognitive side effects (some patients have linked it to depression). It's led some to headlines questioning whether the leader of the free world should be taking it. And he should certainly keep it away from Melania and Ivanka: health officials warn that if women even touch finasteride, it can lead to genital malformations in unborn boys.

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Other hair loss treatments

With that in mind, you may like to try other cures. Dr Eleni Yiasemides, consultant dermatologist specialist, walked me through them:

Nutrition: very little research behind nutritious eating, vitamins or supplements and hair loss.

Laser: No scientific evidence of its effectiveness.

Topical Minoxidil: Available over the counter, roducts which contain 5% Minoxidil are considered to be the most effective in regrowing hair. Minoxidil works by helping the blood flow to the hair follicles and increasing follicular size and hair shaft diameter, stimulating and prolonging hair growth. But can take up to 6 months to work.

Hair transplant

Ryan, 34, lives in Queensland, but chose not to give his surname. He received a hair transplant from DHI Australia via extraction of donor grafts - follicles were taken from the side and back of his head because they're less prone to male pattern balding. A tool made holes in his scalp to implant them.

Ryan started losing his hair aged 20 and was "tired of having no confidence for 14 years." He'd tried both Regaine and finasteride but wanted "a more permanent solution - I didn't want to take these for the rest of my life." He'd previously tried a laser comb which was supposed to promote blood flow to the scalp, but to no effect.

He's now back on finasteride - hair transplant patients are recommended to take it because it helps as the old hair sheds out and new hair grows back as permanent.

A pricey risk

For many, a hair transplant is the ultimate solution. But it's not for the faint hearted: it has cost Ryan $40,000. And it can be painful. There are two types - follicular unit transplantation, and follicular unit extraction. FUT means less time off work to recover. FUE means less time away from physically strenuous activities.

Patience is also key. During the "shredding" phase, Ryan's confidence was still fragile (he charted his progress with this diary): "You lose all your transplanted hair and it takes three months. But when it starts growing back, that's when it starts getting exciting. Yes, it's expensive, but what price can you put on getting your confidence and your life back?"

What treatments have you used to prevent hair loss? Tell us in the comments section below.

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