What are the options for treating hair loss?

References At the Update Pharmacy, a man with a private prescription has been referred to pharmacist David Spencer. The man says: "I read about Propecia for hair loss. I went to my doctor, but he said it's not available on the NHS and gave me this private prescription. I've been to another chemist with it but they asked an exorbitant price. What's your price?" David takes the script, calculates the price and quotes it to the man, who says: "That's a bit less than the last chemist wanted, but it's still very expensive. What about generic Propecia, how much would that cost?" "As far as I know, there is no generic form of Propecia," David says. "Oh yes there is. I've found it on the internet, and it's less than a fifth of the price you're asking." "Was it on a UK website?" David asks. "I found several sites, actually. The one I liked was in the US. It said that their generic Propecia was exactly the same as the US brand, but made in India by a reputable drugs manufacturer. The UK websites charge even more for Propecia than you are asking. They make you go through an online consultation with a doctor first and then supply the UK licensed brand." "And that's all I can supply, too," replies David. "Well, is there anything else that's effective that you can sell me? And is it any cheaper than Propecia?" asks the man. Questions 1. What is Propecia and how does it work? 2. How effective is it? 3. What is ‘generic Propecia'? 4. What other licensed medicine(s) is/are available? How effective is/are they and how does the price compare with Propecia? Answers 1. Propecia (finasteride 1mg tablets) is a treatment for male pattern baldness. This hair loss is believed to be caused by an increased sensitivity of hair follicles to dihydrotestosterone, which tends to increase with age. Finasteride is a competitive and specific inhibitor of type II 5-alpha reductase, which converts testosterone to dihydrotestosterone. Finasteride blocks this conversion, significantly decreasing serum and tissue concentrations. In larger doses finasteride is used in the treatment of benign prostatic hyperplasia. 2. The manufacturer states that, generally, three to six months of once-daily treatment are required before evidence of stabilisation of hair loss can be expected. Continuous use is recommended to sustain benefit. If treatment is stopped, the beneficial effects begin to reverse by six months and return to baseline by nine to 12 months. 3. Finasteride 1mg produced outside the EU. It is not licensed for use in the UK. 4. Minoxidil 5 per cent lotion or foam (Regaine), a potent, direct-acting peripheral vasodilator, originally developed for the treatment of hypertension. A side effect is the encouragement of hair growth, which has been exploited to treat baldness. Clinical trials have reported some hair regrowth in 20 to 90 per cent of subjects, but it is effective only for as long as it is used.1-4 The trade price per day's treatment is about two-thirds that of Propecia. References 1. Savin RC. Use of topical minoxidil in the treatment of male pattern baldness. J Am Acad Dermatol 1987; 16: 696–704. 2. Kuan YZ, Chen SY, Chen MJ, et al. Safety and efficacy of 2 per cent topical minoxidil in the management of male pattern baldness in Chinese. Changgeng Yi Xue Za Zhi 1990; 13: 96–103. 3. Connors TJ, Cooke DE, De Launey WE, et al. Australian trial of topical minoxidil and placebo in early male pattern baldness. Australas J Dermatol 1990; 31: 17–25. 4. Karam P. Topical minoxidil therapy for androgenic alopecia in the Middle East. The Middle-Eastern Topical Minoxidil Study Group. Int J Dermatol 1993; 32: 763–766.