Dear Dr. Rassman,
Could you talk a little bit more about what you see over long-term with results with Propecia? Let’s start with the assumption that nine of 10 patients will have not lose hair from baseline at year 5.
At year 10, what percentage of patients would you say have a very noticeable decrease in hair, what percentage have a modest decrease in hair, and what percentage do not have any visible decrease in hair? I, for instance, have modest diffuse thinning-just barely visible to the naked eye. It has been diagnosed as MPB. I started on Propecia and minoxidil a few weeks ago, and am just looking for rough probabilities that 5 and 10 years from now, I will still have reasonably good hair coverage.
I know there are no hard and fast numbers and no clinical studies beyond the 5 year point, but any rough estimates would be great.
Your assumption that 9 of 10 patients will not lose hair from baseline is incorrect. Almost all patients will lose hair from baseline, because Propecia is not a cure! The rate of hair loss will be slower, but you still continue to lose some hair. Some will lose more hair and some will lose less hair, as it mainly depends on their genetic predisposition. That’s why I always tell folks here to get their miniaturization mapping done so that you have a baseline status at different regions of your scalp. This way you can track the progress of hair gain/loss.
As you know, the actual study was for only a 5 year time period, so I don’t have the data to be able to make any realistic estimates beyond that. A few years ago I posted a 10 year projection estimate here, just as an example. I really cannot give you probabilities on how good your results will be, just like I cannot predict the weather a year from now. If you have modest diffuse thinning on your front, top, and crown, I can expect the worst and say you may be an early Norwood Class 6… and that means you will likely go bald sometime in your life. With Propecia that will hopefully buy you a few years or maybe even a decade or more of good hair. But really, I haven’t examined you and I don’t know where your loss pattern will go.
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Dr. Rassman appears to be contradicting Merck literature on Propeciaefficacy. Rassman says that at the end of five years, “Almost allpatients will lose hair from baseline, because Propecia is not acure!”
However, Merck says that at year five, “65% of men treated withPROPECIA maintained or increased hair count.”
Citation:http://www.propecia.com/finasteride/propecia/hcp/clinical_results/hair-count.jsp
Merck also says that 85-90 percent of patients will appear to maintainor grew hair over the five years.
It is probably true that these patients are losing some hair andgrowing some new hair. Technically, then, they are losing hair. ButMerck clearly suggests that 65 percent of men have maintained orincreased a total amount of hair over a five-year period and about 90percent appear to have the same amount of hair or more.
I agree…I guess I am bit confused by this post because it seems somewhat contradictory. Not only to Merck literature but also to his link posted to his projected example of Propecia over a ten year time-span. I realize that it’s pretty unpredictable, not a perfect science, but in this “chart” he at least guesstimates hair count at or above baseline at the six-year mark. Which gives me the impression that this must be at least somewhat of a normal occurrence with the drug. Obviously hair count is decreasing after the first few years, but not straight from baseline as he seems to describe in this post. Perhaps I am misinterpreting somehow.