Propecia: The Goose That Lays the Golden Eggs

The document discusses the success and concerns associated with finasteride (Propecia), an oral medication for male pattern hair loss. Sales of finasteride reached $65 million in the second quarter of 2004, reflecting its high demand due to limited previous success in treating male pattern hair loss, its low side effects, and aggressive advertising. However, a study involving 18,882 men aged 55 years or older, which was published in the New England Journal of Medicine in July 2003, found that while finasteride reduced the incidence of low-grade prostate cancers, it increased the rate of high-grade cancers by 1.3%. This raised concerns about the drug's safety, particularly at a daily dose of 5 mg. The document also mentions other potential side effects such as loss of libido, cataracts, and gynecomastia. The authors suggest that dermatologists prescribing finasteride for androgenetic alopecia should now discuss these new findings with patients, monitor them appropriately, and possibly refer them for routine urologic evaluations. The enthusiasm for prescribing finasteride must be balanced with the potential risks associated with its long-term use.