You start taking medication for hair growth, and you wake up just to notice an increase in shed hairs on your pillow.
What’s the deal?
In this post, I’ll introduce the hair loss drug Propecia and one of its major “side effects”: shedding.
You’ll learn what it is, why it happens, and what you can do while you wait for the regrowth to begin.
What Is Propecia?
Propecia, also known by its generic name finasteride, is an oral medication that was initially developed to treat enlarged prostate (1). As a drug for Benign Prostatic Hyperplasia (BPH), it has the brand name of Proscar.
The drug was soon discovered to have the side effect of hair growth, however, and it was then prescribed off-label to sufferers of pattern baldness and similar hair loss conditions.
After years of off-label use, Propecia was finally approved by the FDA to treat hair loss.
How Does It Work?
To understand how Propecia ‘treats’ hair loss, it’s first important to understand how hair loss occurs.
An Introduction to Hair Loss
There are various types of hair loss. These include temporary (from illness or medication, for example) or permanent (from genetic predisposition or autoimmune disease).
But the most common type of hair loss falls into the latter category.
Androgenetic Alopecia (AGA), also known as male-pattern baldness, is a genetic condition that results in progressive hairline recession, shedding, and hair loss (2).
The exact cause of AGA is unknown. And there are many factors that play a role in its development and progression.
However, one factor that is known to play a significant role is the androgen hormone Dihydrotestosterone (DHT).
DHT is a hormone and, as such, it’s synthesized (3). More specifically, a biochemical process involving the enzyme 5-alpha-reductase (5AR) and the hormone testosterone results in the production of DHT.
This occurs in places within the body where you’d expect hormones to be synthesized. I.e. the adrenal gland and testes.
However, it’s also produced in less-than-logical places such as the prostate and the hair follicles.
For individuals without AGA, this is fine.
But men and women with a genetic predisposition to AGA have what’s known as DHT sensitivity.
When DHT is present at the hair follicles – even at normal levels – it triggers miniaturization.
This results in thinning of the affected hair strands until, eventually, they can no longer reach the scalp. And if left untreated, miniaturization can even cause death of the hair follicle and baldness.
How Propecia Fights Hair Loss
There are a few approaches to combating hair loss caused by AGA.
Rogaine, for example, works by increasing blood flow to the follicles and opening potassium channels so as to reduce the effect of miniaturization (4).
Propecia takes a more direct approach, though, and here’s how.
As mentioned above, one of the main triggers of miniaturization is sensitivity to DHT.
It would make sense, then, that blocking DHT so as to reduce levels at the follicles would benefit those with AGA.
But blocking DHT directly can be tricky and, overall, it’s not a good idea. This is because DHT plays a large role in male sexual function.
So the next best thing? Inhibit the enzyme 5-alpha-reductase (5)!
Propecia works by inhibiting the activities of 5AR. This leads to lower levels of DHT throughout the body without blocking the androgen hormone entirely.
Propecia Shedding: What It Is
When you start taking a drug to promote hair growth, the last thing you expect to see is hair loss.
Propecia is one such drug where hair “loss” initially occurs, and it even has its own name – Propecia shedding.
But believe it or not, shedding is actually part of the hair growth process.
Hair growth is a cycle that occurs over three main stages: anagen, catagen, and telogen (6).
The anagen phase is active growth, and this lasts for several years. It’s during this stage that the stem cells at the base of the follicle will continue to proliferate and differentiate and, therefore, increase the length of the strand.
The next stage is catagen, and it’s really just a transitional phase between active growth and shedding.
It’s now that the lower portion of the follicle recedes and active hair growth (and cell differentiation) ceases.
The final stage is telogen, which involves shedding the club hair (as the strand is known by the end of catagen) so as to make room for the anagen phase strand to grow.
As the cycle above clearly demonstrates, you cannot have new growth without first shedding your old hairs.
This is the very reason that Propecia shedding occurs and, in fact, it’s a sign that the drug is working.
How Long Does Propecia Shedding Last?
You may be wondering just how long you’ll have to put up with this disconcerting “side effect” of Propecia.
And, while the length of shedding will vary from person to person, we can offer a basic timeline.
You may first notice an increase in shed hairs as early as one to two weeks after starting treatment. This will often continue for upwards of four months, though it should slowly decrease as time goes on.
You very well may not even begin to see positive results – i.e. new hair growth – until you’ve five or six months into your treatment.
This is why it’s recommended that you take the medication consistently for at least six months before you decide if it’s right for you.
How to Slow Down / Stop Propecia Shedding
As you’ve learned above, the shedding you see as a result of taking Propecia is a good sign.
That’s why we don’t want to stop Propecia shedding, or interfere with the process at all.
What you can do, however, is to create an environment in which healthy hair growth is possible. This will ensure that, once the shedding phase is over, you’ll see the greatest results.
Fortunately, there are a few approaches you can take.
Increase Blood Circulation to the Scalp
I briefly mentioned earlier that Rogaine – the most popular topical drug in the treatment of hair loss – works in large part by increasing blood flow to the follicles.
Where does blood flow fit into the hair growth process, though?
It’s true that hair strands are made up of dead, keratinized cells. So it seems odd that they would need blood to grow.
It’s not the strands that need blood, but instead the follicles. Here’s why.
The circulatory system – which consists of arteries, veins, and vessels – is the body’s way of transporting oxygen and nutrients to organs.
And just like all other organs, the hair follicles need proper oxygen and nutrients to survive.
The oxygen and nutrients the follicles receive is beneficial to the dermal papilla cells, and it ensures that the hair’s structure is strong (7).
Unfortunately, poor blood flow is often associated with AGA and similar conditions.
This is because miniaturization of the follicle slowly strangles the connection to the blood vessels.
And scalp tension also likely contributes to poor circulation to create a vicious cycle (8).
What’s the answer, then? To increase blood flow!
If you’re taking Propecia as part of your hair growth regimen, then you’re likely not opposed to conventional treatment options. As such, Rogaine, also known by its generic name of minoxidil, may be an option for you.
There are also more holistic ways to increase blood circulation to the scalp, though.
One such method is scalp massage.
Scalp massage is mechanical stimulation of the scalp using either your fingertips, or a specialized device.
It works in two major ways:
- Decreasing scalp tension; and
- Increasing cutaneous blood flow.
But you’re probably wondering, “does scalp massage have a measurable effect on hair growth?” And the answer is a resounding yes.
Study: Standardized scalp massage results in increased hair thickness by inducing stretching forces to dermal papilla cells in the subcutaneous tissue
A 2016 study evaluated the effect of scalp massage on hair in Japanese males over a period of 24 weeks (9).
Nine men were included in the study, and they received four minutes of standardized scalp massage each day for 24 weeks.
The three main factors that were evaluated throughout the study included:
- Total hair number;
- Hair thickness; and
- Hair growth rate.
Even further, human dermal papilla cells were cultured to examine gene expression.
Standardized scalp massage increased hair thickness from 0.085 ± 0.003 mm at the beginning of the study to 0.092 ± 0.001 mm at the end.
But even more telling, the practice increased expression of hair cycle–related genes (such as NOGGIN, BMP4, SMAD4, and IL6ST) and decreased hair loss–related genes (such as IL6).
This is fantastic news for hair loss sufferers! Why?
Scalp massage is not only easy to perform yourself, but it also only takes just a few minutes per day.
Prevent Follicle Blockage / Clogging
It’s important that you work from the inside out when you’re looking to build a healthy scalp environment. But there are outside factors that can contribute to poor hair growth, too.
One such factor that is commonly seen in AGA patients is follicle blocking and clogging.
So, what can clog the follicle? Just a few examples include sebum, sweat and dirt, and build up from hair products.
Some of these things – namely sweat, dirt, and hair product – can be easily controlled with a regular hair washing schedule.
Sebum, however, can be a bit trickier to balance.
Sebum is a waxy substance produced by the sebaceous glands (10). These glands sit near the top of the pores.
But too much sebum is never a good thing, and it can lead to clogging and blocking of the pores.
When the pores are blocked with excess sebum, it can be difficult for the newly-formed hair to make its way through to the scalp. This is especially true if the follicle is otherwise compromised, such as from miniaturization.
What can you do to combat excess sebum production, then?
The first step is to get on a regular hair washing schedule.
Change Your Hair Washing Schedule
You may think that washing your hair more often will provide the greatest results. But nothing can be further from the truth.
In actuality, the longer you can go between washes (within reason), the better.
This is because washing your hair and scalp strips them of their natural oils. The sebaceous glands will then go to work producing more and more sebum to combat the dryness.
During this cycle, you may experience a “greasy” or “oily” scalp.
But the only way to combat this is to reduce the number of times you wash your hair per week so as to get your sebaceous glands back to normal.
The number of times you should wash your hair will depend on the type of hair you have, and whether you suffer from any scalp conditions (such as dandruff, or bacterial overgrowth).
Those with coarser hair can go up to a week (or even more!), while those with thinner or straighter hair may only be able to go three days.
You’ll need to experiment a bit to find the right fit for you, but I highly recommend a schedule of no more than three times per week.
Adopt a Healthier Diet
There is still much debate as to the connection between diet and overactive sebaceous glands (13).
But that doesn’t mean that the potential link should be ignored altogether.
The simple fact is, if you suffer from overactive sebaceous glands you’ll likely want to evaluate a number of lifestyle factors.
One of these factors that you can easily control is your diet.
That’s why I recommend that you consider keeping a food journal to pinpoint potential “trouble” foods and then remove them from your diet for a trial period.
If your sebaceous glands continue to produce sebum at their usual rate, then the food isn’t likely an issue. But if the problem begins to resolve, then you may have found your answer.
So, what’s the “best” diet for reducing sebum production?
As mentioned, there’s still quite a bit of debate on the topic. As such, a consensus has not been reached.
However, I’d recommend you start with dairy and high-glycemic foods.
It may be alarming to see an increase in shedding once you start the hair loss drug Propecia. Keep in mind, however, that this is actually a sign that the drug is working.
As such, it’s best not to interfere with the process except to ensure that your scalp is in otherwise good condition.
This means increasing blood flow to the area, as well as ensuring there are no blockages or other obstacles to growth.
Do you have questions about the information shared above? Leave a comment below.