For thousands of years men have smeared smelly stuff on their scalps in a vain attempt to beat back baldness. Cleopatra reportedly anointed Caesar with a concoction of bear grease, burned mice, deer marrow and horse teeth.
Other remedies have included pigeon droppings, horseradish and buffalo dung.
More recently, men have spent thousands on toupees and transplants. And Rogaine Topical Solution has become available without a prescription.
But while Rogaine was the first medicine scientifically shown to stimulate hair growth, it has drawbacks. It has to be applied twice a day and works for only about 30 percent to 40 percent of the men who use it. If Rogaine is discontinued, the hair that was gained usually falls out.
Now there is new hope for the hairless. The story of the development of the anti-baldness pill Propecia (finasteride) is fascinating.
Merck researchers were intrigued by a 1974 scientific report on pseudohermaphrodites in the Dominican Republic. At birth these individuals appeared to be female and they were raised as girls. But at puberty it became clear that they were young men.
The explanation is biochemical. These men have testosterone, but an enzyme that converts this male hormone to a more active form, dihydrotestosterone (DHT), is impaired. The result is that these men develop external sex characteristics only after puberty. In addition, they never develop enlarged prostates, acne or male pattern baldness.
Merck has spent years working on a drug to duplicate this effect and marketed Proscar for enlarged prostate in 1992. That same year, researchers started investigating the compound as a baldness remedy.
Scientists believe that the buildup of DHT in hair follicles contributes to balding as men age. Propecia, which blocks the synthesis of DHT, was tested in two year-long studies.
The effects of the drug were evaluated by counting hairs in a one-inch diameter circle. The men on Propecia had on average 86 more hairs after one year, while those on placebo actually lost an average of 20 hairs in the circle.
More importantly, this quantitative measure was bolstered by evaluations done by patients, investigators and dermatologists working from photos. Between one-half and two-thirds of the subjects had cosmetically noticeable hair regrowth.
Although Propecia and Proscar are both finasteride, the dose of Propecia is one-fifth (one mg vs. five mg for Proscar). Proscar is used to treat men with enlarged prostates.
Side effects of Propecia were rare. Lower libido and erection difficulties occurred in about 1 percent to 2 percent of the men.
We have discussed this advance in greater detail in our updated Guide to Hair Care. Anyone who would like a copy, please send $2 with a long (No.10) stamped, self-addressed envelope to Graedons' People's Pharmacy, No.HQ-93, P.O. Box 52027, Durham, N.C. 27717-2027.
Propecia is under review at the FDA and it will probably be several years before the agency decides whether to approve it. But at long last, balding men may be able to outwit their genes.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their latest book is "The People's Pharmacy: Completely New and Revised" (St. Martin's Press).
Pub Date: 4/15/97