Propecia and Prostate Cancer: Balancing Vanity With Health

As you can see from the headshot of me that runs with my articles, I am one of the many men in America who wakes up every morning, looks in the mirror, and wonders what I could do to grow more hair.

So far, I have decided to embrace the changes that come with middle age, but many men who are experiencing hair loss do decide to try and "grow more hair." Treating male-pattern baldness, however, is not a risk-free endeavor. There is a range of anti-balding products on the market today. Treatments and strategies vary, and so do the all-important side-effects of these remedies.

I may one day choose to entertain my vanity myself. Should I do so, the first thing I need to be aware of are the potential health risks of the different baldness treatments available.

One of the more common approaches to reversing baldness on the market today is the popular and successful drug Propecia. All drugs and medications come with the risk of side effects, and in some cases, taking a medication for one thing can mask or hide other developing health problems. In the case of Propecia, recent research indicates that using the drug can alter the results of the prostate-specific antigen (PSA) test used to screen for prostate cancer in men.

A study from Anthony V. D'Amico, MD, PhD, of Brigham and Women's Hospital, and Claus G. Roehrborn, MD, of the University of Texas Southwestern Medical Center, found that men on Propecia may have dangerously high PSA levels even if their test indicates levels are in the normal range.

"The men who use Propecia are young men, in their 30s, 40s, and 50s," D'Amico said in an interview with the medical website Web MD. "This is important because these are the guys who, if they have prostate cancer, need to be diagnosed."

Merck, which makes Propecia and funded the research, said that information advising patients to inform their doctor if they are taking Propecia has been included in the drug packaging since the product was initially approved in 1997.

The study found that Propecia cuts PSA levels in half after one year of use. While there is no PSA threshold below which cancer risk is completely eliminated, or above which cancer is a certainty, the conventional normal range is between 0 and 4.0.

However, for men on Propecia, a PSA level of 2.0 could indicate prostate cancer risk.

"If you've been on Propecia for a year, you should double the PSA score," D'Amico said.

"If you are on Propecia for more than a year, don't multiply the score; look at the change in PSA over time. If it goes up by more than three-tenths of a point, consider a biopsy," he said.

The danger is that men may get Propecia from one doctor and PSA tests from another, says urologist Yair Lotan, MD, of the University of Texas Southwestern Medical Center.

"So if your internist doesn't know you're being treated for male pattern baldness, and your PSA is 2.5, they may assume you are normal -- but you really need to double that [score] and see a urologist," Lotan told WebMD.

It's a difficult problem, said Wayne B. Harris, MD, assistant professor of hematology and oncology at Emory University and the Atlanta VA Medical Center.

A doctor may see a PSA result of three, and not be aware the patient is taking Propecia, and therefore actually has a PSA level equivalent to a six, Dr. Harris explained.

If you are using propecia, you must inform your doctor. Being thorough, and being aware that Propecia can mask PSA test results, will help you and your doctor determine your actual cancer risk. Legitimate, safe and test-proven drugs like Propecia don’t need to compromise your health.

Men and women today have many options for delaying and offsetting the affects of aging. The information to do so safely is out there for the taking-- and so are the marvels of medicine. If looking better means feeling better, then perhaps appealing to your vanity will not only eliminate your bald spot but may enhance your overall middle-age experience.

WebMD contributed to this report.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.