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Dr. Sheila Kirk

Should Procepia be Considered for FTMs?

by Sheila Kirk, M.D.

Recently, and with great promotion and expectation, another new medication was made available to the pharmacies we deal with and to all of us who may have need for such a product. The giant pharmaceutical company, Merck, has received FDA approval to market a weakened version of the anti-androderm Finasteride, also called Proscar, to promote hair growth on the scalps of genetic males. It's will be available under the name Propecia. Good results are forecast for about 50% of male users based on clinical trials before drug release. By good results are meant a cessation to the progress of male pattern baldness particularly, but baldness of other patterns as well--and the stimulation of quiescent hair follicles, hair roots, that have ceased to function. Hair will grow in those areas that have scant and no hair. 50% is a good figure and of that percentage some undoubtedly will have really notable benefit. The downside or side effects expected are important ones but thought to occur in only 2% of the users. The side effects are impotency and reduced libido--rather concerning ones for those genetic males who want to enhance their masculine prowess. "Just what would be the effect upon libido in the FTM population is not known at this time.

The drug acts to inhibit the conversion of testosterone to dihydrotestosterone, the more potent of the two androgens. Dihydrotestosterone exerts direct activity against the hair follicles-- immobilizing them and eliminating hair growth to stop this reaction allows for hair growth and in some instances luxuriant growth at that. But note--the new product is being marketed to the genetic male population and not to the genetic female population. The reason is that it can be very harmful to pregnancy. Hence women in childbearing years at least are not to use it. Now, here is an interesting consideration. What about genetic women who have no anatomic capacity for pregnancy and even those with no interest in one as well? Why would they not be candidates for such medication? Baldness affects upwards of 20 million genetic females in this country alone. To be more specific, FTM individuals taking testosterone frequently suffer hair loss and particularly develop the male pattern of hair loss. Why aren't these candidates for the drug?

The medication was not tested in such a population. There is no information available to guide us in its use in FTM individuals. Will they have reduced libido and to what degree? Are there any other side effects to anticipate? Will they even grow hair at all with this drug? One good effect is that in clinical trials in men blood testosterone levels increase about 10%. Is this also the case with FTMs? Will they have heightened response to their testosterone regimen? Will such studies be done? Probably not! Anecdotal and empiric information will come to the FTM community when and if some try the medication.

Would I recommend it? I think I would and any FTM individuals in my practice who want to begin trials in my care could expect very close observation. I'm not proposing another study but it would be a good idea. Hence anyone wishing to let me know about their experience with Procepia should contact me. I would want to know what is experienced after one month, two months, four months and six months. This information could benefit the FTM community and I'm happy to collect it and report it.

©1998 Sheila Kirk, M.D.

Sheila Kirk, M.D. is a board-certified obstetrician/gynecologist specializing in transgender medicine and in private practice in Pittsburgh, PA. She is a board member of the Harry Benjamin International Gender Dysphoria Association. She is the author of several books including "Masculinizing Hormonal Therapy For The Transgendered" and "Medical, Legal and Workplace Issues For the Transsexual" Dr. Kirk can be contacted by phone Tues/Thurs 10A-5P EST (412) 781-1092, 24 hour fax: (412) 781-1096, by post: P.O. Box 38114, Blawnox, PA 15238 or by e-mail: SheilaKirk@aol.com

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