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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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