Dr. Dan Sperling: Preventing Baldness and Prostate Cancer: Is There a Connection?

Written by: Dr. Dan Sperling
Published 02/10/2025
Updated: 02/10/2025

Hey guys! If your hair is thinning as you grow older, you’re not alone. It’s estimated that two-thirds of men have gradual hair loss starting in their 30s. It’s a condition called male pattern baldness. It’s not life threatening, but it can endanger your self-image and sense of manliness. Fortunately, there’s help.

Treatments range from styling solutions to platelet-rich plasma to hair transplants. However, the usual starting point is a class of medication called 5-alpha reductase inhibitors. The prescription drug for male hair loss is Propecia. Its active ingredient is finasteride. Research studies show that men using finasteride have less risk of prostate cancer (PCa), but if they do develop PCa, it tends to be more aggressive.

A closer look

Let’s analyze this more closely, because there’s a complicated relationship between finasteride and PCa. Finasteride works by making testosterone less available to prostate cells, causing the gland to shrink. This is why men with a condition called BPH or benign prostatic hyperplasia—an enlarged gland that can cause urination problems—are often prescribed a finasteride drug called Proscar to reduce prostate size and relieve urinary symptoms. A reduction in gland size can affect the PSA blood test used to screen for PCa by lowering the PSA number. A smaller prostate usually means lower PSA.

PSA and finasteride

PSA stands for Prostate Specific Antigen, a surface protein on prostate cells. It can be “shed” into the bloodstream, where it can be measured. The higher number of cells, the higher the test result. Likewise, any activity that disturbs the gland’s resting state (e.g., infection, inflammation, sexual activity, bike riding, a cancer tumor, etc.) can cause more PSA to be released. As you can imagine, an abnormally high or rising PSA causes suspicion—but it doesn’t necessarily mean cancer. However, experts agree that a suspicious PSA should be monitored by follow-up blood test and MRI to determine if a biopsy is needed.

If finasteride shrinks the gland, it can suppress or artificially lower a PSA test result. This raises the question, could a low PSA hide the presence of prostate cancer? If so, it would account for the studies that show men taking Propecia or Proscar have less chance of being diagnosed early with PCa but higher odds of being diagnosed later with aggressive prostate cancer. In other words, it may not be that finasteride prevents PCa, it may simply camouflage it by lowering PSA. More research is needed before we have firm evidence one way or the other. For now, experts recommend that before a PSA test, a doctor should ask if the patient is taking Propecia or Proscar as a precaution against missing PCa.

Look at the bright side

In all of this, there’s some good news. First, Propecia can work! Over half of men who take Propecia report no further hair loss or even visible regrowth. Second, an abnormal PSA result is no need to panic, because what’s causing it can be checked by a special prostate MRI to rule out PCa before rushing to a biopsy. Third, I recommend an annual PSA test to screen for PCa because if it’s found early, a patient may be a candidate for a focal treatment as an alternative to radical (whole gland) surgery or radiation. Focal therapy means an outpatient, minimally invasive treatment to destroy the PCa tumor while preserving urinary and sexual function. Several methods are available, such as Focal Laser Ablation or TULSA.

We’ve come a long way in understanding what’s important to a man’s identity. His hair is as much a part of his image as his freedom from urinary or sexual dysfunction is for his self-confidence and masculinity. If taking Propecia is right for you, don’t take chances with your prostate health. Talk with your doctor about having a PSA test, and let him know that you are using a finasteride medication. Save your hair and your prostate at the same time.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.