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If you are taking Propecia, marketed by Merck to forestall hair loss, there is a new study that may give you pause.

The medical journal, Lancet Oncology, reports that this drug may prevent detection of prostate cancer. There is an active ingredient in Propecia that may artificially lower the important PSA levels that indicate the possibility of prostate cancer. Check with your doctor about your PSA levels and whether your Propecia use can be affecting the test’s outcomes.

I guess less hair but longer life due to early detection of prostate cancer might be a fair trade off.

Finasteride (brand name Propecia�) is an orally administered medication for male pattern hair loss (MPHL). It is the only specific MPHL treatment approved by the U.S. Food and Drug Administration for prescription by a physician. Several years of investigation and use by more than a million patients show that finasteride has long-term effectiveness and safety in treating MPHL in men of all ages and all ethnic backgrounds. Finasteride is sometimes used alone or in combination with minoxidil (see Using Minoxidil (Rogaine)) to complement hair transplantation. Finasteride is not recommended for use in women.

Finasteride’s effects in slowing hair loss and stimulating new hair growth work best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to experience much regrowth with finasteride; these men are better candidates for hair transplantation or other surgical approach to hair restoration.

Finasteride is most effective in stimulating hair regrowth over the crown of the scalp. It is less effective in stimulating regrowth at the front of the scalp-where hair loss is commonly called a “receding hairline”. Physician hair restoration specialists may prescribe finasteride to prevent further hair loss by the patient, and carry out hair transplantation to provide coverage at the frontal hairline.

Finasteride: How It Works

Finasteride works at the molecular level to halt hair loss and stimulate new hair growth. It is a medication that selectively inhibits the activity of an enzyme that converts the “male hormone” testosterone into a form that is active in hair follicles.

Androgenic (”male”) hormones such as testosterone have multiple effects in the body, including actions in the skin, hair follicles and prostate gland. Hair follicles and sebaceous (oil-producing) glands in the skin are particularly responsive to androgenic hormones.

Testosterone is the most potent of the androgenic hormones. Its actions on hair follicles, skin and prostate tissue is not direct however; These tissues are responsive to a form of testosterone called dihydrotestosterone (DHT); testosterone is converted to DHT by the enzyme 5-alpha-reductase. Finasteride acts by inhibiting the action of 5-alpha-reductase and thus inhibiting the conversion of testosterone into DHT.

Men now have another good reason to consider taking finasteride, a well-known generic drug that shrinks an enlarged prostate and reduces the risk of getting prostate cancer by 25 percent.

A new study from the Southwest Oncology Group strongly suggests that for men at risk of the disease - which strikes one in six men - finasteride also raises the odds that physicians will find fast-growing prostate cancers early, when they are most easily treatable.

It appears that a man concerned about prostate-cancer risk, who is having a PSA test on a regular basis, will not only reduce his risk of prostate cancer if he takes finasteride, but will help find the cancers that pose the highest risk, says Ian M. Thompson, M.D., the study’s senior author and a urologist at the University of Texas Health Science Center in San Antonio.

The new results, embargoed until 4 p.m. Sept. 11, appear online ahead of print publication Sept. 18 in the Journal of the National Cancer Institute.

“This report provides an important interpretation of results that confounded an overall favorable interpretation of the Prostate Cancer Prevention Trial initially, and should help lessen fears that finasteride somehow causes more aggressive prostate cancer,” says Frank L. Meyskens, Jr., M.D., Southwest Oncology Group associate chair for cancer control and prevention.

The Southwest Oncology Group (SWOG), headquartered at the University of Michigan and one of the nation’s largest National Cancer Institute-sponsored clinical trial networks, conducted the study to further analyze data from its National Cancer Institute-sponsored 18,882-man seven-year Prostate Cancer Prevention Trial, which in 2003 found that finasteride was an effective prevention agent. The Food and Drug Administration has not approved finasteride for use in cancer prevention; the drug is approved for treating enlarged prostate.

Four years ago, Southwest Oncology Group researchers closed the Prostate Cancer Prevention Trial (PCPT) early to report very good news. Study results showed that finasteride, commonly used to treat enlarged prostate, could also make a man one-fourth less likely to get prostate cancer.

But that positive overall result - which potentially could keep around 50,000 men from developing prostate cancer each year - was clouded by a troubling finding: Men who took the drug but still developed prostate cancer by the end of the study had higher rates of detected high-grade tumors, an aggressive form of the disease, than did men in the placebo group.

The follow-up study, along with two others published recently, strongly suggests that finasteride makes it easier for physicians to detect high-grade cancers early by improving screening tests and prostate biopsy itself. The two previous studies show that finasteride improves the effectiveness of the two main measures of possible problems: digital rectal examination and the PSA (prostate specific antigen) blood test, which measures hormone changes associated with the disease. In some men who have low PSA test results, cancer is present but not found in time.

“Generic Finasteride makes the PSA test perform better, so we can find the cancer earlier,” Thompson says. “Our current study also shows that by shrinking the prostate gland, finasteride makes a biopsy more sensitive for any cancers that are present.” That increased accuracy is very important, he adds, because if a biopsy reveals a slow-growing cancer but fails to spot a fast-growing one, a doctor and patient may take a “wait and see” approach when prompt treatment is actually needed.

In part because of concerns about possible drawbacks, most urologists, when asked about finasteride, say they seldom prescribe it as a prevention drug, despite the positive 2003 PCPT findings, Thompson says. Now, with several studies allaying concerns about the drug’s possible drawbacks, including concerns about sexual dysfunction, Thompson believes men should be told routinely about the potential benefits of finasteride when they come to the doctor’s office for a PSA test, in much the same way patients at risk of heart disease are told about the benefits of statin drugs.

When the PCPT trial results were announced in 2003, it was unclear whether finasteride produced biological changes that could lead to more high-grade cancers. Researchers in the follow-up study analyzed tissue from biopsies and in men in the finasteride and placebo groups to compare hormonal levels and disease extent. They compared prostate size at the time of biopsy in the two groups. They also examined tumor grade and extent in men in the study who went on to have their prostates removed.

They found no significant differences in degenerative hormone changes when they examined high-grade tumor biopsies in men in both groups. However, the men taking finasteride had smaller prostates. Their biopsies correctly identified a higher proportion of high-grade tumors found later when their prostates were removed, compared to men in the placebo group.

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Men and their physicians need not hesitate to use a drug proven
effective in preventing prostate cancer out of concern that it is
likely to cause sexual dysfunction, say authors of a study conducted by
the Southwest Oncology Group.

The authors, who surveyed more than 17,000 men 55 and older for seven years,

reported their results in the Journal of the National Cancer Institute.
The study found that men given finasteride reported on average more
dysfunction than did men given a placebo. That small effect diminished
over the seven years.

The results allay concerns about a negative side effect associated
with finasteride up till now. Physicians usually warn that sexual
dysfunction is a possibility when they discuss the drug with patients. Finasteride
is an FDA-approved drug for the treatment of benign prostatic
hyperplasia, but it is not yet FDA-approved for the prevention or
reduction in risk for prostate cancer.

The study’s large sample and long follow-up period allowed
researchers to examine whether or not finasteride negatively affected
sexual function and, if so, whether this effect was lasting, said Carol
Moinpour, Ph.D., of the Fred Hutchison Cancer Research Center in
Seattle, the study’s lead author. She coordinates quality-of-life
studies for the Southwest Oncology Group, the nation’s largest National
Cancer Institute-funded clinical trials network.

The study grew out of the Prostate Cancer Prevention Trial, a large
double-blind National Cancer Institute-funded study which found that
finasteride, a drug which curbs the proliferation of prostate gland
cells, is effective at preventing prostate cancer in men age 55 and
older. The 2003 results of that trial, conducted by the Southwest
Oncology Group in more than 18,000 men, showed that finasteride could
reduce a man’s chances of getting prostate cancer by almost 25 percent.

The authors of the newly published sexual function results wanted to
assess how many men in the Prostate Cancer Prevention Trial reported
experiencing sexual dysfunction, and whether the problems decreased or
increased over time. In earlier studies, some men taking finasteride
reported decreased libido, impotence and other signs of diminished
sexual function. But these studies were short-term and didn’t try to
assess the effects of age and other health factors, as well as
individual variation.

“Millions of men may benefit from finasteride’s ability
to reduce prostate cancer risk,” said Leslie Ford, M.D., who oversaw
PCPT for the Institute. The nation’s number one cancer doctor,
Andrew C. von Eschenbach, Director of the NCI, called it a “landmark
study.” The story appeared on the front
page of the New York Times, and it was widely covered by other major
news agencies such as CNN
and The Wall
Street Journal. At the press conference, which will be available
online as a webcast for the next year, Dr. Peter Greenwald, Director
of Cancer Prevention for the NCI, said, “This trial proves that
prostate cancer is at least in part preventable. It is a huge step forward.”
On the day
of the NCI press conference, USRF Director Leonard S. Marks, M.D., appeared
live on CNN television to explain the importance of PCPT.

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What is the role of testosterone / hormones / androgens in male pattern hair loss?

Male pattern hair loss, or androgenetic alopecia, is an androgen-dependent disorder. In genetically susceptible men, dihydrotestosterone (DHT), a potent metabolite of the male androgen testosterone, contributes to male pattern hair loss. The conversion of testosterone to DHT is regulated by the enzyme 5-alpha reductase.

How does finasteride affect the body’s hormonal / endocrine system?

Finasteride (Propecia®) is a specific type II 5-alpha reductase inhibitor. That is, it inhibits the enzyme responsible for regulating conversion of testosterone to dihydrotestosterone (DHT). By reducing DHT levels in the scalp, the drug decreases DHT’s effects on the hair follicles, reversing the process of hair loss.

What is finasteride approved for?

Finasteride is indicated for the treatment of men with male pattern hair loss (androgenetic alopecia) to prevent further hair loss and increase hair growth.

How does Propecia (Finasteride) work?

Propecia (Finasteride) belongs to a group of medicines called “5 alpha reductase inhibitors”. It is a tan octagonal tablet, which is swallowed and is available in just one strength - 1mg.

Propecia (Finasteride) works by blocking the enzyme, Type II 5 alpha-reductase, and in doing so it reduces the level of the hormone in the scalp which shortens the hair growth cycle and allows hairs to revert to a normal growth cycle. This can result in stopping further hair loss and increasing new hair growth in men with male pattern baldness (androgenetic alopecia).
Continuous use once a day for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued so continuous use is recommended to sustain benefit.

Does Propecia (Finasteride) always work?

Clinical trials conducted on thousands of men have shown that after 2 years of use 66% (two thirds) of men showed increased hair growth. 30% of men showed a slight improvement, 31% moderate improvement and 5% great increase. 83% of men in the trial showed no further hair loss.

Propecia (Finasteride) side effects

When taken at the recommended dose, the possible side effects of Propecia (Finasteride) are usually mild and generally have not caused the men to stop taking the medicine.

Possible side effects that have been identified with Propecia (Finasteride) include decreased libido, erectile dysfunction, decreased volume of ejaculate, breast tenderness and enlargement; rashes, itching and swelling of the lips and face; and testicular pain.

Finasteride: How It Works

Finasteride works at the molecular level to halt hair loss and stimulate new hair growth. It is a medication that selectively inhibits the activity of an enzyme that converts the “male hormone” testosterone into a form that is active in hair follicles.

Androgenic (”male”) hormones such as testosterone have multiple effects in the body, including actions in the skin, hair follicles and prostate gland. Hair follicles and sebaceous (oil-producing) glands in the skin are particularly responsive to androgenic hormones.

Testosterone is the most potent of the androgenic hormones. Its actions on hair follicles, skin and prostate tissue is not direct however; These tissues are responsive to a form of testosterone called dihydrotestosterone (DHT); testosterone is converted to DHT by the enzyme 5-alpha-reductase. Finasteride acts by inhibiting the action of 5-alpha-reductase and thus inhibiting the conversion of testosterone into DHT.

Investigators over a number of years found that 5-alpha-reductase occurs in two forms identified as Type I and Type II, and that finasteride is effective in inhibition of Type II. Type I of the enzyme predominates in sebaceous glands. Type II occurs most abundantly in hair follicles and prostate tissue. Investigators found that: