Month: January 2006

Hello Doctor:

Thanks for you candid forum. I have three questions for you. If I’m a male on Propecia to prevent hair loss, will taking protein supplements for body building militate against the benefits of reducing DHT by Propecia? And, how can I reduce the sexual side effects of Propecia; namely, the reduced sperm volume? Finally, is there any evidence yet that taking Propecia and its active agent long term will cause permanent side effects or potential diseases?

Thanks again

I’ll answer your questions in order and they are all good questions;

1. Protein supplements will not change how Propecia works, namely, by blocking DHT formation. I WOULD warn you against taking any steroids which conceivably could alter hormone levels and diminish the benefits of the Propecia.
2. The sexual side effects of propecia are often temporary, but if they persist for you, I usually recommend trying a half-tablet twice daily or even just once a day. You will get less than the full benefit (I am led to believe that 1/2 tablet may give you 80% of the benefit), but you will at least get SOME benefit and that is the important thing.

   Sperm volume and ejaculate volume are two different things. Ejaculate contains several body chemicals and fluids, not just sperm, and decreased ejaculate does NOT mean less sperm at all – as a matter of fact sperm levels for those with decreased ejaculate are usually still within normal levels, possibly higher. Decreased ejaculate volume was shown to occur in 0.8% of people taking propecia versus 0.4% of the placebo group in the initial studies (that decimal point is correct, it is LESS THAN one percent). Although the frequency of reduced ejaculate volume is reported small, in my experience after probing many men on this issue, it is far more frequent than the literature seems to suggest. If you are worried about potency or having problems with conception, I’d see a urologist and get your sperm count done.

3. Finally, the long term data for finasteride (~15 years of data) does not show any permanent side effects or potential disease. As a matter of fact, the data so far indicates that there is less prostate cancer in those taking it. So there you go!

I recently read on one of your previous blogs that you would be attending a international hair restoration conference at the end of the month and would comment further on avodart, mainly if you would begin prescribing it. I’m just curious if you have any further comments?

I apologize for not posting this response sooner. There were too many exciting events happening at the ISHRS 13th Annual Meeting for me to describe everything to you. For those that may not be familiar with this event, it occured in late August 2005 in Sydney Australia. I do recall there was some discussion about Avodart which may appear to have better result than Propecia. Unfortunately, there was concerns about whether Avodart persists for a significant amount of time in semen, which may have an unwanted affect on development in the male fetus. Currently, there is no FDA approval for Avordart to treat male pattern hair loss. I am somewhat perplexed about why GlaxoSmithKline, the drug company producing Avodart has suspended further tests for treatment of male pattern hair loss, but that would be a better question to ask the drug company.

Paid advertisements (not an endorsement):

Hi Dr,
I’ve learned a great deal from your site. I have two questions — one general, one specifically for me.

1. I read that you encouraged the use of propecia in the AM. I take a multivitamin and calcium citrate in the morning, and therefore I take propecia at night to offset the risk of an interaction. I also take creatine pills at various times in the day. I’m on no other drugs or supplements. Is there any problem with taking any or all of these pills/supplements together? I’m especially concerned about the creatine and its potential role with testosterone.

2. Some background info:
– I’m in my early 20s
– I’ve been using propecia for about 16 months because of a maturing hairline at the temples.
– My hair is black, extremely thick and curly, and my facial hair is extremely coarse as well — Before 2 years of laser surgery I had 5 o clock shadow 24 hours a day. In terms of facial hair, I made Richard Nixon look like a backstreet boy!

That being said, I’m under the impression that I have more testosterone than most guys, and that 5 MG Proscar pills (which I will cut in half) might work better than 1 mg Propecia. The only reason I contemplate doing this is that I think -although it’s hard to tell — I’m still losing ground on my hairline. I’m also going to reinitiate minoxidil-use at night.

Avodart sounds very promising, but I’m willing to wait until it gets FDA approved for hairloss. I’m under the impression that will never happen.

Basically, I’m looking for your input on this matter. In addition to 2.5 MG of finasteride daily and minoxidil, is there anything else you can recommend to keep as much — if not all — of my hair as I can?

I look forward to your response

The medications you are taking should not be negatively impacted by Propecia, so I would still suggest taking Propecia in the morning.

I am not certain that you have more or less testosterone than others to explain losing hair on the top of your head — probably just strong genetics. The strong beard again points to strong genetics and the DHT effect on those genetics. Male pattern balding is caused by DHT (so is your beard). Taking 1.mg vs 2.5mg of finasteride may or may not make a difference in terms of reducing hair loss, because there is no conclusive data for better results with higher dosage of the drug. If you find that 2.5mg of finasteride works better for you, then you should continue doing it, but you must be aware that the higher dose does correlate with more negative sexual side effects. I recommended that to stay healthy, eat a balanced diet and exercise. Crash diets may accelerate hair loss. I would like you to email some photos of your hair for further evaluation. If you truly have hair loss, I would be happy to email back more insights.