Month: July 2008

I have been on generic finasteride 1.25mg daily for the last 3 and a 1/2 months, prescribed by a hair transplant consultant.

I am worried that I may be starting to develop gynecomastia, my chest area around my nipples feels softer than usual. There also appears to be a slight protrusion of the nipples, whether this is a reality I am not so sure. I am by no means overweight but I have a good “pinch” of belly fat at the moment. However I have been the same weight to the best of my knowledge since commencing with finasteride.

I have searched your archive but there seems to be no example/instruction of how to assess whether you have “gyno” or not? I know self diagnosis is not to be advocated but is there any way the layman can make an objective judgement?

I really enjoy your blog and it is great to have a professional opinion on hair loss available online.

This diagnosis is best made by a doctor. There’s no real instructions on assessment, but this article may prove valuable to you — Evaluation and treatment of gynecomastia. If you are really experiencing more breast tenderness, it may be caused by Propecia (finasteride 1mg), but for enlargement of the breasts from gynecomastia, this is a diagnosis that requires an examination. Although breast cancer is rare and usually not tender, any mass in the male chest should be examined by a professional familiar with the difference between breast cancer and gynecomastia.

Was the consultant who prescribed you Propecia a physician? If not, then he broke the law by prescribing a prescription item and this should bother you. I would hope that if you had a doctor prescribe the medication, that doctor should be responsible enough to see you again and examine you accordingly.

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Does minoxidil deplete collagen levels, hence making the face appear comparatively older over time?

There is an interesting scientific paper showing some impact of minoxidil on collagen synthesis: Inhibitory effects of bFGF, VEGF and minoxidil on collagen synthesis by cultured hair dermal papilla cells. These studies are not in humans, but may very well translate. That being said, I did a brief Google search and couldn’t find reports of minoxidil users looking well beyond their years after using the drug, and considering it has been marketed as a hair loss treatment for 20+ years, I’d say the old face look from the medication isn’t likely.

Thanks for the question. I continue to learn a great deal and realize how little I know in the grand scheme of things.

Dr Rassman,
In your clinical experience if a male is slightly less than a NW2 by his early 40’s and takes Propecia, would it be highly unlikely that he will become a NW3 or NW 4 by the time he reaches his early 50’s. In other words could he have late onset acceleration of balding like a young person in their early 20’s even if he is taking Propecia. My father started balding at 18 years old, yet his brother who is in his 70’s still has a full head of hair. I am just wondering if it is likely I will have a late onset acceleration of balding since I am noticing more diffuse thinning in the past few years which is the same time I started Propecia.

I do not recommend Propecia to men who are not losing hair, nor do I recommend Propecia to men who are worried that they may lose hair. I need to make a diagnosis of genetic male pattern balding before I consider recommending Propecia to my patients. So despite your family history and worries, I really do not know if you will bald or not as I have not examined you and made a diagnosis. Hair loss can start as early as puberty, but it can also start later in life well past your current age. If you are worried that this may happen to you, get your hair mapped out for miniaturization yearly.

I read Propecia doesn’t help with temporal recession and receding hairlines but I’m on a NW2 right now and it looks like I’m heading to a NW3, can Propecia prevent that from happening? And it seems I’m now a little more then a NW2 do you think Propecia can help me go back to a solid NW2?

It is possible, though full regrowth in the hairline is rare — at least more rare than regrowth in the crown/top of the head. At the very least, Propecia should halt the progressive hair loss for some time so that you can retain what you have now.