Month: September 2008

Dear Dr Rassman,

I know this has been asked more than a couple of times in your splendid blog, but you have never gave a definite yes or no answer to this dosing question.

I have been on finasteride for some time and although it worked well for the early few years, im starting to recede pretty aggressively this year. Will increasing the dosage from propecia (1 mg) to taking half proscar (2.5 mg) or even 5 mg even helps at all to fight the losing battle?

Thanks so much for your time!

I thought I’d answered this many times before, but if I was too vague, I’ll try it again –

The FDA says that 1mg finasteride is all you need to treat hair loss, but perhaps 2mg for those people who are losing the effect of the drug may be better (discuss this with your prescribing physician). Side effects must be titrated. Try it and see. If there is no increase in side effects (and with your doctor’s knowledge), you might go for it. The more finasteride you take, the higher the risk of side effects.

I read on your site, that when you stop using finasteride after several years, you will lose many hairs because your genetic aging will catch-up, to the point where you would be when you never used it. But is this right? Because I would think that your DHT-hormone, after being suppressed for several years by the drug, and when you stop using it, it will go “over-producing” (like for example: 200%) and that would make your hair losing rapidly. Can I be right about that?

Yes, I suppose you could be right, but somehow it does not make sense to me scientifically. Testosterone is the source of dihydrotestosterone (DHT), and after you have been on Propecia (finasteride 1mg) for several years your testosterone levels should be normal. Therefore, one can potentially make the leap that the DHT will also be normal after you stop taking the Propecia.

I really can’t get into all the genetics and biochemistry aspects of why Propecia works or why you can have rapid “catch up” hair loss if you stop taking it. If you want to know the exact reason, well, it’s been many years since I took my biochemistry courses, so I’d not feel qualified to get into it (hey, I’m being honest). As a physician who treats patients and sees patients who lose hair when they stop taking Propecia, I can tell you that this happens.

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I am 25 and I started taking propecia about 5 years ago. around two years ago however I took a prohormon called methasterone to increase muscle mass, totally unaware of the side affects. I developed gynocomastia soon after. My question is I no longer take prohormons but I still have gynocomastia with quite a bit of tenderness. Is any of caused from the propecia even though i didn’t have it the first three years of taking it?

That is interesting, and I’m surprised it would start years after the fact. You might want to consider stopping the Propecia for 2-3 weeks and see if the problem goes away. Definitely talk about this with your prescribing doctor before stopping the medication, though.

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I have been taking Propecia for a few years. I am convinced that Propecia has caused both a reduction in the size of my erections and a significant increase in breast tissue. (However, I would not discourage anyone from taking Propecia. It appears that cases like mine are a very small minority so I would tell any prospective Propecia user to take the drug and see how it works for them. We don’t all have identical bodies. Some of us react differently.)

I am well aware of all of the published results of drug trials on Propecia. I don’t need to be reminded. What I can say is that I personally have not had a positive experience with this drug. Can I prove Propecia reduced the size of my erections and increased the amount of breast tissue? No. I have seen several doctors, including specialists, about this and most of them react the same way Dr. Rassman has–they point to the drug trials. Again, I KNOW what the drug trials say. I KNOW they don’t support my hypothesis.

That being said, any doctor would be foolish to think these drug trials are the last word on the effects of a drug that was developed as recently as finasteride (Propecia.) When there is a long term study of 20 years or more that focuses DIRECTLY on erection size and breast size then, and only then, can a doctor point to drug trials with complete confidence.

In the past few years we’ve all become aware of the flaws that exist in the relationship between the FDA and pharmaceutical companies. We all know the story of Vioxx. Even the former editor of the New England Journal of Medicine, Marcia Angell, wrote a book highly critical of Big Pharma.

The public doesn’t see the results of ALL the trials that are conducted on a drug. Pharmaceutical companies can cancel trials if they’re not going the way they would hope. They then have the freedom to start trials again and you’ll never hear about the former trials. Often the only published results we see are positive ones. Negative ones go unpublished. We all have to remember that pharmaceutical companies are businesses first and foremost.

Bottom line: If I don’t like the effects of a drug I always have the choice to quit. Just don’t annoy me and point to drug trials when I can see with my own eyes that my body has changed. I don’t need a medical degree to measure my penis or notice that my previously flat pectorals are now pointy.

Every person has the ability to make the decisions that are best for them. I agree with you in that problems with erections and breast tissue may be caused by Propecia, and in your individual case, it sounds like that is what is happening … and that does not make you crazy. That being said, the information we have available is factual and published, and that is the best that I can point to.

I know you said you don’t know much about this equol, but I have a question you may be able to help me with nonetheless. I’ve read equol still allows DHT to form, but binds to DHT specifically and doesn’t allow DHT to bind to androgen receptors. Would this still cause any side effects in your opinion from what you know or not?

Thanks

If I fully understood the way Equol worked, I’d be able to render an opinion (or facts), but I am afraid that I just don’t know enough about the physiology here. Essentially, everything I know about Equol was outline in two sentences in a post I made over a year ago — Equol. If there are any new exciting studies that I come across, I’ll surely write about them, or if any readers have additional information to provide, please sent it in.