Month: December 2009

I have been taking propecia for a year now, I am currently twenty. Propecia has worked wonders to regrow hair all over my head, including the temples. My question is, and I know results vary, but on average do young patients that use propecia long term continue to retain the majority of their hair over the long term, ten-plus years. I know that at some level it will continue to work, but what has been your experience? Do young people retain a significant amount of their hair over the long term?

It all depends upon what your rate of genetic hair loss will be and the degree of balding you may undergo. At 20 years old, it is almost impossible to determine this.

Now with that said, I just saw a 20 year old male with a full Norwood Class 5 pattern hair loss. He has miniaturization through the remaining hair and although he was not treated with finasteride prior to seeing me today, I discouraged surgery on him at this time until he had a year’s course of finasteride. His hair density was lower than average, which tells me that his long term supply of hair will be limited and when he gets the surgery, he will probably be limited to a frontal restoration only (based upon his low density). I am hoping that Propecia will help him, but I strongly recommended that he take the decision process slowly and have his parents come in with him when I see him again in a year or so.

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Dear Dr Rassman, I would really appreciate your response to this question. I cannot find the answer anywhere. You say that “if you are concerned about finasteride and its impact on your unborn child, you can stop using finasteride for about 1 week prior to conceiving a child as the medication should be cleared from your body.”

I was told by my Dr. that the semen which you ejaculate was produced 60 – 90 days ago in the body. Assuming you took finasteride in the 60-90 days prior to stopping for one week, surely the sperm you produce will still contain / be affected by finasteride because it was made well before you stopped taking it?

You make a good point. The drug company Merck has not reported any deformities (sexual identification of the fetus) with the use of finasteride and many of the men that take it are in their 20s and 30s. The real answer is there is safety in numbers and the lack of medical or fetal complications with finasteride (Propecia) indicates that this is not a problem.

Of course, you will have to be the final judge on whether you feel it is safe for the unborn child. The FDA would have made it known if this was a problem and they would have forced publication of such complications if they occurred.

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Hello Mr.Rassman. I know your main profession is regarding the hair and scalp, but I have a question regarding finasteride and acne. you seem to be an expert on finasteride. Studies say dht also causes acne. Finasteride inhibits dht, so can someone with acne benefit by taking finasteride. I found a website that states that in europe, the dermatologists prescribe finasteride for acne.

Here is the link. read under 5-alpha reductase inhibitors:
“A recent development in anti-androgen acne treatment is the inhibition of androgen-metabolizing enzymes in the skin or in the sebaceous glands themselves. One such androgen-metabolizing enzyme is the 5-alpha reductase inhibitor finasteride, which metabolizes testosterone into 5-alpha-testosterone in androgen-regulated target tissues. This enzyme exists in its two isoforms. The Type I isoform mainly occurs in the skin, located in the sebocytes, epidermal and follicular keratinocytes. Antagonists that bind selectively to this Type I isoform includes finasteride and dutasteride, and are believed to be capable of treating acne. European dermatologists have been using finasteride (used in combination with oral contraceptives for female patients) to treat acne, and have received effective results. Such an approach is yet to be approved for use in North America.”

since this method is not approved yet here in North america, what is your opinion on this?

Acne is a problem in the production of sebum and infections that get established in the glands of the hair follicle. If I am not mistaken, there is a bit of error in your quote: Finasteride (which is a 5-alpha reductase inhibitor) inhibits mostly the Type II isoform of DHT. I’m not an expert on acne, but I believe it is the Type I isoform of DHT that is partially responsible for acne. That said, I’ve read that DHT inhibitors can in theory treat acne, though theory does not always work out in real life.

I am not aware of a particular dermatologist in the U.S. that prescribes finasteride as an acne treatment, but I have read of such practice. As you know, finasteride is not approved by the FDA for the treatment of acne… but I don’t think it’ll be approved for that purpose, as the costs for the studies likely aren’t worth it to Merck. Honestly though, I get disproportionate emails from people on the Internet who are scared of using finasteride for male pattern hair loss despite its efficacy and safety profile. It takes real work for me to actually educate each and every patient on the real side effect and dispel Internet myths. If indeed finasteride can help with acne, good luck with the other swarm of myths to follow.

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