Month: August 2010

Dear Dr. Rassman,

I am a 22 year old male, and I have been on Propecia and Rogaine for about 2.5 months now. I was developing slight hair loss at the crown, and a receding hairline. It seems as though hair loss in all these places is being reversed as a result of the medication. I can still see room for improvement, but I am pleased with the results thus far.

I have two questions: can either of these medications cause hair to grow on other parts of the body? I’ve always had a lot of body hair, but it seems as though some parts of me have gotten hairier.

The other question is on sexual health. I’ve noticed that my semen has become much less viscous than before; the color remains cloudy white, but it is not as sticky and thick as before — almost like a fairly runny liquid — and orgasms seem less potent. Could this be because of the medications? Can I expect the problem to reverse itself over time? And, a matter of great importance to me: could that be a sign of compromised fertility?

My libido remains as high as always.

Propecia (finasteride) can give you less viscous semen and a smaller volume of semen. These are well known side effects. This drug does not compromise fertility.

Rogaine (minoxidil), if you apply it on other parts of your body, can give you more hair. I recall a patient that worked outdoors, and sweating in the hot sun caused the Rogaine he applied to his scalp to run down his neck. As a result he grew more neck/back hair than he was used to. I do not know if Propecia is making you have more hair on your body, but it has been reported.

I am 27 years old and I write regarding a side effect of propecia which is making me extremely nervous — to the point that I haven’t been able to sleep for many nights, and have been surfing the internet in search for answers and hope leading me to your site).

I took propecia for about four weeks, and at the fourth week mark, I noticed that my erection was significantly weaker. Because I am only 27, this was very odd — it had never happened before. I apologize for being graphic, but by weaker, I mean that the erection was only “half way” and “half full” and it was noticeably smaller, even though I was still able to ejaculate. The experience was not that pleasurable. Moreover, even when I am walking around on a daily basis, my penis “feels” smaller. One month later, the problem is just as bad.

I read online that a small percentage of men can suffer permanent, irreversible ED from propecia. I have already set up an appointment with a urologist, but suppose the worst happens and I am in that 1% group. Then, what could the urologist even do? And, what could I even do? Will I need to take Viagra the rest of my life?

This wouldn’t be as big of a deal if I were 50, but because I am only 27, I’m so, so worried that the rest of my life will be worse. I am being serious here: How can I ever be happy if I cannot perform sexually anymore? How can I even have a girlfriend or get married to someone or have a fulfilling life? Of course, if I had to take Viagra the rest of my life, I guess that wouldn’t be as bad as never again experiencing a full erection — but will Viagra even work for me?

Again, I know that you will advise me to see a doctor, and I will. Until my next appointment, though, I just need some hope. Besides, through your site, you probably have more knowledge and information about this problem than the urologist I will see.

Please, please help. I feel like my happiness in life is on the line.

You need to make an appointment with the doctor who prescribed you Propecia and discuss these issues with him/her. I suppose the appointment you made with the urologist may help too. I may be a doctor, but I am not your doctor and can’t give specific medical advice. I simply don’t know any of your medical history. There’s absolutely know way for me to know if you need to take Viagra for the rest of your life or if it would work for you.

In general, patients who have erectile dysfunction (ED) issues with Propecia can stop the medication and have the side effects go away within a week. That is the norm. I am not sure of reports that reflect permanent ED in men from Propecia, so there is hope in that regard. According to data in the medical literature, sexual side effects are not permanent in the less than 2% of men that experience them.

I had been taking Finasteride for around four months until I stopped due to side effects. I was off the drug for around three weeks but then began to think that the side effects were psychosomatic so I decided to start taking it again. I was wondering if I could have suffered some hair loss during my brief break?

There’s really no way for me to know if you lost hair after your brief finasteride vacation (I don’t have access to any before/after miniaturization mappings), but I’d suspect that it’s possible to lose hair in as early as 3 weeks time.

Side effects are entirely possible (thought the percentage is small), and there are plenty of times that these side effects are psychosomatic. I mean, some men even documented hair growth when they were taking a placebo. The mind is a powerful thing.

I have been taking 5mg of Finesteride daily for a year now and noticed early on a sharp decrease in ejaculate volume. I have since found out that this sympton does occur so any concerns have been laid to rest.

My question though: Is there a medication that can be safely used along with Finesteride that will increase the force and volume of my ejaculation? – Thank you

This is a known side effect of finasteride, particularly with the higher 5mg dose (used to treat the prostate). There’s no medication that I know of, but I’d recommend drinking plenty of water and eating a balanced diet to see if that helps.

There are natural supplements some people swear by to increase ejaculate volume, and while I can’t vouch for any of these, I suppose if you want to try them it couldn’t hurt. See the list here.