Month: February 2011

Hi Doc,

I’ve been reading your blog on a fairly regular basis and have found it very informative. I’m almost 19 and my hairline has been creeping back since around my seventeenth birthday. At the moment I’m probably an nw2. My brother who is 21 would be considered nw4 if it wasn’t for a very fine scruff of hair in front.

Concerned that I was following suit with him, I decided to fill a prescription of propecia. The possible side effect were pretty unnerving but I figured it was my only real chance at keeping my hair.

I’ve read on your blog that the 1 mg dose does not affect the prostate but it definitely did in my case. The day I took the first pill, my prostate had sudden pains throughout the day. My semen also became water-like. I know this isn’t supposed to be a big issue, but it concerns me that it started happening right away and seems to me like another sign that it was affecting my prostate.

My question is where do I go from here? Have any of your patients had a similar experience? I recently started using a minox product but am unsure what to do as far as meds. Should I try a lower dosage of propecia? Would saw palmetto be worth trying?

Also, have any of your patients experienced results in the hairline from minoxidil alone?

Thanks for your work

First, how do you know what prostate pain feels like? I don’t imagine most men would be able to pinpoint which internal organ is hurting so quickly… particularly the prostate. Prostate pain generally ranges anywhere from lower back problems to urinary issues. Is that what you felt? Second, you had sudden pains after one dose? That strikes me as extremely odd. It’s worth noting that there are some rare reports of testicle issues after taking finasteride, but I haven’t heard of any case where this occurred on the same day that you took your first dose ever. I’d think it’s more likely that you psyched yourself up for side effects, as you said you were pretty unnerved about the medication before you even took it. You were expecting some negative reaction and you got it — this would also be known as the power of suggestion.

You need to get a good, solid diagnosis with the tests I have suggested (miniaturization mapping, hair bulk measurement) before you make the decision on taking finasteride for life. I hope your prescribing doctor gave your scalp a thorough examination before suggesting you take this medication. Now that you’re noting problems though, you should talk to your doctor about this. I’d get off the medication to see if the pain goes away. Remember, a good Master Plan is needed for every young man facing an uncertain future for hair loss.

As for minoxidil, that is an over the counter treatment and so long as you don’t become worried over potential side effects from that drug, it might be worth a try. It would be rare to see regrowth in the hairline from minoxidil or finasteride.

Hello Doc,

I have been a frequent reader and an occasional poster on your blog for a while now. I have been on finasteride (1 mg) for the past year and a half with mixed results. The drug has definitely slowed down my hair loss to an extent and could have also initiated some regrowth in the crown area. Of late (for about a month now) , I have been experiencing some sexual side effects that I had never experienced during the past year and 5 months. Although I do not want to discontinue the medication (since it seems to be working) I am apprehensive about the long term ramification of these new developments. Under the circumstances, would you recommend reducing the dosage from 1 mg a day to 0.5? I might have come across a post on this blog, where you had mentioned about virtually no difference in the potency of the medication at dosages of 0.5 and 1 mg (I might be wrong). It would be great if you could respond to this query.

Thanks for your time and keep up the good work.

I am not your doctor and Propecia is a prescription medication that a doctor needs to prescribe to you. You need to ask this question to the doctor you get your prescription from. You should ask your doctor about changing doses in your medication. As for the reduced dosage, I’ve read a study that cites about 80% effectiveness with 0.5mg.

There may be other issues (not only the possible side effect from Propecia). Some men (even in their 20’s) experience impotence, decreased libido, etc, WITHOUT any medications. These issues are not discussed openly in public, because of their sensitive nature… but it does happen. Find out if your issue is due to Propecia or other medical or psychological issues.

Snippet from the article:

When it comes to taking medicine, you may get what you expect.

A new study has found that your expectations can affect how well pain medications work. Being optimistic may boost their effectiveness in blocking pain, while being pessimistic may lower their effectiveness.

Unlike earlier research, the new study used brain imaging techniques to examine brain regions that are known to be associated with pain. Scientists say that until now, little research has been done to clarify the brain mechanisms that control how different expectations affect drugs.

Read the full story — Positive Thinking May Make Drugs Work Better

This is a very interesting article. Pessimism may lower effectiveness, wishful thinking may make the drug work. We’ve talked about this before on the blog, and this is something many of my colleagues have expressed. When physicians prescribe a medication to patients who are obsessed or too worried about side effects, they usually seem to get the side effects. It’s almost a self-fulfilling prophecy.

I’ve been taking Propecia/finasteride for going on 10 years now (started when 23). I am very pleased with my results, including hair REgrowth on dome and even in front.

My question is, how long can I anticipate this will continue to work and should I have any concerns about taking this drug for so many years now and into the future? I have not experienced any known side effects.

I am glad you’ve had good results with Propecia with no side effects in the last ten years you have been taking it. Unfortunately, I cannot predict the future. I have no basis of your own personal progress. I do not have a set of measurement points so that I can even take an educated guess. This is one of the reasons why we remind folks to follow up with their doctor. Hopefully if one doctor has been following your progress, there should be some sort of documentation or some objective measurements that they can refer to give you a better answer. Generally speaking, some patients report their visual benefits decrease after around 5 or 6 years, but I’ve got some patients taking it for over a dozen years with excellent results. Each person is different.

We suggest that all men taking finasteride get a bulk measurement baseline to help quantify when the drug may be starting to show less benefits. Bulk measurement will tell you much and if you do it every year, then you can clearly see a trend if it is starting.

As for safety… well, Propecia is a safe medication and I don’t think you should be concerned about the long term use. It’s worth noting that finasteride (in a larger 5mg dose) has been on the market for nearly 20 years now.

Hello,
I have used Minoxidil 5% with good results for 2 years. In the first year I used a solution with ethanol and retinoic acid but switched to ethanol retinoic-free minoxidil 5% after a year.

1. Are these agents vitally important to the work of minoxidil?
2. My hair seems to go in cycles from quite thick to quite thin and back again over 6 months or so.
3. is this normal with minoxidil use?

Many thanks

1. Retinoic acid produces a mild burn to the skin which increases blood supply and the absorption of minoxidil. That is why, I believe, some doctors use retinoic acid, though it isn’t necessary for minoxidil to show benefits. Ethanol (alcohol) is an ingredient in Rogaine and I’d assume most topical minoxidil products.
2. Some patients have reported hair cycling by time of year. It seems to be rarely talked about, so I really do not know the answer to question #2.
3. Cycling occurs with or without minoxidil use, but this is the normal hair cycle — anagen, catagen, and telogen. I’ve previously written about hair cycles.