Dear Dr. Rassman,
If one is in the early stages of MPB, is it possible to have a hair transplant straight away, and then keep having “top up” hair transplants as the hair behind the transplanted hair begins to recede? I wanted to take Propecia to begin with, but I am petrified after reading about the possibility of irreversible sexual side effects. I know that some people, including yourself, believe that these may all be in the mind, but the problem is, I am very fragile mentally (I suffer from depression, OCD, and social anxiety), and so I believe that I could be more likely to suffer from them because of this.
Many thanks.
If you are “petrified” about using Propecia, maybe the drug is not right for you. You are already biased against the drug and if you do have an obsessive-compulsive disorder and anxiety issues, it will be a difficult hurdle. I do find that most people who are very apprehensive about the side effects of Propecia almost always end up with the side effects. This has been corroborated by other hair transplant doctors in the past. In that sense I think there is something to be said about the negative placebo effect. I do not mean to shed a negative light onto your issue with medication, but in the end I believe you should speak to a doctor about your options.
With respect to hair transplants in men in their early 20’s with early stages on MPB, I generally do not recommend transplanting at that age, because you may do more harm than good. The process of hair transplantation may accelerate the MPB and you could end up looking even worse after surgery. This is a generalization and you also need to address this one-on-one with a qualified physician.
In the end, there is no easy answer and I do not have all the solutions.
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This is ridiculous. You should keep away from the drug because it can cause actual lasting side-effects, not because you are afraid that it potentially may. Many guys, who have taken the drug were not concerned about the possibility of side effects, ended up developing them permanently. You can see this documented on many hairloss forums online.
Also documented on many forums online: Bigfoot sightings, 9/11 conspiracy theories, alien abductions, etc.
Jeremy: I hope you have hobbies other than spreading fear, because your one note song is getting tired.
Hairloss forums are notorious for being poor sources of information. Individuals that frequent those forums tend to be more depressed, anxious and obsessive than the rest of the population; definitely not a good place to take a statistical sample from.
However, I agree with Dr. Rassman here. I submit my own experience as a perfect example. I used to display the same tendencies that the person submitting their question does, and fell victim to my own mind. Paranoia, worry and obsession over what Propecia ‘might’ do to me ultimately was my undoing. Even though Jeremy believes my story is ridiculous and/or made up, targeted therapy was the answer in my situation, and I have been able to continue on Propecia coming up on 3 years with no problems.
To the OP; I strongly recommend Propecia as a solution to your hair loss. This in itself may relieve much of the anxiety you are experiencing due to your hair loss. However, being of sound mind is crucial before starting on it, and visiting with a therapist may be needed if you haven’t already.
Good luck!
Maybe start using some Minoxidil? It is unlikely to cause any lasting side effects.
Tex –
I have never stated that I think your story is ridiculous, but rather I think you are ridiculous. Since to the best of my knowledge you did not undergo any objective tests I cannot comment on your case. However the norm is for men to recover from finasteride, not the exception, so there is a good chance you would have recovered independent of your therapy sessions.
Dougie –
I have my assumption that you have common sense is not too presumption. A bit of logic and an IQ above 85 will help you realize that balding forums are are legitimate and reliable than conspiracy and alien abduction forums. Many of the men on the forums had expressed no anxieties, fears, or worries which seems reasonable to believe unless you are one of those conspiracy theorists and believe the anti-Propecia mob randomly congregated to destroy the drug for no apparent reason.
Jeremy: People on conspiracy and alien abduction forums also believe their sites are sources for reliable and legitimate information. You have at least a little sense to realize that as an outsider looking in, their claims sound ridiculous. Then you go and throw that sense out the window when it comes to hair loss forums, insisting that the anonymous claims are reliable and need no further scrutiny. Give me a break. I’m not saying all of the claims are made up, but they aren’t verified. It’s just awfully convenient how easy it is for you to throw common sense out the window to suit your agenda.
I still don’t quite get why you feel it is your life’s mission to piss on everyone’s parade. Don’t take the medication, but don’t spread fear and uncertainty while trying to pass unproven claims off as fact. I doubt that most of the people that are members of a site with the words “Propecia” and “help” in the name aren’t just visiting that site without some anxiety or preconceived notions.
And I am still waiting for the “countless” cases of irreversible sexual dysfunction noted on blogs to be written up as even a single case history in a medical journal. Such a case should exclude other factors that are known to cause sexual dysfunction (eg diabetes, anxiety, hormonal issues, aging, etc), show a temporal relationship between onset of Propecia and sexual dysfunction, involve electroplethysmography, and report any irreversibility (reversible sexual dysfunction has already been described). The two Journal of Sexual Medicine articles from last year are nothing more than surveys and are noted by the authors as unscientific and limited in scope.
Dougie:
I’m not referring to PropeciaHelp forums. There is absolutely no discussion of this sort on PH, but if you were to look at other very popular hair loss forums you will find many men who claim to be interested in trying Propecia and report back on their experiences. Unless you assume they are entirely lying and have some ulterior motive (which is extremely unlikely and conspiratorial in and of itself) it seems very possible to believe at least some of these reports. There are dozens of red flags that make the forums you mentioned very dubious that are not present for average posts on hair loss forums.
It is not my life’s mission to “piss on everyone’s parade’ but I was personally impacted very negatively by the drug. I was misled but online information like Dr. Rassman’s blog and through advice given by doctors and developing sexual side effects after taking the drug that have not yet improved despite being off the drug for more than a year.
There is substantial proof that Propecia has the potential to cause long-term sexual damage but most of it is unknown to physicians or known and ignored (in the case of Dr. Rassman and friends).
Your last sentence actually contains a triple negative (that is a new one for me) but many people do research about medications on the internet before taking them. The only men who I ahve seen join have developed the side effects themselves which have not reversed. They have joined to discuss various treatment options and efforts to find research into our problem.
“If you are “petrified” about using Propecia, maybe the drug is not right for you”
Wow, if that’s not the understatement of the year! It’s not that “maybe” the drug isn’t right for the writer, the answer is this fellow shouldn’t walk but run away from Propecia! Don’t even handle the tablets and wash your hands well afterward if you ever touch on pal.
Dougie: “I still don’t quite get why you feel it is your life’s mission to piss on everyone’s parade. Don’t take the medication, but don’t spread fear and uncertainty while trying to pass unproven claims off as fact.”
Piss on everyone’s parade? What is this veneration of Propecia you see on these hair loss websites? What, this is the miracle baldness cure of the century? Are you guys throwing Propecia parties or something? Jeremy is just trying to WARN people of the dangers of a prostate/hormone altering drug that is routinely prescribed by hair transplant docs with no informed consent whatsoever being obtained in advance: no warning of adverse side effects, nothing, zip. The drug not even offered as an option. I was virtually told I HAD to take Propecia if I wanted a hair transplant, that there was no choice (treated like I would be a fool not to take it). Thank god I has the brains to check in it out myself, something I owe thanks to the internet for.
That’s how these docs are. They don’t ask, they just say, “here, you need to take this.”
Jeremy: So now I am getting grammar tips from the guy that said “I have my assumption that you have common sense is not too presumption”. Right. I apologize that I confused your mighty brain so much, but there’s no edit button on here and I thought you’d be smart enough to get it. Turns out, you’re petty along with whiny.
If you’re so easily persuaded by things you read online – as you just said you were convinced to take prescription medication because of what you read online – it’s no surprise that you’re so quick to believe the hair loss forums that publish unverified claims. Thanks for clearing that up. Clearly, you have issues greater than anything the medication supposedly caused you.
The problem is not with the anti-Propecia crowd bad-mouthing the pill, the problem is that hair transplant docs push this stuff on everyone who comes through the door. I had the doc I consulted not only TELL me to take it (no option like “this is available if you so choose”) but simply “here, start this right away”. She even went on to make the bizarre comment that she thought all men ought to take it even if they weren’t experiencing hair loss! Imagine that. Fortunately I said, “to hell with you lady, YOU take it”. I even had a plastic surgeon say to me, after I told him what she had said, “sounds like she doesn’t like men very much!”
I meant to type presumptuous, that should have been obvious and was a mere typo.
I didn’t say I took the medication because of things I read online, in fact I claimed the OPPOSITE. I consulted with doctors in person but I also read Dr. Rassman’s blog. I’m reporting on my personal experience and you should be grateful this information is reaching you. You clearly are dense so I will not attempt to reason with you. Good luck with your experience with Propecia. Even though you are quite irritating, I would not wish PFS on my worst enemy.
BiotechMD brings up a very good point. There are hundreds of articles, dozens of news reports and a ton of media attention focused on these persistent propecia side effects. With seemingly thousands of individuals experiencing these problems, how could there not be a single article in a medical journal that reasonably concludes Finasteride can actually cause any of these problems? Clearly, if the problem is really so widespread, how is it possible no link has been made yet?
The closest thing to this is the 100-something guys that were interviewed over the phone in Dr. Irwig’s study. Basically the word of each patient is the only ‘evidence’ gathered. From what I can ascertain, most if not all of these subjects were gathered from propeciahelp. It isn’t unreasonable to also say that some of these guys would choose to exaggerate their problems in an attempt to have their plight more widely accepted. As an admittedly un-scientific guy, I can clearly see how weak this study is. It seems like the entirety of the medical community agrees.
The basis of all the media attention thus far has been on propeciahelp, and Dr. Irwig’s flimsy article in the journal of sexual health. Anybody that takes a reasonable amount of time verifying the validity of these sources will conclude the same thing I have.
I would bet money on the fact that most people with these problems are experiencing some degree of anxiety and/or depression, which is perpetuating the problems they believe they are experiencing. All of these guys flat-out refuse to believe it could possibly be in their minds and refuse to seek any sort of psychiatric help. From what I have seen, if they do seek psychiatric help, it is to deal with the problems ‘propecia’ has caused. Not to deal with the false beliefs in their minds; the root of what is keeping them sick.
When you convince yourself of something, and reinforce your beliefs daily by participating in the type of talk that goes on at Propeciahelp, your problems become more real and more entrenched in your mind. Your mind is extremely powerful. It can warp perception and make your fears become reality. It becomes extremely difficult to escape from that mindset; I went in and made it back out, and I’m sure there are thousands of others going through the same thing.
This isn’t a theory of mine; it’s the same conclusion most of the medical community has reached as well. I believe this will be proven over time. Perhaps when people realize self-medicating by pumping their bodies full of hormones, taking all sort of ‘alternative medicine’ cocktails do absolutely nothing in the long run, they may realize something else is going on. I think this will all be a forgotten blip in the history of medicine, and that these men will become well again after getting the right type of help.
Biotech MD – The Irwig study, which you possibly have read, is a case series of more than 70 men who took Propecia and developed persisting sexual dysfunction. The case series excluded all of the factors you mentioned and Dr. Irwig is in the process of collecting hormone and semen analysis samples. I don’t understand how you think it could be possible for a single doctor to conduct a more methodologically complete study of thousands of men with this problem? It has already taken the doctor hundreds of hours alone to complete what has been done, and is only marginally less rigorous than what you have requested. While it remains to be published, there are hundreds of reports to the FDA which complain of these persisting side effects.
Tex – You are perhaps the most dense commenter on this blog. I don’t know why you are so insistent on claiming these effects are psychosomatic when you have not addressed the many significant points that demonstrate they are not.
1. Neurological dysfunction has been demonstrated in many of the men who have had testing for abnormalities.
2. The loss of morning erections indicates the problem is physiological and not psychological. This has been reported by almost every PFS sufferer. A psychologist I have visited confirmed this is the case in his experience and he did not believe my problems had psychogenic effects.
3. There are other indisputably physiological symptoms such as reduced semen volume, lack of color, and sharp decrease in viscosity that are tied with the sexual dysfunction.
Please address these points before you go on one of your ignorant and speculative rants. Lastly, it is possible in a variety of scenarios for psychological stress to cause sexual problems. This is not due to the magical thinking, you describe, where thoughts somehow become reality. Anxiety and stress affect the autonomic nervous system which releases adrenaline throughout the body which is a potent erectile inhibitor. This would not affect men continuously for months straight without cessation and really has very little to do w/ the “power of one’s mind”. It is a simplistic stress response that does not seem relevant to nearly any of the men with this problem.
BiotechMD – August 2nd, 2011 at 1:38 pmAnd I am still waiting for the “countless” cases of irreversible sexual dysfunction noted on blogs to be written up as even a single case history in a medical journal. Such a case should exclude other factors that are known to cause sexual dysfunction (eg diabetes, anxiety, hormonal issues, aging, etc), show a temporal relationship between onset of Propecia and sexual dysfunction, involve electroplethysmography, and report any irreversibility (reversible sexual dysfunction has already been described). The two Journal of Sexual Medicine articles from last year are nothing more than surveys and are noted by the authors as unscientific and limited in scope.