Day: January 1, 2023

Doctor Rassman, I’m curious as to your thoughts on the following article. I just learned of the development process for Propecia and was shocked to find they intentionally engineered the drug to match the hormone profile of pseudo-hermaphroditic children because they had smaller prostates and a lack of male pattern baldness. I can’t see any patient willingly taking this drug if they were aware of its origins. The entire concept seems drawn up by a completely mad scientist.

Only page 1 is necessary to read, the rest is just sycophantic quotations regarding Merck’s profits.

Link: Keeping the Pipeline Filled at Merck

I agree that what you read seems strange, but this isn’t only limited to Propecia/Proscar (finasteride). These types of discoveries in medication development are common.

Scientists often look to nature and outstanding traits/illnesses to understand certain diseases. When scientists found a group of a population with no prostate issues and no male pattern hair loss, they made a connection that it may have something to do with being pseudo-hermaphroditic, which led to the realization DHT had something to do with it. But the converse is NOT true: Just because you have low DHT does not mean you will be pseudo-hermaphroditic. Just because you take a drug to lower your DHT does not mean you will be pseudo-hermaphroditic. The hermaphroditic issues ONLY impact the fetus in the first trimester of pregnancy and not in boys or men. And even then, the dosage for this to occur in pregnancy is not understood.

Back to pharmaceutical discoveries — many drug origins are from strange findings. The common drug penicillin was discovered from molds. The widely used anti-wrinkle treatment Botox is from the poisonous toxin botulism. The flu shot many people get yearly is derived from viruses. The mascara that women put on their eyelashes are derived from earth worms. The first hormone replacement therapy drug to treat symptoms of menopause was made from the urine of pregnant horses. Certain blood pressure medications were derived from venoms of snakes. Coumadin is a rat poison that is used to thin the blood for certain patients to save their lives. My point is: medications can be very strange.

Hi doc. I am a 22 year old male and I have been on propecia now for about 13 months. It has been working very well for me, and I was even getting some regrowth at my temples and along my hair line. however, around the tenth month my hair started to get worse, and I started to loose more hair and my hair looks as though it is miniaturizing especially along the hairline and my temples. This has been occurring for the past 3 months and my hair does not seem to be improving at all. Is it possible that propecia is causing my hair follicles to become more sensitive to DHT or that my body has up regulated androgen receptors in the hair follicles to make up for the low amount of circulating DHT? I just wanted to know what I should do? Thanks.

It would be highly unlikely that Propecia would be causing your hair loss. The most likely explanation is that your genes are causing your balding process to continue, and Propecia can only do so much to arrest the process. It is possible that the hair loss process has itself, accelerated.

Since you are using Propecia, you must have a prescribing doctor. You should ask him/her to do a miniaturization study of your scalp to get some metrics knowing at least from this point forward, where your miniaturized hairs are and to what degree they are miniaturized.

I have been on Propecia for 10 years. I was out of the country and lost the bottle, so was off of it for 5 weeks. When i got back I started up again, but now obe month into restarting I am losing a ton of hair throughout the scalp. It is now very noticeable. Does that mean I lost the “propecia hair” for good after stopping for only 5 weeks? Will it come back now that I am back on it?

It may not all come back, but hopefully most will. The important lesson here is to stay on Propecia unless you want to undo the hair maintaining or regrowth benefits you received.

Lots of Propecia questions this week…

I am 21 and notice that my hairline is going. Should I start taking Propecia?

There are many important elements to your question and like all good questions, the answer may be more complex than you were expecting. There are many reasons for the hair line to move, the most common reason is the transition from having a youthful hairline to acquiring a mature hairline. This frontal change in the hairline occurs in 95% of young men and it is not reflective of the balding process. I can not tell you if Propecia will stop or slow this process down, but I suspect that it might considering that this is probably a DHT induced manifestation.

With regard to early genetic balding, I would get a good doctor to examine your hair looking for miniaturization of the hair shafts. The finding of miniaturization is an absolute sign of genetic hair loss, If you have it, Propecia is recommended to be started at the earliest appearance of genetic hair loss in the post pubescent male. Since genetic hair loss is a progressive process, the earlier you get a good diagnosis, and begin Propecia, the better your chance is to keep your hair for a longer period of time.

thanks so much for your reply i really appreciate it. i dont mind taking all the medication for the hair loss but i would rather prefer to get the hair transplant because it will last forever and then i dont need to worry about taking a tablet or putting minoxidil on twice a day. i would rather just get it over and done with so i dont have to worry about it anymore and it will also be good for my self esteem and confidence. what do you recommend?

Here, my age and experience come into place for value. If you are not going to get really bald because your final hair loss pattern is a simple Class 3, 3A or 4A, then you can take the view you discussed. If however, you eventually bald to a Class 6 or 7 pattern (advanced balding), then you will run out of donor hair before the process is complete, unless you are unusually blessed with very high densities. None of us have a crystal ball into our future. The question you should have is, “How bald will I become?” Hair loss is progressive, so chasing hair loss can be a losing proposition for some men. For that reason, I strongly suggest the use of Propecia because there is almost no down side to it, and it will slow down or stop the hair loss for some reasonable time so that you can enjoy your hair. Getting hooked on having expensive hair transplants surgeries on a yearly basis to keep up with progressive hair loss, until you run out of money or donor hair is not what you need.

Propecia is a simple, safe way to make sense of this entire genetic hair loss process.

I have a question for you … on merck site it says hair mass can thicken up to two yrs… but I was told it can thicken up to three yrs… is that true??? and when is the best time to take propecia am or pm???please let me know your answer… thanks

Propecia is best taken in the morning. The thickening of the hair shaft will, almost certainly, vary with the patient. In some patients the best fullness may be obtained in one year, in others it could take two years, and in some possibly three or more years.

Dear Dr. Rassman:

I am a bit concerned about continuing with Propecia in light of the recent finding on the risk of high grade prostate cancer. At the FDA hearing in June of last year, the FDA statistician estimated that the risk of getting high grade prostate cancer using 5mg of Finasteride over a 7 year period was 1 in 200. I realize that Propecia is one fifth that, but even a 1 in 1,000 risk when it comes to an aggressive cancer seems, well, risky. If you told me that there was a 1 in 200 or 1 in 1,000 chance the plane I was about to board would crash, I would not board. So, my question is this: is there anything in the study you see that makes you think it’s safe to keep going with this drug?

I believe you are reading things out of context. The FDA site states:

“The labels of all 5-alpha reductase inhibitors (5-ARIs) are being revised based on FDA’s review of two large studies examining whether these drug products (Proscar, Avodart) reduce the risk of prostate cancer. The studies did find an overall reduction in the risk of lower-grade forms of prostate cancer, but both studies also showed an increased risk of high-grade prostate cancer.

As a result of these two studies, the labels of all FDA-approved 5-ARIs will be revised to include new information that these drug products may increase the risk of high-grade prostate cancer. The product labeling will also state that 5-ARIs are not approved for the prevention of prostate cancer.” [Source]

I did a quick Google search and found prostate cancer statistics, unrelated to finasteride use. “Based on rates from 2006-2008, 16.48% of men born today will be diagnosed with cancer of the prostate at some time during their lifetime.” That is about 16 in a 100 or 1 in 6 men.

My point is: Propecia does not cause cancer. The studies that the FDA quotes and the media has latched on to point to how those men who ended up with prostate cancer while on finasteride had a higher grade prostate cancer than men who did not take finasteride… but the controversy of why this is, was not clear from the studies.

A final point is that if you are concerned about the medication, you do not have to take it. It is an option I give to all my patients. This is one of the many reasons why a doctor should prescribe you the medication, because each and every patient is different and the prescribing doctor should be there to address all of these issues one on one with the patient.

In a recent blog post you wrote about sexual side effects associated with propecia use, “These side effects are reversible withing one to two weeks after you stop the medication.” You then went on to say that Dr. Irwig’s study in Journal of Sexual Medicine was not a scientific study.

When you read through the FDA hearing on Propecia (FDA link) Keith Kaufman of Merck talks about the 3.8 percent of finasteride users experiencing side effects versus 2.1 percent of the placebo. He then goes onto say that these patients then completed a validated sexual function questionare. I am not a doctor but Merck basically based these figures on self reporting, should those numbers not be considered scientific?

In July the Dr. Irwin Goldstein the Editor-in-Chief of the Journal of Sexual Medicine wrote “I think of the frequent phone calls I receive from distressed men with varying degrees of hair loss who have used 5 alpha reductase inhibitors and now have newly manifested sexual and cognitive complaints that often persist despite discontinuation of the 5 alpha reductase inhibitor. Often such 5 alpha reductase inhibitor users have sought help only to be belittled, betrayed, misdirected, and sometimes misinformed. In general, these patients feel deceived becuase of the lack of information warning them of the potential side effects.”

I am one of the individuals suffering from persistent sexual dysfunction after stopping propecia and it appears pretty certain to me that in a small subset of men the persistent sexual dysfunction is due to the medication.

I am not going to get roped into an anti-Propecia agenda. I will leave that up to those who regularly comment on almost every post where the word “Propecia” appears.

My heart goes out to you if you actually have long-lasting sexual side effects, but the questions of validity ring true to your cause of sexual dysfunction. I am not in a position to judge your problem or to put the pieces together for you. That must be between you and your doctors. I am a doctor, but the posts here are just my opinions on my blog. Some may not agree with me, but that is OK! As the disclaimer on every page says, BaldingBlog is not a place for treatment advice or diagnosis. If the readers want to discuss their issues on a professional basis, they can always make an appointment and see me.

I will post an interesting excerpt from the 1997 FDA Drug Evaluation Hearing that you quote (the last sentence particularly worth noting):

“We attempted to obtain followup on all patients reporting sexually-related adverse experiences. Of the 36 patients on finasteride reporting these adverse experiences, 21 reported resolution of the adverse event while continuing finasteride therapy. Seven reported resolution following discontinuation from the study, and seven had persistence of the adverse event while continuing in the study on finasteride therapy. The pattern for patients on placebo was essentially similar, with most patients resolving either on or off drug, four patients reported persistence of the adverse event while remaining on placebo therapy.”