Day: January 1, 2023

I read somewhere that propecia doesnt prevent baldness it just slows down the process.I am using propecia since i was 19, so should i expect to get bald sooner or later one day even though i continue to use propecia? If yes,on an average at what age will get bald?

Everyone is different and reacts differently to medication. Some people have a strong and aggressive hair loss pattern and Propecia will slow it down, but not by much. Other people have a not-so-strong tendency to bald and it may slow it down for years and years. Others will reverse the balding process. I have a number of patients who took it for crown balding when the drug was first released and the hair loss completely reversed and has stayed normal since 1998 (no evident balding to the naked eye, although it can be seen with some miniaturized hair when looked at under high magnification).

Hello Doctor:

Thanks for you candid forum. I have three questions for you. If I’m a male on Propecia to prevent hair loss, will taking protein supplements for body building militate against the benefits of reducing DHT by Propecia? And, how can I reduce the sexual side effects of Propecia; namely, the reduced sperm volume? Finally, is there any evidence yet that taking Propecia and its active agent long term will cause permanent side effects or potential diseases?

Thanks again

I’ll answer your questions in order and they are all good questions;

1. Protein supplements will not change how Propecia works, namely, by blocking DHT formation. I WOULD warn you against taking any steroids which conceivably could alter hormone levels and diminish the benefits of the Propecia.
2. The sexual side effects of propecia are often temporary, but if they persist for you, I usually recommend trying a half-tablet twice daily or even just once a day. You will get less than the full benefit (I am led to believe that 1/2 tablet may give you 80% of the benefit), but you will at least get SOME benefit and that is the important thing.

   Sperm volume and ejaculate volume are two different things. Ejaculate contains several body chemicals and fluids, not just sperm, and decreased ejaculate does NOT mean less sperm at all – as a matter of fact sperm levels for those with decreased ejaculate are usually still within normal levels, possibly higher. Decreased ejaculate volume was shown to occur in 0.8% of people taking propecia versus 0.4% of the placebo group in the initial studies (that decimal point is correct, it is LESS THAN one percent). Although the frequency of reduced ejaculate volume is reported small, in my experience after probing many men on this issue, it is far more frequent than the literature seems to suggest. If you are worried about potency or having problems with conception, I’d see a urologist and get your sperm count done.

3. Finally, the long term data for finasteride (~15 years of data) does not show any permanent side effects or potential disease. As a matter of fact, the data so far indicates that there is less prostate cancer in those taking it. So there you go!

hi doctor Rassman. Is it true that propecia can cause weight gain due to its antiandrogentic properties? I heard that androgens like testosterone and DHT promotes fat loss in the body. Also, would taking propecia affect the heart at all? I read on propecia forums of users reporting heart synptoms after using the drug. Some reported a “dipping” feeling of the heart. I really wanna try the drug but now im highly discouraged by these negative claims.

Not everything you read on the Internet is always true. There may be a great wealth of information available, but I wouldn’t rely on the Internet for your source of medical diagnosis and treatment. A doctor will know better than some anonymous guy on a forum that has no liability or reputation (not to mention experience or even a real name). You need to see a good doctor and ask him/her if you have genetic balding… and if you do, talk to them about taking Propecia. I have not heard of such weight gain side effects from the patients I treat and side effects are rare in general with Propecia.

Keep in mind that all medications can have side effects. Have you ever taken Tylenol or Advil? Do a search for the side effects of those medications and you will likely lose more hair over it (pun intended). For example, Advil side effects include rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn (see full list).

I take 1/2 Propecia once every other day and this seems to have completely halted hair loss and it will not cause the permanent side effects documented at www.propeciasideeffects.com and the forum at www.propeciahelp.com

Another strategy might be to take just 1/4 a table every day based on the pre-approval data submitted to the FDA which shows no statistical difference between .25 mg and 1 mg in the actual level of DHT at the scalp.

The bottom line is that although the Merck studies only cite a 2% occurance of side effects that were observed, this drug does cause change and damage to the penis itself if taken long enough.

So I think one should try to find a balance between the minimum amount of propecia needed to halt hair loss and then use other compounds to stimulate regrowth.

If you look at the placebo comparisons with finasteride, you will see that they are relatively close, but when people talk about drops in libido, the placebo data is rarely discussed. We offer finasteride (Propecia) at doses lower than 1mg per day to our patients (take a 1mg pill and cut it in half) if they have a drop in libido with the medication. In some patients, the side effects go away with lower doses of finasteride. In many patients who get the side effect of decreased libido, the side effect goes away in a month or two without changing doses. There is no research to support that lower doses of finasteride causes less side effects and this is only suggested on rare times by us based on logic. There is also no proof to show that lower doses of finasteride can provide the same results on prevention of hair loss in balding patients, in fact, the clinical tests show that the 1mg dose is the best dose for effectiveness against hair loss. There are some studies on effectiveness of lower doses of finasteride on animals, but before we see more results from human studies, we can not recommend a lower dose hair loss treatment.

DHT is crucial for growth and development of male genital organs before puberty, but there is no report of any changes in size and shape of male genitalia in adults who take finasteride for a long time. I have to emphasize that finasteride is contraindicated in children and pregnant women, and may adversely affect development of genitalia in male children or unborn babies.

Note: I believe these were from two different people, but the questions are related so I’ll answer them together…

Email #1

Now doc , i have a suggestion to make just like you do.You write “Every person will eventually lose the benefits of this drug, but the open question is when” – there is no proof for this , or you do have one ? Even if this statement is based on your experience , you are aware that this is not official and there is not way to be.The official one is that after 5 years only 10 % of the people lose some hair , and please attention – more of teh 50 % of the rest CONTINUED to improve even after this.So unless you can prove the opposite ,please flag those ones as “my opiniion ” or “may” or “might ” , but please do not make statements which are neither proven nor stuided in the medical literature – 10x

Email #2

Why do you recommend Propecia to people that come to you for hair transplants if the effect is only temporary? I just ask because you emphasize a master plan for long term benefits, and it seems like as soon as the drug stops working, the hair it saved will fall out and the patient will have that embarrassing pluggy look -bald head with transplanted hairs. Isn’t it setting up people for more misery to take a drug that temporarily grows their hair back, only for it to fail and then they experience going bald again?

Thanks for your time

Read the official study posted at Hairlosstalk.com and you can draw whatever conclusions you want from it. I believe that this drug has a forever component, but that does not mean that it will hold all of the initial benefits forever. Each person will react differently and I can’t give an exact timetable for when you’ll start to see thinning continuing (if ever). So yes, the medication does work “forever” as long as you continue taking, but the benefits may eventually appear to be less. It could be 5 years, it could be 20 years. The only facts at our hands are in the official Merck/FDA studies.

Propecia’s benefits aren’t quite temporary. It’s not just going to suddenly one day turn itself off 100%. The entire point of a Master Plan is to create a roadmap for a worst case scenario of hair loss so that nobody is taken by surprise if the progressive nature of MPB becomes more evident a decade after you start Propecia. With the modern hair transplantation, the “embarrassing pluggy look” you described shouldn’t occur.

Propecia is a miracle drug for many people, as it gets them some (or a lot) of their hair back… and it largely slows or stops the hair loss. Many of my patients swear by this medication. This is a type of medication in that if it grew hair back and stopped or slowed hair loss, them some benefit will probably last ‘forever’. Of course, you can test this by just stopping the drug and seeing what happens. Most people who saw substantial benefits and then stopped the medication saw hair loss, which suggests that the drug had some residual value. The alternative is that you can elect to take your natural balding process to its conclusion, reflecting your genetic makeup. Your choice, of course.

Hi Dr Rassman I have a question regarding long term efficacy of Propecia in older men who have been using it for an extended period of time.

I am in my mid fifties and have been using it for 10 years and I’m happy with the results it seems to be maintaining fairly well. However I see posts on other hair sites (by users not doctors) who say it stops working. I tend not to trust some of these people as it sometime seems they are freely expounding personal experience rather than hard facts.

Can you shed some light on this for me?

I’ve written about this before, but if the benefits of this medication eventually becomes less apparent and if you should stop it, then you’ll surely find out if it was still working when you begin to lose more hair. In other words, it is best to continue it even if you think it isn’t working anymore, because it likely is still working and stopping the medication may cause you to lose any hair that it was holding onto.

As an aside, there is great evidence that this medication will reduce the risk of prostate cancer in men over 55 years old.

Hi Dr. Rassman,
I am 19 years old with no signs of hair loss but I have a family history of mild MPB (Dad has thinning in crown + vertex, no recession). I was just wondering if there was anyway starting Propecia now could worsen my hair. I understand that it doesn’t make sense to take a drug if there is no hair loss, but I’d rather not play catch up. Also, have you had patients where there is no recession but thinning on the top near the mid scalp + crown? Thanks!

Propecia (finasteride) is not something you take to prevent balding when you don’t have a diagnosis of androgenic alopecia. You don’t use an antibiotic when you are healthy to prevent getting an infection. You don’t take blood pressure lowering medication to prevent high blood pressure that you don’t have.

This is one of the many reasons that you need to see a doctor before starting medication. You should begin by finding a doctor who can examine your hair for possible miniaturization and/or bulk changes, and ONLY if you are diagnosed with androgenic alopecia can you consider taking Propecia.

This is not about catching up or waiting for hair loss to occur. It is about a medical process that is logical and safe for you.