Day: January 1, 2023

I went on Propecia about 2 years ago and my sex drive increased to the point that I could not manage it. I am generally sexually active, at about once per day. On Propecia, I found that I needed to have sex at least twice a day and my girlfriend could not / wound not cooperate. So I stopped the Propecia and went on Minixodil. After stopping Propecia, my hair loss pattern went from a Class 4 to a Class 6 pattern. Any thoughts? I am 46 years old.

Minoxidil is not as good as Propecia for preventing hair loss. If you have miniaturization in the areas behind and to the side of the balding area, then Minoxidil may not stop further progression. As a rule, people your age are not in very active hair loss. You are an exception.

Increased Sex Drive: Although I find an increased sex drive in about 1% of the patients I put on Propecia, no one has ever had your degree of increase. Again, you are an exception. You might consider higher doses of finasteride to see the impact on your sex drive (up to the Proscar-level dosage).

Decreased Sex Drive: About 1-2% of men report a decreased libido with Propecia. At times we confuse libido (the desire for sex) with Erectile Dysfunction (a performance issue). If a man has a performance issue, he is often ‘gun shy’ about failure in performance and then the libido goes down in response to it. But it is all not that simple. The physical causes for decreased libido or erectile dysfunction include: alcoholism (quite common); abuse of drugs – such as cocaine; anaemia – unusual unless the man has been bleeding for any reason; hyperprolactinemia – an uncommon disorder in which too much of the hormone prolactin is produced by the pituitary gland; obesity – quite common and simply slimming down will often help; some prescribed drugs – particularly Proscar (finasteride), a tablet used for prostate problems in doses of 5mgs rather than 1mg as with Propecia; low male hormone level (testosterone) – contrary to what many people think, this is rare; and any major ‘generalized’ disease, such as diabetes. There are also psychological causes of libido decrease including: depression – very common; stress and overwork; sex hang-ups; or a serious relationship problems with the wife/partner.

I’ve been using Propecia for about 3 months now and my testicles are extremely soft and sensitive. Should I continue using it? Will this condition worsen to where I may become impotent?

Although testicular pain and tenderness are sometimes reported by patients who are on Propecia (finasteride 1mg), the rate of this side effect is the same as those on the placebo. Impotence is not one of the documented side effects of this medication and I would doubt any permanent side effect like this would occur from taking Propecia. My advice to you is to stop Propecia for a few weeks and see if the pain goes away. You may also cut the dose of medication to half a pill each day (after stopping it for a week or so to see if the symptoms go away). Some of our patients had good results by cutting the dose of medication. If you continue to experience the pain, stop Propecia and discuss it with your doctor.

Dr. Rassman, if you could, please answer this question. It’s very important, I’ve seen a ton of people online that really need this clarified for them by an expert in this field. Can Propecia cause Reflex Hyperandrogenicity, thus actually accelerating your MPB and, if so, what are the symptoms? I can’t tell if this is happening to me or not. Also, if I have lost hair due to Reflex Hyperandrogenicity is that hair gone forever or is there a chance I can get it back?

HairLossHelp.com has a good explanation of reflex hyperandrogenicity —

“When the effects of androgens in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor blockade, the body seeks equilibrium through a process called upregulation. This can take the form of increased hormone production and/or increased tissue sensitivity to the remaining hormones. The reason side effects usually gradually disappear with finasteride is probably due to such upregulation. In a small percentage of individuals, it may be that this process overshoots the mark, resulting in significant hyperandrogenicity. This is marked by such signs as greatly increased facial oil, increased pimples, and greatly elevated libido. It’s possible that in certain cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride, though this does not appear to be the case for the vast majority of people.”

The term “reflex hyperandrogenicity” is a new one to me, and while I unfortunately do not have the answers to your questions directly, hair loss from genetic causes in men is usually not reversible.

More about reflex hyperandrogenicity at PropeciaHelp.com and Google Answers.

I am almost 30 years old and just started propecia. My general practitioner advised against taking it due to the risk of prostate cancer. I’ve tried to research this and have not really found any evidence to support this other than the increased risk at the 5mg level.

I’ve been told by a few doctors that I should take propecia and not necessarily have a hair transplant at this time given that my hair is only beginning to thin; and that propecia should help.

Additionally, I’ve heard recently that I should not be surprised if “hair cloning” becomes available in the next few years. Would appreciate any comments.

Best Regards

Propecia, according to a recent article in the New England Journal of Medicine, reduces the risk of Prostate cancer by 25% in the men who were studied. I personally believe that it is a good medicine for this. There is some general argument on those who may develop cancer while on the drug, that the drug may have made the tumors look more aggressive. I think that the evidence amongst most knowledgeable people points to safety and Propecia is not a carcinogen. Your doctor is misinformed.

Hair cloning, I believe, will not be addressed in the next decade.

CNN released the following news in 2003: In the study, which was funded by the National Cancer Institute and published in the online version of the New England Journal of Medicine, researchers at 221 sites nationwide followed nearly 19,000 men older than 55 for seven years. About half of them were assigned at random to take either finasteride, a drug that lowers male hormone levels, or a placebo. By the end of the trial, those taking the drug reduced their risk of prostate cancer by nearly 25 percent over those on placebos.

Also, give the following reference to your doctor: New England Journal of Medicine Volume 349:2387-2398, December 18, 2003, Number 25, The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia, John D. McConnell, M.D.,et. al.

Dear Dr Rassman,

Can Propecia be taken along with Paxil (Paroxetine)? Do you have any patients on the combination?

Background: I am a 22 year old male. I have had social anxiety disorder and was prescribed Paxil CR 25 mg. I had weaned myself off it 15 months ago. Now my hair has started thinning and I was prescribed Propecia. But within 2 weeks of use I have had intense anxiety.

Please help me with your suggestions. thank you.

As far as I am aware, you can take Paxil and Propecia, but you need to ask your prescribing doctor before starting or stopping any medication as he/she may have more insight into what is going on with your problems. I am not your doctor and my suggestion to you is to speak to your doctor and ask him/her these questions.