Month: January 2023

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.

Dear Dr. Rassman,
Thank you very much for maintaining this very informative and detailed website. I would sincerely appreciate your advice regarding my propecia therapy. I am 21 years old and have been taking propecia since July 2007. After the first 6 weeks on the drug, I noticed a complete cessation of hair loss. I subsequently discontinued the drug on the very poor advice of my father, an internist with little experience with finasteride treatments for MPB. I then restarted the drug about 2 months later, and again noticed complete cessation of hair loss within several weeks. I stopped taking propecia a second time, again on the advice of my father. Once again the hair loss returned within a few weeks.

I went back on propecia in late December, and have been taking it for the past 8 weeks. Unfortunately I have not noticed any change in the amount of hair I am losing. I am wondering if you would kindly explain the mechanism of this phenomenon. Have I induced resistance or tolerance to propecia in my hair follicles? Have I upregulated the expression of DHT receptors on the follicles? Is it possible that my estrogen levels or testoterone levels are relatively higher than they were when I started treatment several months ago?

I realize that I have committed a very grave error in discontinuing my propecia on two separate occasions. Have I irrevocably lost my responsiveness to the drug, or will it likely prevent further hair loss? Fortunately my hair loss is still not noticeable, and I would be happy simply to retain what I have.

With best wishes,
A stressed-out medical student.

It is often surprising how little doctors tend to understand about hair loss and its treatment. If you are playing with this drug, you allow the hair loss to continue its downhill course each time you stop taking it. The hair that you lose when you stop taking it may be lost forever, so stopping the Propecia intermittently may just set you up to a progressive lower hair count over time. Perhaps you were just in a rapid state of hair loss. Whatever is the cause of your situation, from a mechanistic point of view, you MUST continue on this drug for life. Stopping it allows you to play catch-up hair loss and eventually you will just progress further down the balding road.

First of all I would like to thank you doctors for allowing time out of your days to answer questions. I began shedding more hair than normal 3 years ago at age 22. I received the opinion of two dermatologists that I was not experiencing male pattern baldness. Even with these opinions I became paranoid based on the increased shed and my maternal grandfather and uncles baldness so I began using finasteride.

I showed no visible signs of hair loss then and do not now at the age of twenty-five. I am scared to stop using finasteride because if I am genetically predisposed I know I will lose what I have prevented the past three years. My question is, based on my age and beginning the treatment early do I have a good chance of keeping my hair well into older age and is it worth suspending the treatment just to see if I need to be taking the drug or not?

Paranoia is clearly not a good reason to take a prescription drug meant for treating something you might not even have.

At 25 years old, you still might see hair loss if you have the genes for it, but I have no way to know if finasteride is protecting your hair or if it is an unnecessary daily medication. I would see a doctor first and foremost, so that you can have an exam and any hair loss that is observed can be noted. Your doctor may decide to discontinue your medication and just have you keep your fingers crossed that there’s no loss that finasteride was delaying.