Author: Dr. William Rassman

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.

Hello all. I have not been on the blog for some time, but I wanted to take an opportunity to answer a recurring question that I see (with the Doctor’s kind permission, of course) Many are asking about Avodart (5-6 weeks)and it’s superior half-life over Propecia (24 hours). Many are under the impression that you just pop the Avodart and magically, 90% of the circulating DHT is eliminated. This is not the case. In order for there to be a 90% DHT serum decrease, the patient must be on the drug, every day, for a minimum of 90 days. Probably more like 120 days.

There is a thing called “steady state”. This refers to blood levels of a drug. You must ingest the drug, on a regular basis, and for a predetermined period of time, in order to reach “steady state”. All steady state means, essentially, is saturation. This means that the blood is saturated with as much of the drug (in this case, Dutasteride) as it can hold. Dutasteride is bound to a blood protein called albumin very, very tightly. This is the reason for its half life. It doesn’t want to let go!

Now, after 90-120 days you should be able to get away with megadosing once or twice a week, however, there is this little concern regarding the law of “Diminished Returns”. Plus, if .5mg every day for 90 is sufficient at blocking 90% of type II 5ar, I personally don’t see how juicing it to 94 or 95 percent would have that much more clinical benefit.

Thank you for your opinion. I haven’t seen any information about the appropriate Avodart (dutasteride) dose for treating hair loss. More importantly, it has never been clearly shown that Avodart is necessarily better than Propecia (finasteride), particularly since it has a higher side effect potential.

What if I take Propecia for a while and then get side effects? Do I just stop taking it or should I take less of it?? I havent had any issues yet but I just want to know what I should do if I have good effects from Propecia and then see bad effects down the road. Thanks

One of my patients (age 43) spoke to me about the developing sexual side effects of Propecia. He has been on the drug for 10 years and his libido seemed to slowly reduce over the past year or two. While it is possible that the libido change was influenced by his age, I recommended that he reduce the finasteride dose to 0.25mg.

The idea was that if that reduced his sexual side effects to a level he is satisfied with, he can up the dose to 0.5mg. He did this over a two month course (one month of 0.25mg and one month of 0.5mg). Now the sexual side effects he has had in the past at the 1mg level, have disappeared. He hasn’t reported any benefits from the medication disappearing, which was one of his biggest concerns. It’s only been a couple of months, though.

I’m not suggesting this is the proper course for everyone, and you should talk to your prescribing doctor about changes to your medication.

Something that has always bothered me about minoxidil is that fact that it can only be stored at a temperature roughly between 66 to 77 degrees. Even if I am careful storing the minoxidil that I buy how can i know that the same precautions were taking during product shipping, stocking at store, etc.? There is no way to know!

So in your expert opinion do you think minoxidil will still work if it gets too hot or too cold? I tried calling the Rogaine manufacturer but the person on the other line was not very knowledgable about the product.

While most medications should be kept at room temperature, some allow for temperature variation in short periods of time for shipping.

So while there is no way to truly know if your bottle of minoxidil was appropriately stored every step of the way, most places that sell this medication have some quality control standards during shipping and warehousing. I’m certainly not an expert on this, but you can read about this “cold chain” here.