Author: Dr. William Rassman

Hello Dr.,

A little back-story: I’ve been on generic propecia (1.25mg) for the last 9 years. I am a 32 year old male. When i started taking it, I was a Norwood 1.5. Presently, my hairline is the same and i’m still a norwood 1.5. My father is not bald. However, my maternal grandfather was.

Unfortunately, for the last 2 years or so, i’ve noticed a severely lower libido. I suspect that it might be the finasteride, although i am not 100% certain.

Hoping to get off of finasteride by confirming whether i have (or will develop) MPB, i decided to take the HairDX genetic test. My results stated that i was: “Low Risk” (Negative for the “short” CAG allele; CAG >= 24)

In my report, it stated that a score greater than or equal to 24 had approximately a 60% chance of NOT developing male androgenetic alopecia.

Doctor, should i get off finasteride? In your view, am i reasonably safe from developing MPB? I would like to get my libido back. Do you think i need a miniaturization test to truly CONFIRM whether i am at a risk for MPB?

Any thoughts would be greatly appreciated, kind sir!

The HairDX genetic test for balding is not a simple yes/no test. It provides a percentage factor, which is why in my humble opinion, it only confuses patients (as it seems to have done for you).

So basically the HairDX test said you have a 40% chance of developing MPB… and now you’re asking me if that means you should stop taking Propecia. With all due respect, I am not your doctor. You must have a discussion with your prescribing physician before starting or stopping or changing your medication.

Having said that, there is no such thing as a Norwood 1.5 (which I guess means nearly a NW 2?), but for some men that could just be considered a mature hairline. In other words, it isn’t balding. Could it be that you didn’t need the medication to begin with? Or could it be that the medication halted the early loss from progressing? I do not know the reason for the utility of finasteride for a non-balding man, but I will defer that judgment to your doctor.

You took the medication for 9 years, and for 7 of those years you didn’t see any sexual side effects. The libido issue might be unrelated to the finasteride. For example, up to 25% of men in their 30s may experience erectile dysfunction. Lower libido can come with age, or it can also be a sign of other serious medical issues (not related to medication). See your doctor.

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I’m 25 years old from Israel and I’m a big fan of your website and very impressed by the elaborate answers you give. As part of my research of treating my own hair loss, I read a lot about dutasteride (Avodart) and ran into this clinical trial.

It looks like GSK is doing the last phase before taking it out to the market as a hair loss product. What is your opinion about this study:

Avodart Phase 4 Protocol Summary

Thank you for bringing this to our attention. I really don’t have anything to add, as this Phase IV study just started in April and isn’t scheduled to end until 2013. There’s not much info available beyond what is listed on that summary page.

The US ClinicalTrials.gov glossary describes the four phases of clinical trials: “Phase I tests a new drug or treatment in a small group; Phase II expands the study to a larger group of people; Phase III expands the study to an even larger group of people; and Phase IV takes place after the drug or treatment has been licensed and marketed.”

The glossary further defines Phase IV as: “Post-marketing studies to delineate additional information including the drug’s risks, benefits, and optimal use.”

So while Phase IV trials are generally done after the drug is already approved by the FDA (at least in the US), perhaps things are different with the phases outlined by the Korea FDA. Searching the Korea FDA site isn’t proving too helpful. I do know that Avodart (dutasteride) isn’t approved for treating hair loss yet in the US, though. Any readers out there with some knowledge about the various clinical trial phases and how they might different by country, please feel free to set me straight in the comments section.

Hey guys. I have been taking proscar (in 1/4’s) for about 10 years but recently I’ve noticed a decline in its effectiveness. So I upped it to 1/3’s. I’ve been under a fair amount of pressure lately and I’m not sure if that is the cause but it seems like I’m always out of breath. I’ve read on various hypochondriac forums that it can be a side effect of the drug. Can you please set the record straight on this?

Thanks so much!

Shortness of breath is a rare, severe side effect of finasteride… so the hypochondriacs are correct. I don’t recall any of my patients reporting respiratory issues from the medication, but it is listed as a known side effect.

I hope you discussed changes in finasteride dosage with your prescribing doctor before you did the increase.

Hi,

Like a lot of other people taking finasteride, I have opted to cut Proscar into my daily amounts to save money. I began by taking 1/4 of a 5mg Proscar pill per day and then moved onto 1/5 per day – Both of which left me with some side effects.

Recently I have attempted to take 0.5mg per day, by way of cutting 5mg into 10 pieces. The pieces I am left with are all reasonably similar in size (for the exception of perhaps one piece, which may end up slightly lesser than the others).

My question is, should there be any problem with going about 0.5mg per day in this fashion? It’s likely of course that some days I may be getting slightly more or slightly less than 0.5mg, but should that slight possible variation effect my attempts at reducing DHT within my body?

Thanks.

Wow, you’re the first person I’m aware of that can cut a Proscar pill into 10 pieces. Not that there is some sort of competition for these things, but the pill just seems too misshapen to be cut into 10 equal parts. I’d think a pill cutter might be too difficult to use for that, so perhaps you’re using a knife.

In any case, to answer your question… there is nothing wrong with what you are doing. If you are doing it to minimize the side effect risks, 0.5mg finasteride should still have some impact on DHT. If you’re doing it just to save costs, you should consider getting the generic 5mg finasteride since it’ll be cheaper than the name brand Proscar.

Dr. Rassman, have any of your patients ever complained of Propecia causing Dry Eyes? I’ve been experiencing severe dry eye for a while and until now I hadn’t really thought that cause might be the Propecia. My eye doctor wasn’t aware of that being a side affect but she was going to research it. I’m thinking about stopping it for a month or so to see if I notice any improvement.

Thank-you

Dry eyes is not an officially reported side effect, but I have heard other doctors in my field report rare occurrences of it. I would speak to your doctor and consider stopping the medication after weighing out the risks and benefits of your treatment (with your doctor).