Author: Dr. William Rassman

Hi Doctor,

Thank you for maintaining this great and informative blog and answering all our questions.

I was on propecia for 9 years until last year I was prescribed Avodart because propecia was losing its effectiveness. I decided to go off avodart after a year and go back to propecia. The dermatologist told me to give it a year before deciding to switch back. It appeared to me that my hair loss had increased slightly on avodart and the side effects built up after a year were a bit too much – slight loss of libido, slight ED. After a week of switching from propecia my hair loss accelerated substantially. Could this be catch up hair loss – maybe avodart was not working for me – or could this be a shed as of a result of restarting propecia.

Thank you.

There is no drug in the world (yet) that completely stops hair loss. Avodart and Propecia work in similar ways (the two drugs are not drastically different in the mechanism of action) although there are reports that Avodart is better at stopping hair loss, particularly when Propecia benefits have been exhausted. I personally have not seen a worthwhile benefit of taking Avodart because:

1. My patients that have taken Avodart have not noticed a significant change in hair gain/loss.
2. Sometimes the risk (of sexual dysfunction, etc) outweigh the benefit of (marginal) improvement over Propecia.
3. I rarely prescribe Avodart, so my personal experience is admittedly limited.

While I will never know what is going on with your specific case, your experience is real and there may be the correlation you are asking. However I would not think your hair loss is from “catch-up” hair loss for not being on Propecia as you were still taking Avodart and you only noted the hair shedding after starting Propecia. Coincidence? Maybe.

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Been using rogaine and propecia for 2 years now and the results have been great, and I feel as my area is a littl. I thought about my applications and on average do about 80-90% of the rogaine applications, and probably about 90-95% of the propecia prescriptions. Do you think this could explain the loss ( however much imagined, I haven’t seen my doctor in a while).

I guess I’m wondering all of this because I’ve done some reading and it seems as one gets older (I’m only 24), the dht overrides the treatment. Is that usually the case, or do you find propecia and rogaine can often sustain the same amount a hair through middle age?

You should probably see the doctor that prescribed you the Propecia to get his take on it. It’s always good to talk with your doctor about results (or lack thereof) from medication he prescribed. Hopefully he made notes about your hair loss the last time you were there so you can compare to your current results.

Many people find that Propecia has been holding off their hair loss for many, many years, but sometimes the genetic balding is stronger than the drug. This is the tug of war type situation. I wouldn’t expect it to occur after only 2 years, but each person will react differently to the medication so I can’t say for sure. At 24 years old, you wouldn’t fall into the “older” category, as your hair loss is likely still early enough to see maximum benefits from the medications.

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Some of the posts on this site about minoxidil frightening! I have used this for 2.4 months and this scaly bumpyness has covered my ears and spread down my forehead to nearly my cheeks. This has pretty much entirely happened in the last 1-2 weeks. It is uncomfortable and looks bad and i hope it goes away! someone said this could be permanent in one of these posts. Any idea here?

More important question: After 2 months of treatment the lymph nodes on my neck front and back have swollen up, mostly on one side. They havent gone down and its been 2 weeks. Also parts of my head are sore to touch – this came on suddenly so i cant be sure if its a reaction or an unrelated medical issue.

Any advice or feedback – at what point do i need to go to a doctor? Thanks

It could be allergic reactions to an ingredient(s) in the minoxidil, but really just from your descriptions alone — “scaly”, “swollen lymph nodes”, “sore”, “spreading” — you should’ve seen a doctor by now. What are you waiting for?

Rash or hives are a known rare, but severe allergic reaction to this medication… however, it’s odd that you’ve been using the medication for months and just started to see these symptoms in the last couple weeks, which makes me wonder whether it is coincidental. Any of these things might unrelated to your minoxidil use, and there could be other medical issues you have to worry about. See your doctor!

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From your practice, what is the worst progression of balding that you have seen with someone taking only Propecia and not anything else like Minoxidil? Like what Norwood was he before and after and how long was he taking it and how old was he?

I routinely prescribe finasteride for all balding men, so progression is not evident as the process slows down considerably. In the days when Propecia was not available, the balding process was very evident in a matter of a few years, but now when Propecia is used, I just have not seen the radical changes in balding patterns.

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