Author: Dr. William Rassman

Hello,
I am turning 40 and have been on propecia for over 14 years. In the last year I have really noticed a decline in its effectiveness, and I uped the dose with no real results. I am seriously looking at switching to dustasteride and was wondering why there are a lot of safety concerns about the drug. It is prescribed for prostate patients with no real problems. At my age, would it really be a problem switching over to it? Do you think we will ever see it as a prescribed treatment for mpb?

Doctors, when prescribing medications, stay with medications that are FDA approved for the particular condition they are treating. That is because the FDA gives its stamp of approval that the drug is safe and effective for the condition that it is being prescribed for. The doctors have some restrictions in the way they use their medical license when prescribing drugs and their insurance carriers will not cover them for drug use outside the FDA approved drugs, so if something went wrong, they are bare for insurance coverage.

Let’s say that you are 21 years old, are prescribed Avodart (dutasteride) to treat your hair loss, and after 10 years of taking it you become sterile. That would not be good for you and you could take legal action against the doctor who prescribed it, which would not be covered under his malpractice insurance policy. For Avodart, there is no evidence that long term use is safe for young men and as such, it is not presently FDA approved for the treatment of hair loss. For the prostate, on the other hand, this drug is used in men usually over 60 years old who are statistically unlikely to be having children, so Avodart is approved for men with prostate problems.

As I mentioned in yesterday’s post about dutasteride, if you already had children / had no desire for children and had a vasectomy, and you’d already tried Propecia for a year or so and it was not working well, I would consider prescribing Avodart for you for off-label use. Other doctors might be more willing without qualms about it, but that is on them. There would be qualifiers that it has not been proven safe for a 40 year old man and it is not FDA approved for treating hair loss, so I would be at risk. You could also be at risk if you end up taking it for 20+ years. Usually, 60+ year old men who start Avodart to treat their prostate issues have a life expectancy of less than 20 years, so they may not even live long enough to develop problems that may not have been defined as of yet.

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hey doctor, it seems everywhere (mainly hair loss forums) i read it’s saying that propecia is meant to just maintain hair and that any regrowth is an added bonus. But propecia’s website says in their 2 year study that 66% of men had visible regrowth. 2/3 sounds like the majority of people should regrow hair. furthermore the 5 year study says that almost 50% regrew hair. could u shed some light on this as nearly every forum i visit states that hair regrowth with propecia should not be expected.

I have seen substantial growth from Propecia, and even a complete regrowth in the frontal area once or twice in my years in practice. Regrowth in the crown is much more common and expected in men under 30 years old.

As for forums vs scientific data, well… let’s put it this way. If you got great growth, are you going to spend time on a message board letting everyone know? Probably not. But if you didn’t get the results you expected, you’ll be more likely willing to spend the time to warn people. So when it seems like a lot of posts say the same thing, its because it can be easily skewed.

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Dear sir,

When I started on finasteride I noticed a very strange but rather pleasant side-effect: an increased libido. This makes sense since finasteride raises the levels of total testosterone; it is, however, contrary to the science literature, which commonly reports DECREASED libido as a potential side-effect.

Why do some men suffer a decreased libido when finasteride actually gives them more testosterone? Thank you and best regards

We really do not know the reasons for the increase or decrease in libido that some rarely observe after taking finasteride. The decrease is seen in 1-2% of men, and the increase is even more rare… so congratulations!

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Dr. my hair loss started when I was 23. At that point I started researching my options. I’m now 27. My hair loss has progressed at slow pace (thank god). I tried propecia based on my research, a lot of which came from your blog. Right around the 3rd month I really felt like the loss at least stopped where it was at and if I would have kept taking it possibly could have had some regrowth. I was deployed to Iraq at this time. When I came back I came into your office for a consult. Where I saw Dr. Pak. My hair loss was determined to be I beleive the 4a pattern. (can’t remember for sure)

Anyway to get to the point. someone had pointed out to me that that my chest was getting kinda big. I definitly had some breast enlargement which I ended up having reduced by lipo suction. (Very happy with the results by the way incase anyone else has this issue) I’m not sure if the enlargement came from propecia or a combination of bad diet and heavy heavy drinking. My question is whats your opinion on me trying propecia again? and when there is enlargement from taking propecia is it fat deposits as mine obviously was or is it actual breast tissue like a female would have? As this could possibly answer where my enlargement came from propecia or something else. I am not sure how fast I got the enlargment. It could have been very gradual which is why i didn’t notice myself or maybe sudden when I was taking the propecia. I would really love to stop my hair loss. what do you think I should do?

Thank you very much for your time!

I would try the Propecia again and follow closely what happens. While it is possible you experienced gynecomastia from the medication, a poor diet with weight gain could also cause the same symptoms. I wouldn’t be able to determine if it was just the medication, just your weight gain / poor diet, or a combination of everything. I believe the medication (as rare as the side effect is) would cause the mammary glands to enlarge. This is mostly composed of fat, so it’s difficult to visually distinguish if the enlargement was caused by diet or medication. That’s one of the reasons I’m skeptical about a lot of the reports I’ve read on various forums. People might be seeing it, but it doesn’t necessarily mean it was Propecia.

Coincidences happen all the time. At least you recognize that. I’m glad your liposuction was successful, and if you’re in the LA area and would like to come in again, we can get a good baseline on your chest size before restarting the medication.

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