Author: Dr. William Rassman

How do you keep the hair that you have without any side effect medications?

Most men have no side effects from Propecia, as the sexual side effects only occur in 1% of patients. Members of my own family take it and have no side effects, nor have they ever had them. Minoxidil has side effects of its own, including changes in blood pressure and skin irritation, but these are also not the norm.

Every medication has some potential for side effects, including extremely common drugs like Tylenol. Each person will react differently.

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Hello Mr.Rassman. I know your main profession is regarding the hair and scalp, but I have a question regarding finasteride and acne. you seem to be an expert on finasteride. Studies say dht also causes acne. Finasteride inhibits dht, so can someone with acne benefit by taking finasteride. I found a website that states that in europe, the dermatologists prescribe finasteride for acne.

Here is the link. read under 5-alpha reductase inhibitors:
“A recent development in anti-androgen acne treatment is the inhibition of androgen-metabolizing enzymes in the skin or in the sebaceous glands themselves. One such androgen-metabolizing enzyme is the 5-alpha reductase inhibitor finasteride, which metabolizes testosterone into 5-alpha-testosterone in androgen-regulated target tissues. This enzyme exists in its two isoforms. The Type I isoform mainly occurs in the skin, located in the sebocytes, epidermal and follicular keratinocytes. Antagonists that bind selectively to this Type I isoform includes finasteride and dutasteride, and are believed to be capable of treating acne. European dermatologists have been using finasteride (used in combination with oral contraceptives for female patients) to treat acne, and have received effective results. Such an approach is yet to be approved for use in North America.”

since this method is not approved yet here in North america, what is your opinion on this?

Acne is a problem in the production of sebum and infections that get established in the glands of the hair follicle. If I am not mistaken, there is a bit of error in your quote: Finasteride (which is a 5-alpha reductase inhibitor) inhibits mostly the Type II isoform of DHT. I’m not an expert on acne, but I believe it is the Type I isoform of DHT that is partially responsible for acne. That said, I’ve read that DHT inhibitors can in theory treat acne, though theory does not always work out in real life.

I am not aware of a particular dermatologist in the U.S. that prescribes finasteride as an acne treatment, but I have read of such practice. As you know, finasteride is not approved by the FDA for the treatment of acne… but I don’t think it’ll be approved for that purpose, as the costs for the studies likely aren’t worth it to Merck. Honestly though, I get disproportionate emails from people on the Internet who are scared of using finasteride for male pattern hair loss despite its efficacy and safety profile. It takes real work for me to actually educate each and every patient on the real side effect and dispel Internet myths. If indeed finasteride can help with acne, good luck with the other swarm of myths to follow.

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Dear Dr Rassman, I would really appreciate your response to this question. I cannot find the answer anywhere. You say that “if you are concerned about finasteride and its impact on your unborn child, you can stop using finasteride for about 1 week prior to conceiving a child as the medication should be cleared from your body.”

I was told by my Dr. that the semen which you ejaculate was produced 60 – 90 days ago in the body. Assuming you took finasteride in the 60-90 days prior to stopping for one week, surely the sperm you produce will still contain / be affected by finasteride because it was made well before you stopped taking it?

You make a good point. The drug company Merck has not reported any deformities (sexual identification of the fetus) with the use of finasteride and many of the men that take it are in their 20s and 30s. The real answer is there is safety in numbers and the lack of medical or fetal complications with finasteride (Propecia) indicates that this is not a problem.

Of course, you will have to be the final judge on whether you feel it is safe for the unborn child. The FDA would have made it known if this was a problem and they would have forced publication of such complications if they occurred.

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Dr.,

If you’re a good responder to Finasteride, doesn’t that mean you’d have an even better result on Dutasteride/Avodart? Seems like the only guys saying dutasteride didn’t work for them were the ones that didn’t get any benefit on fin. Glaxo Smith Kline is making a big mistake if they don’t do the studies to get avodart to market as a hair loss drug.

Thanks, hope you can answer this

Some unofficial studies suggest that there is a better response to dutasteride than finasteride, but measuring this may not be very scientific. The real cost with dutasteride is:

1. We don’t know if it is safe for young men with regard to long term fertility
2. Side effects may be greater with dutasteride than with finasteride
3. The half life of the drug is 5-6 weeks
4. Most doctors will not go off-label in prescribing drugs that are not FDA approved for the purpose

Will the medication be available as a hair loss treatment? I don’t have the answer to that. If the studies show it is safe and effective, I hope it does become an option.