Author: Dr. William Rassman

Hello doctor, I have had diffuse pattern thinning since I was 15 years old. my hairloss slowed down considerably and I am now 23 and still have decent coverage. However my hairloss has not stopped completely. I began using 5% minoxidil/azelaic acid compound a year ago with which I achieved good results. My hair was much stronger and i noticed some regrowth. However i developed a severe reaction to it after some time and was prescribed a topical steroid and advised by my doctor to stop using it. My hairloss has now comeback and i started using 2% which has not really helped but ive had no reaction to it. I have now tried 5% minoxidil without the azelaic acid for about a week and I’ve had a noticable slowing down of hairloss and so far no reaction. I would like a better coverage of my scalp and I went to see a reputable transplant clinic who advised me I was too young to consider surgery, but prescribed me propecia.

After reading certain forums about propecia i am very nervous to start taking it and if I want better coverage would I be better sticking to minoxidil or taking propecia, or even using them both? I apologise for such a long message, but any help would be much appreciated. I would prefer it if you wouldn’t post my mail and reply to me via my email address. Thank you very much for your time Doctor.

With regard to posting on various forums, you will note that you are just a voice out of the crowd without identifying references. Propecia is far better a solution than minoxidil for the young balding man, assuming that you really have genetic hair loss. I have mentioned over and over again that you need to establish a baseline measurement (metric) for the degree of miniaturization before you start drugs like Propecia, because you need to know what the benefit is over time. These miniaturization measurements are invaluable for that purpose. Minoxidil with acid compounds tend to irritate the skin over time. The use of steroids work to manage the irritation, but chronic use of them will cause hair loss. Get a doctor to work with you so you know what you are doing.

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Hello Dr. Rassman,

I would like to ask you 4 things about Propecia.

1. I am not worried much about the sexual side effects of this drug. I am worried, though, about the possibility of getting gynecomastia – as I already have it to some degree from my teen years and I am very self-conscious over it. I know what the percentages are for getting sexual sides, but do you know what the risk is for possibly getting gynecomastia?
2. Also, do you think I may be at an even higher risk – since I have already acquired it once? I wouldn’t want to make it worse and if I decide to get surgery to reduce it, I don’t want to spend the money and get it again!
3. Is there any type of test, whatsoever, that might show if I am at risk of getting this condition from the drug before I take it?
4. I noticed when I started to thin about 5 years ago, I also started growing more ear, nose and chest hair. I guess this is the “DHT Paradox.” I am wondering….if I take Propecia to regrow my scalp hair, do you think it will diminish my ear, nose and chest hair? I am hoping it will, because the only place I want to be hairy is my head. I had heard that dht causes hair-loss on the head, but actually stimulates it pretty much everywhere else (the paradox.) If this is true, do you think I’ll stop growing excessive hair in my nose and ears by being on it, in addition to helping with hair-LOSS on my scalp?

Thanks!!!!

The side effect of gynecomastia is hormonal when it occurs from Propecia. If you had it before, I do not know if it will happen again, but if that was in your teen years, the risks (although present) should not be great. I wouldn’t worry about the other side effects, as one of the great advantages of this drug is if you try it and experience anything untoward (other than gynecomastia), the side effects go away very quickly since the drug is largely out of your body in 24 hours. There is no test that I know of that will tell you if the gynecomastia will return or if you are sensitive at this time in your life to getting it back.

With regard to ear hair, nose hair, and body hair, this is caused by DHT… so welcome to the world of many curses. Propecia can slow or stop these in some men, but as it works differently in each person, I couldn’t say for sure how it will control your non-scalp hair, if at all.

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Anyway, I’ve read on many sites that minoxidil does not actually help regrow hair, except peach fuzz. Is that true? And is it better not to massage minoxidil onto the scalp, as it’ll get “lost” on your hair and fingers? Some people suggested just dropping it onto the scalp with the dropper, and leaving it be.

Thank you so much..

Using your hands can produce local absorption to the applying hand (see Should I Be Applying Rogaine with a Rubber Glove?). In some people it will only produce peach fuzz and on others it will produce actual hair. Using a dropper and spreading it locally around (probably good to use a rubber glove) will work.

Hello Doctor. I thought this might be interesting. it recommends that you cut propecia, not proscar, in 5ths because the effect of 1/5 mg of propecia has the same effect as 1 mg. Here is the link. It states: ” We advise you to stay away from Propecia. If you do decide to take it, you should know that the standard dose is one milligram, but studies show that one-fifth that amount works just as well. If you cut the pill into fifths or quarters, you can save a considerable amount of money. “(UC berkely)

What do you think????

I have reported on this blog that Propecia works at lower doses, but at varying degrees (see here, here, and here). If my memory serves me right, Propecia at 1/2 mg works about 80% as well as the full dose, and at 1/4 mg it works somewhere around 40-60% as well as 1mg. I would ask however, why reduce the dose if there are no side effects? The best dose is 1mg. I certainly don’t agree that 1/5th of 1mg will be as effective, as that site suggests. I think they are confused.

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My MD has me on Avodart 0.5 MG once daily for hair loss and I have been taking it for about 20 months now and it seems to work better than the Proscar that I was taking the five years before.I just had my second HTP a couple of months ago and the HT doctor said the Avodart that I’m taking stays in my system fot 5-7 days and that I should not need to take it daily to have the same results. Where do you stand on it?

Avodart (dutasteride) does stay in your system for several weeks (5 weeks are reported for half of the drug to disappear from your system). In other words, if you take Avodart today only, half of the drug will be in your body in 5 weeks. In fact, the drug will still be detectable in your body for up to 6-12 months.

I do not personally recommend Avodart to my patients, because it is not proven safe for treating hair loss in younger men (the drug is a prostate medication, so the FDA approvals were based on tests of those men in an older age group). There are reports of sterility with this drug on men. I do have a handful of patients that choose to take Avodart despite my concerns, but that is on an individual basis. Likewise, my feeling on it is that you need to address these concerns with your doctor and decide on the appropriate treatment plan after understanding all the risks and benefits associated with its use. That stands true for all other drugs and medical treatments.

In general (to confuse the situation even further), the 0.5mg dose of Avodart is not generally used for hair growth, as 2.5mg is shown to produce a better effect. However, the 2.5mg will increase the side effects and the risks associated with it as well. All that is just more to discuss with your doctor. Read this study published in the Journal of the American Academy of Dermatology for more info — Dutasteride vs. Finasteride.

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Hi I just got a propecia prescription but I wanted to ask you a question before I started to use it.

I’ve read on the internet that propecia may cause shedding but my doctor, when I asked him, said it wouldn’t. Can you possibly explain further (my doctor said that I was in the very early stages of loss). Hope to hear from you soon! Thank you.

Some people report shedding for a month or so when they start Propecia. We postulate that Propecia moves hair on an accelerated hair cycle and that the shedding that is reported is the result. I am not familiar with any permanence with whatever shedding that occurs (if, that is, it really occurs).

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