Author: Dr. William Rassman

Hello..i have been on propecia for 7 yrs now and its losing its effectiveness…my hair is shedding more from 10 hairs a day to more than 25+…i have added saw Palmetto to the regime but no success.. my hair line is thinning out badly….should i increase my propecia dosage from 1mg to 1.5mg..will that help the problem..PLEASE HELP!!

Losing 10 hairs a day is normal, and in fact, up to 100 hairs fall out a day normally. I do not believe that saw palmetto grows hair (as you’ve seen first hand) and there are no studies I’m aware of to prove me wrong. Taking more Propecia (finasteride) will not help either (aside from possibly having a negative side effect).

Drugs such as Propecia and Rogaine work, but there will always be limitations. There is no magic cure. If you are continuing to lose hair you may consider a hair transplant procedure for thickening it up, but even that has limitations. Basically, if Propecia isn’t retaining hair as it once did, you’ve got 3 options: hair transplant, minoxidil, and prayer.

The best thing to do is to see a doctor to find out about your options. As you are indicated you’re in Los Angeles, you might pay me a visit (no charge for the consultation) or come to one of our Open House events — the next one is this Saturday (November 1) from noon – 2PM, where I also can evaluate you.

Please tell me a few things about minoxidil.

1. I realize that minoxidil requires twice daily use to be effective. I am wondering what the minimum amount of time that basic 5% minoxidil must be left on the scalp to be effective? I have no problems with application at night, but it’s too greasy to apply during the day and then go to work. I figure I can apply it, wait “x” amount of time and then shower. Can I do this without losing inoeffectiveness? How long do I need to wait before showering?
2. Please tell me what percentage of users typically experience the “puffy face” side effect? If I am one of the unfortunates to experience this, will the puffiness go away during the day or is it gonna be there as long as I am on minoxidil? If it goes away during the day, how long does it typically take? Also, please tell me, in either case, will a person eventually become “acclimated” to the product and stop getting this side effect totally – with time?

And last question…if one were to get this side, how bad does/can the puffiness get?

1. It is best to use minoxidil twice a day. The 5% is stronger than the 2% mixture, with the 5% usually referred to as “extra strength”. The application instructions will be listed on the packaging. If you can not or will not use the oil based minoxidil, use the foam (with its alcohol base it will not be greasy). I’d say to wait around an hour or so after applying it before you shower.
2. A puffy face may indicate an allergy to the medication and this may be a contraindication. I would try the Rogaine Foam, as the allergy may be some of the other ingredients in the mixture, but if it continues to produce that side effect then I’d stop it, of course. I don’t know what percentage experience facial swelling as a side effect, but I wouldn’t think it is a common occurrence. If the side effect does occur, the degree of swelling is likely different for each person.

I have been thinning pretty bad for a tad less than two years. I tried all those dht saw palmetto blockers which were junk. I have the horseshoe effect going but i have some miniature hairs on top that look like they are on their last limb. I was wondering if i start using propecia and rogaine asap if there is any hope since i still have visible hairs? Any advice would help. Thanks for your time.

There is always hope. While I doubt you will grow an abundant amount of hair, you can at least expect the hair loss to slow down. It’s not too late. See a doctor for the Propecia prescription.

Dr. Rassman,

I just received a prescription for Avodart from a general practitioner. I have been on Propecia for 3 years; however, I think the drug is loosing its effectiveness. About 1 month ago I started taking 2 mg of Propecia daily. Then out of desperation, I consulted with a physician and received the prescription for Avodart.

The Avodart clinical studies on hair loss that I have read on-line involved doses higher than the standard .5mg which is recommended for men with enlarged prostates. I’m reluctant to take the drug every day. However, would you consider taking 2mg of Avodart 3x weekly and 1mg of Propecia on the other days an effective strategy to achieve maximum DHT reduction, stop further hair loss and/or grow back hair?

You are desperate and experimenting with your body. There are limitations of medical science and you need to accept you are losing hair. Taking a high dose of Propecia (finasteride) will not cause more hair growth. Taking a high dose of Avodart (dutasteride) may not cause more hair growth either. We just don’t know, and I certainly can’t give you recommendations on how much of a prescription medication you should take, even though you have a doctor that prescribed it to you for off-label use. The Internet is a wonderful source of information, but you need to understand that everything you read is not always 100% accurate.

I am purely guessing that your general practitioner agreed to prescribe you Avodart, as he saw how desperate you were and your need to be proactive with some sort of medical treatment. I am sure your general practitioner gave you information on Avodart and its possible long term side effects (risks of sterility is present) and how it is not at this time approved by the FDA for the treatment of hair loss. There are also no long term studies on young men taking Avodart. With these warnings I am sure you made an informed decision. Now you must accept some responsibility on limitations of drugs and your genetic predisposition for hair loss. I realize this sounds harsh, but it is an unfortunate fact of life. There are no easy answers or solutions.