Author: Dr. William Rassman

Hi Dr,
I have a problem like this. I am Taking 5 mg finasteride 1 tablet/3 days due to the difficulty to cut it and here i also don’t have any 1 mg finasteride production. Now the problem is i am taking finasteride for 3 months. some times i feel lack of libido and sometimes i feel high sex drive.There is no stability.Many times i feel high sex drive and i can stay without masterbation. the problem is the volume of my ejaculation has also been increased significantly.Is it possible due to finasteride. Really ti has been increased. But i feel it’s a bit watery i feel than before.Is it possible due to finasteride? Does it mean decrease of my sperm count?

There are reports in the literature of a reduction in ejaculate volume from finasteride, but I don’t remember reading of the reverse effect and I confirmed this with some more research. I can’t seem to find any cases to match your findings. In those with a decreased ejaculate volume, sperm counts were generally as good as before taking the medications, but there are reports that suggest a decreased sperm motility with finasteride. See this study (The Effect of 5α-Reductase Inhibition with Dutasteride and Finasteride on Semen Parameters and Serum Hormones in Healthy Men) from 2007 that was published in the Journal of Clinical Endocrinology & Metabolism — PDF file. Also see this past blog post — Propecia and Sperm Count.

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What is the difference between scalp DHT and serum DHT? Avodart reduces scalp DHT by 55% and serum DHT by 92% what does that mean? How does that impact the hair?

Yes, it is true that Avodart (dutasteride) inhibits 92% serum DHT and 55% scalp DHT — and Propecia (finasteride) inhibits 70% serum DHT and 38% scalp DHT (see study). I hear the terminology of scalp DHT and serum DHT every once in a while, but I really don’t know how significant they are. You would think that lowering scalp DHT is better than lowering serum DHT, but one flows to the other starting off in the serum.

So while Avodart has been proven to be more effective than Propecia in inhibiting serum DHT and scalp DHT, Avodart actually has more short and long term side effects than Propecia. For example, there is a worry about sterility (not common but present) with Avodart, something that should worry the young man.

i’m using both dutasteride0.5/day and finasteride1mg/day for last 2.5 months. but they makes me very very very aggresive man. stopping the medicine will keep this aggression?

If you believe that your demeanor has changed since you started to take these medication in combination, you might consider stopping one of them. These are both prescription items so you should ask the doctor who prescribed them to you. I have not heard this complaint before from my own patients, but I am aware that testosterone levels do rise on these medications and this could be responsible for aggressive behavior.

Hi. I took propecia at the 1.25mg dose for 2 years and noticed no cessation of hair loss. I’ve been off it for 2 months and am thinking of trying advodart. If I do try advodart, will it or any DHT inhibitor help the follicles that have already shrunk or are in the resting phase or should I use a combination of rogaine to help swell the follicle base and something like advodart to help reduce serum levels?

You sound like you’re trying to be your own doctor and have drawn conclusions that may not be correct. You should approach this process like a clinical scientist and get your hair mapped out for miniaturization and then have a doctor work with you on drugs or anything you need, producing a treatment plan that makes sense and is not random (a little bit of this, a little bit of that). Had you approached it that way two years ago, you would have a better hand on what is happening to you.

I can’t say whether Avodart (dutasteride) is right for you. For starters, I know nothing of your medical history. Even so, I don’t generally recommend dutasteride to my own patients since it is not FDA approved to treat hair loss — so advising someone on the Internet that isn’t even my patient about whether that prescription drug is suitable for them is definitely out of the realm of what I can offer. Since you’re on Propecia already, I’d discuss this with the doctor that prescribed that medication to you. With all that being said, you can give Rogaine (minoxidil) a try, as it is available over-the-counter.

Hello Dr. Rassman

I’m a 19 year old male showing early signs of Male Patterned Baldness(Small bald patch on crown area). My doctor prescribed be Finax (Finasteride 1 mg) and he is also insisting on getting one blood test done (DHT,DHEA etc.).Can you tell me what is the significance of this blood test?Also, I’m an engineering student and my IQ is 141, recently I got to know that finasteride lowers your IQ.Is it true?

Do you get wrinkles from finasteride? I looked at few before after pictures of people on propecia, and I could see that they got wrinkles on forehead within 8-9 months! Please confirm it. And if I start taking finasteride now, for how long I can keep my hair?

Thanks

There is no connection between IQ and finasteride. Some people believe that bald men are smarter than non-bald men, and that the balding is reflective of an overworked brain that overheats. I’m kidding!

I am not aware of any evidence that shows finasteride causes wrinkles or any aging process. The best test you can have is a miniaturization study before you start the finasteride so that you can establish a metric of the hair shaft thickness in different areas of your scalp and the degree of miniaturization. Finasteride should reverse much of this in a man at 19 years of age. There is no need to test for DHT or DHEA. I can’t tell you how long it’ll have visible benefits, as I’ve seen patients that have been taking the drug for a decade with great results, and have received emails from people saying their hair loss resumed after 5 or 6 years. Each person is different.