Author: Dr. William Rassman

Thanks so much for writing this blog. When ever I have hair loss questions, I always start be searching your blog. I recently received an email from my doctor about his own brand of finasteride. In his email and on his website he refers to it as “compounded finasteride.” He also states that it is not an overseas generic and that is custom-compunded by a US Pharmacy. A quick google of “compounded finasteride” shows that there a few doctors in the US now offering this.

I was wondering if you knew anything about it? I’m all for saving money but I want to make sure I’m getting the same stuff. What exactly does “compounded” mean?

There are more and more “compounded” versions of finasteride on the market today. Most of these versions have the important medication, finasteride, along with other ingredients that when combined allow the physician to claim his or her own brand of finasteride. The important point here is that in most these concoctions, finasteride is the only FDA approved medication to combat hair loss and all other additives are very unlikely to help and from an effectiveness point of view, it must be taken orally as there is no science to support other ways to take it (skin, inhaling, or rectal use).

In most states, doctors are allowed to mix their own medications so if they know what they are doing and it is legal in the state that they do it in, then I guess it is legal. I know nothing about mixing medications. Some interesting historical reading includes:

• Encyclopedia: Apothecary
• A Physician’s Lexicon: The Art And Words Of The Apothecary
• History 1450-1789: Apothecaries

Hi Dr. Rassman,

I just wanted to say thank you for providing some very useful information and answers to questions on your website.

Although I have full coverage, I have been experiencing thinning hair throughout the top of my head since my early 20’s (Im now 25). Finally, I decided to visit a dermatologist last year. After asking questions about my family history (my father has experienced hair loss), he recommended that my hair loss is from genetic factors and prescribed Propecia. However, there was no miniaturization performed.

My 6 month experience with Propecia has been fairly unique. Within the third month of taking Propecia, I experienced a pretty good shed. I also noticed after a few weeks that my hair was becoming very oily (I have never had oily hair in my life). Around that same time, I was noticing that I had some abdominal bloating which was very uncomfortable. In the 4th month, I stopped taking the medication (due to the stomach pains) and within a week these pains went away.

My dermatologist encouraged me to resume propecia as I was simply “connecting the dots” to link cause and effect. After doing so, within a couple of weeks the stomach problems returned. At that point, I discontinued the medication. It seems I am worse off then when I started as the hair caused by shedding never fully returned and the scalp is now more visible (however, my hair is no longer oily).

Have any of these problems been reported or am I experiencing a very unique situation?

Thanks for your help.

Although what you are describing is not common and is not usually one of the side effects of the medication, you may be having an adverse reaction to the medication. With the half life of Propecia (finasteride 1mg), one would expect your side effects to disappear sooner than one week after you stopped taking the medication. Have you tried taking half the dose you were taking to see if you have any side effects? I would also make sure you have a miniaturization study done by a specialist in order to properly diagnose your hair loss problem.

Dear sir,

i would like to try one product containing topical saw palmetto and topical finasteride !

i am only 20 years old,i would like to know if i will have the same orally finasteride side effects(reduced libido),thank you

There is no evidence that finasteride on the skin can predictably be absorbed. Interestingly, Merck (maker of Propecia) warns that women should not touch Propecia because of a threat of absorption, particularly in pregnant women, yet there is little information on this subject. I’ll try to get some clarification from Merck for a future blog post. I am also not familiar with topical saw palmetto having any value for hair loss treatment.

According to an article from the Journal of Drugs in Dermatology in 2004, 5 alpha-reductase and finasteride in pattern alopecia and acne: “Topical finasteride is well absorbed, but clinical results were minimal with this mode of drug delivery.”

The bold styling was not part of the original article — I added that to drive the point deeper. The question about topical finasteride has been asked of me many, many times, and I hope this explains why finasteride comes in an oral pill rather than a spray, gel, foam, cream, or even a suppository.

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Hello,

My question is in regard to Minoxidil. About ten years ago my mother tried the product and ended up having a very severe allergic reaction. Her face and throat swelled greatly and she was convinced she was going to die. Thankfully, she ended up ok after several months of treatments and recovery. Doctors told her that because she applied the product after scraping her head, it most likely entered her bloodstream and resulted in the reaction she experienced.

I am now 28 years old and have been losing my hair for about 5 or 6 years. I would very much like to try Rogaine, but I am afraid of having an experience like the one I just described. My question is whether an allergy to Monoxidil is hereditary, and if there is a way to be tested in advance to determine whether or not I am allergic.

Your response is greatly appreciated, and please accept my apology if this topic has been covered before.

Most medications reactions are not true allergies. A true allergic reaction to a medications cause, itching, rash, swelling, difficulty breathing. From your description it sounds like your mother had a true allergic reaction. A family history of reaction to a specific drug does not mean that one has an increased chance of reacting to the same drug. You can do a skin test where you apply minoxidil to the skin (a very small area on your arm, possibly the size of a pea) and then wait to see if you react to it.

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