Author: Dr. William Rassman

The doctor who did my hair transplant has offered to sell me his ownn blend of Finasteride. He says it is the same as propecia just less expensive. He claims it has 1.1 mg of finasteride plus some vitamins that allowed him to get FDA approval and not violate propecias patent

In some states, doctors can legally mix their medication ingredients. What he is doing sounds alright to me on the surface, but the issue of patent infringement may be more of a problem for the doctor if the 1mg dose of finasteride is used. This is more of a legal call than a medical one. His special blend is not FDA approved, although the finasteride itself is FDA approved to treat hair loss.

I have been taking 1mg finasteride to treat hair loss for more than a year. I have been facing problem of reduction in sperm quantity. I also get stomach upset and gas trouble on the next day after i masturbate. After reading about the side effects in internet i have now decided to quit. Will the side effects go after i discontinue?? I also find that my penis is bent sidewards (dont remember if it has become after i started taking the medicine). Pls advice

Where is your doctor in dealing with your problems? That is where you should be evaluated, not on the Internet. Starting and stopping finasteride is not something you should take lightly if you are really balding. Sounds like you are psyched up from taking this medication.

With regard to your penis, many men have a bend to their erect penis and this is normal, that is, unless the bend makes it non-functional, in which case you need a doctor to address the problem. The reduced sperm volume with finasteride is a well know side effect (not low sperm count, just a reduced ejaculate), but there is no way that your penis will bend from finasteride.

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Hi doctor,
I have been taking Propecia and minoxidle for 5 months now, and my libido has gone down and and was wondering that if i take some other legal drugs like horny goat weed or other drugs, will it clash with propecia and minoxidle? or is there other ways to get my libido back in another way. Or is it best that i stop using propeica.

I don’t know about horny goat weed (epimedium) or other herbal approaches aside from what I’ve started reading after receiving your email. It is highly possible that a combination of exogenous testosterone and finasteride might work. One has to study the negative effects of the exogenous testosterone against the blocking impact of the Propecia. Is there an overall net gain here? Good thought!

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I have been taking Propecia since April 2007. Within one month of beginning the prescription, I began experiencing severe left shoulder pain without any prior traumatic event, injury or prior symptoms. I am still taking Propecia (prescribed dosage),and the pain continues. I am in physical therapy now for what they have diagnosed as “shoulder impingement”, but I wonder if I stopped Propecia if it would have any effect.

Have you heard of anyone else having this issue with acute joint pain while taking Propecia?

Thank you

No, I have not heard of this correlation (if it is a correlation) from any of my patients, though there have been a few reports from readers that I’ve received by email over the years of writing this blog. If you believe Propecia is causing the shoulder pain, you can try not taking Propecia for one week and see if your symptoms resolve. Stopping Propecia for one week should not have a negative impact on your hair loss treatment course. Keep in mind that there is also the power of a placebo effect when you start or stop a substance or an activity.

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Dr. Rassman,

I recently started using Rogaine foam. I applied it at around 7pm and went to bed around 1 am. I wanted to be sure i didnt react negatively. I was fine until after i went to bed. Around 6 am i woke up with stinging and tearing up in both my eyes. I had to go to the bathroom and rinse out my eyes for about a minute. They were all red and puffy too. It seems like it might have been an allergic reaction, but is there also the possibility that some of the foam residue got onto my pillow and i rubbed my eyes into it during the night?(Because i applied a lot and all over my head). Also, after washing out my eyes i was fine. Have you heard of this before?

Minoxidil can be irritating and if you did get any into your eyes, what you are reporting is logical. If it should happen, be sure to wash out your eyes, under a shower with the water pouring into your eyes from hitting your forehead.

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I am taking between 5 and 15 Propecia a day and I believe my hair is growing back. I think that Propecia is a great drug and everyone who is balding should take as much of if as they can afford.

I am certain, based upon the studies of dose effectiveness, that if you took just one pill a day (1mg), it would work just as well. Also, I am fairly certain that doses that high would have a severe effect on your sex drive. I am curious if you’ve ever tried the proper dosing? Are you willing to give up sex by overdosing Propecia? Please see a doctor for direct one-on-one management of your drug therapy.

This reminds me of when I met a man in my clinic a few years ago who was 23 years old and was taking 4 pills of Proscar (equal to 20 pills of Propecia) every day. His goal was to suppress his overactive sex drive. It essentially killed his sex drive, so I would assume that he was successful in the drug’s unusual application. He reasoned that this was to allow him to focus on his career rather than let his unusually high libido detour him every time he got hired for a modeling shoot (he could earn over $10,000 per day). He figured with that size of earnings, he could put his sex drive on hold for a few years while he piled the money away. Of course, I’m not recommending this course of action at all, but it is just interesting to know that some people are willing to go to great lengths to achieve results they are looking for.

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Dr.,

I have been on propecia for a around 2 years now. Recently I have developed Peyronie’s disease, which is utterly demoralizing and far worse than any hair issue I could imagine. Immediately I began searching for possible links between DHT deficiency and structural abnormalities that can dispose a person to penile fibrosis. I didn’t have to search long or hard:

Effect of androgen deprivation on penile ultrastructure

Recent insights into androgen action on the anatomical and physiological substrate of penile erection (human study)
^^^ more proof that androgens are necessary for proper sexual function in men

The Effects of Transdermal Dihydrotestosterone in the Aging Male: A Prospective, Randomized, Double Blind Study (human study)
^^^ take away DHT, you lose sexual function/libido — restore it, you recover function

Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat
^^^ DHT is necessary for NOS production so you can get an erection

My penis is hardly functional and I am quite upset that nobody showed me these studies before I took the drug. I acknowledge that it is not definite propecia is the cause. But does this research not certainly point in that direction? I feel betrayed by the FDA. This is not on any warning label, and I must live with this for the rest of my life.

Thank you

p.s. I am 20 years old

I am sorry for the problem that you are going through. As a physician all I can do is to follow the evidence based medication before convincing myself to prescribe a medication and that is pretty much true about every medication. As of yet, there is no evidence to show any ‘stastical’ association between finasteride use and Peyronie’s disease. The data that you found during your search points out different aspects of the effects of male hormone on sex function. Based on all available literature, there is really no evidence that can associate Peyronie’s disease to the use of DHT blockers.

The sexual side effect of finasteride is well documented and the question for us is whether we should include this type of disclaimer for all patients considering the use of finasteride. I personally spend a long time explaining the potential side effects of the medication to my patients, as well as discussing the commonly known and published potential complications. I make sure that patients can make an informed decision before starting the medication. I also offer methods for my patients to minimize or treat side effects should they occur. I appreciate your symptoms and belief that there is a connection in your case. I will send this blog posting to Merck, maker of Propecia, for any comments that they may have and will post a follow-up if/when I receive a response.

For more on Peyronie’s disease, see University of Virgina – Urology.