Author: Dr. William Rassman

I think despite how much you caution your readers about the dangers of going with Avodart, as it is not approved by FDA, I think deep down you must understand how desperation will drive us to at least consider it.

With that in mind, it only just occurred to me…a while back, you mentioned that it’s possible, based on your educated guess, that only a monthly dose of Avodart would be necessary since the half-life was so long (again I emphasize for the readers that it was just an educated guess).

For those of us willing to take the risk, wouldn’t this risk be minimized by only taking it once a month? I’m thinking – why not continue to take Propecia daily, in addition to Avodart once a month? Surely, while risky, it’s a safer option for those of us who really aren’t responding to Propecia that well.

I don’t think that I said that Avodart (dutasteride) was a drug with risk, I just said that it was not approved by the FDA for treating hair loss. Clearly the drug is approved for prostate problems and is considered safe. The half life of this drug is 5 weeks, but it reaches only to 65% of its steady state level after 1 month and 90% after 3 months with daily doses of the medication. Once a month should not (in theory) create therapeutic levels in serum, but that doesn’t create it for prostate applications. Although your analysis is reasonable, knowing what dose to use is ‘hokey’. I also just don’t know how to judge if it is working, nor do I know what the best dose is, what the best frequency to take it, or whether to up the dose if it doesn’t work.

I read someone’s comment in one of your blog entries from long ago, suggesting that Avodart was seeking approval from the FDA (something about being in Stage 2 trials). We know it hasn’t gotten FDA approval, but are they actually seeking it?

There is a report just published two weeks ago on the U.S. government website ClinicalTrials.gov which indicates that phase III clinical trials are in process for Avodart in Korea. That is great news for us, because the indications are strong that Avodart (dutasteride) will be more effective than Propecia for the treatment of male patterned genetic hair loss. The most pointed questions which need to be answered are the frequency of side effects, particularly sexual libido supression.

There are some studies out there proving the efficacy of Avodart (dutasteride) for prevention of hair loss. It is documented that blocking type one 5-alpha reductase may be as important as type two in treatment of baldness. Unfortunately, the study done at Duke University, published in December 2006, is limited to 24 weeks and we don’t have enough information on the long term effects of dutasteride on hair loss.

How common is it for side effects from propecia to develop months, or even years into treatment? With so many horror stories posted on the internet, is it unreasonable to assume that if you are months into treatment and have had no side effects that you are in good standings and potentially could take the drug (so long as it is working) for more of a long term treatment? Finally, in your personal opinion do you feel that noticiable thinning but no bald spots at 22 is too young to begin propecia, or that I am using up the drug’s period of effectiveness too soon? Any guidance would be greatly appreciated. Thanks.

Most of the side effects of the medication Propecia (finasteride) are seen in the first few months immediately after starting it. As a matter of fact, most side effects improve with time. The most problematic side effect, which is decreased libido, is proven to get as low as in the placebo group if patients continue taking the drug for over one year. The reality, however, is that as we age, our sexual performance may decrease, our marriages tend to get stale and if you are taking Propecia, it may produce performance issues as you get older for either of these reasons.

With you in your early 20s (with significant thinning vs. balding), you are a better candidate for Propecia than a man in his 50s and the sexual issues, with all of the testosterone floating around, is rarely the problem.

In the grand scheme of things, what is the effect of NOT taking Propecia one day every few months? I have been on the medication for a year now, and it seems like once a month or so (for some reason or another) I miss taking the pill. How serious is this?

If a diabetic skipped insulin every other day, he/she may end up very sick. Skipping Propecia is not the recommended routine, but it is not life or death. If you forget to take the pill once in a while, you won’t lose all of your hair or benefits of Propecia. I wouldn’t recommend skipping it, but if it you happen to forget one day, you won’t run a huge risk in losing medication effectiveness.

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Thank you for your very informative and interesting site. I have read about Propecia extensively and it seems the wording describing the known benefits on the frontal hairline are very vague. I know Propecia has “very little evidence to support regrowth in the temporal regions,” but what if you still have hair in the frontal region? Will Propecia help or hurt the campaign to maintain hair growth in that specific area?

I am assuming that you are a male. What is your age? I can not do you justice to work in the dark. I will therefore answer your question as if you are a young man, under 25 years old. Propecia was only studied for its impact in the crown, so the drug company can make no claims about its impact on frontal hair loss. I can, however, tell you my experience as a clinician. I have seen frontal hair loss reverse (not commonly) and hair fill in behind the hairline in many young men with thinning. Propecia has no impact on non-genetically damaged hair. A normal person taking Propecia (one who has no balding) will not get any observable effect from the drug. Therefore, any hair that is normal and still present in the frontal area will not be negatively impacted, but if hair is being lost in the frontal area, then as a young man you can expect that if you do not protect the hairs that remain in the frontal area, they too will be lost. If you are balding, be sure to get your hair mapped out for miniaturization to determine the diagnosis and get a baseline that will form a Master Plan for your future under the guidance of a good, honorable, caring doctor.

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