Author: Dr. William Rassman

Hi Dr.

I have a quick question. I apologize in advance if you have already answered it as I tried searching. I am 30 yrs old and I have been using Propecia for almost 1.5 years. When I started it worked great, within a few months it stopped hair loss and I even noticed a bit of regrowth on the temples. Recently I got a hair cut and noticed that my hair is thinning again. And I have started to see my scalp.

My question is that is it possible for Propecia to stop working abruptly ? If yes should I consult my doctor again for options ? or is this the end of the line.

Also I might add that there has been added stress in my life recently do you think that this maybe a temporary thing where the effectiveness of propecia may bounce back ?

Thanks in advance

Hair loss can be a very subjective thing. Just to look at your hair and to judge how thick or thin it is can depend on lighting and perspective. It also depends on your hair cut. I would think that getting your hair cut short would make one’s hair look thinner (more light allowed to the scalp) anyway. Besides that… Propecia does not just stop working. Hair grows in cycles, so I would think when hair is actively in a shedding cycle, the impact of Propecia may be lessened – albeit this is somewhat of a stretch.

The best advice I can give you is to stay on the drug even if you think it is less effective. But in any case, talk to your prescribing doctor.

Hi,

I must be at an early norwood 3, in my mid 20’s and have started propecia, (its been a little over a month), has two questions;

1) Have there ever been cases where a complete reversal of baldness has taken place with use of propecia ALONE.

2) Could you explain the post finasteride syndrome (extremely scared of reports on the internet) and was wondering how often it is seen in patients (not just the sexual side effects, but also all the others described by some patients such as brain fog, memory loss, stumbling on words etc etc)

I have done a lot of reading and decided to take the pill anyways, so far no known side effects, except for a slight pressure in my prostate which went away within a week.

I have seen some dramatic results with Propecia, but I would not say a complete reversal.

I do not know the exact issues that are referred to as this post-finasteride syndrome. I realize there are anecdotal stories from people on the Internet who claim Propecia ruined their lives forever, but in the 15 or so years that I’ve been prescribing this medication, I have not seen anyone with permanent and lasting effects after they stop taking it.

I have read about it online, I know a select few readers/commenters on this blog are very vocal about it, and we’ve written about the interviews with patients that have resulted in a study that the media went crazy over… yet I still don’t know what is considered “post-finasteride syndrome”, since there are so many random side effects that people apply to this medication.

I do not know how Propecia may cause pressure on the prostate. I do not think I would even how that may feel. Please speak with your doctor on these issues.

Can propecia cause platelets in the blood to lower. My platelet count was 125 and my doctor said its not anything to worry about. I know the normal range is 150-450.

please help doctor

I would listen to your doctor. I do not believe Propecia has anything to do with low platelet counts, but I did find a case report from 2002 in the medical literature that mentioned it. I haven’t seen more cases mentioned in the 12 years following the report, so I’d expect if finasteride does cause low platelet counts, then it is very rare.

In early 2011 I had a rare adrenal tumor removed called a pheochromocytoma. Doctors also removed the affected adrenal gland the tumor was attached to. This type of tumor spontaneously, without provocation, releases epinephrine, norepinephrine and dopamine. Chemicals collectively referred to as catecholamines. These are your fight or flight chemicals and when the tumor releases them you feel very “wound up”. After the tumor was removed, my catecholamine levels went back to normal and I again felt normal.

In late 2011 I started Propecia. I started on .5 milligrams per day and later reduced that dose to .5 milligrams 3x per week, which I am currently taking. A dose much lower than the standard dose of 1 milligram per day. Almost immediately after starting Propecia, I began to feel like I did when I had the tumor. Spontaneously “wound up” even in the absence of external stimulus.

Recent testing reveals my catecholamine blood levels are back up and my oncologist suspects another tumor. Appropriate scans for tumor detection are occurring “as we speak”.

Are you aware of any evidence that Propecia can cause elevated levels of epinephrine, norepinephrine or dopamine? I have read numerous claims that Propecia can cause anxiety. If this is true, could this anxiety then trigger a “chemical cascade” in which catecholamines are released at high levels.

Thank you for your expertise in this matter.

I know I must sound like a broken record, but you really need to discuss personal medical issues with your doctor.

I wouldn’t expect Propecia to have anything to do with dopamine or other catecholamines. Propecia is a 5 alpha reductase inhibitor, which works to diminish the conversion of testosterone to dihydrotestosterone (DHT).

In my experience, the anxiety caused by Propecia are in those men who read too much about Propecia’s side effects on the Internet without discussing the issues with their doctor. Then again, anxiety could indeed be a rare symptom associated with Propecia, but it’s something that needs further study. The studies that I’ve seen which link Propecia to anxiety or depression were based on interviews with men from a Propecia complaint forum, and the bias is something I’ve discussed before.

First off, thanks doctor for all the help you have given. Your site is very helpful.

I actually have a one question and also a comment about propecia.

Firstly, I have been experiencing balding at my hairline for about a year and a half. It hasn’t gotten too bad yet and is moving quite slowly. I started on propecia about 6 months ago and have recently seen a slowing in the shedding of my hairline. Also I have seen a slight thickening in the hair in right at the hairline. The hairs that are growing are small and kind of thin though, so I was wondering if hair regrowth with propecia can come in cycles. Will it start as smaller miniaturized hairs, then the next cycle will they be thicker? Just wondering if this was common for the drug in your experiences.

My second comment was on the side effects of the drug. About a month after I started I noticed drastic sexual side effects. My sex drive was still there, but I could not sustain an erection. I cut back to half a pill a day and that helped at first, but once again I fell into that same situation. Recently though I’ve notice just as drastic of an improvement though. It almost seems over night the sexual side effects went away. I have even gone back to a whole pill and have no noticeable side effects. Is it normal for the side effects to go away so suddenly? Also, could such strong side effects mean that the pill is working well on me? Not that I’m complaining, just interested to know. I am glad I stuck it out though, seems it just took time for my body to adjust.

Thanks for everything in advance!

Many people who get a decreased libido can work it out the way you did. Hair loss comes in cycles, but Propecia (finasteride 1mg) does not work in that fashion. At times, you may find the hair loss will occur even when you are on the drug, and that hair loss occurs in bursts. The focus here was on libido and hopefully your libido problem has been solved. With regard to other side effects, they tend to occur and stay around while you are on the drug, like decreased volume of your ejaculate after orgasm or breast tenderness. Of course, breast pain could be brought on by other causes as well (even breast lumps, although very rarely from Propecia), so if you get them you should see your doctor.

My temples receded from my highest wrinkle brow to 1.75 inches. You said a mature hairline temples are up to 1.5 inches away from that wrinkle. So I’m slightly more which is fine by me. But around those corners there is a piece of short hairs, they seem to have the same thickness as a lot of my front hairs but they look like they will fall of since I assume they are miniaturized. After that my temples will be about 2-2.2 inches receded which will be too much. I just began Propecia and am almost 22 years old, can Propecia stop those hairs from falling out and even help them grow normal again? But I’m also taking Propecia because I have frontal and mid anterior probs as well but early stage.

Propecia will slow or stop the hair loss in most men of your age. Consider sending me photos (will be kept private) and I will give you an opinion, but you should consider getting your hair mapped out for miniaturization to determine if these hairs at that exact location are really miniaturizing.