Author: Dr. William Rassman

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I Switched From Finasteride to Dutasteride And Now Have Shedding All Over the Scalp

Hello Dr. Rassman. First, a huge thank you for this great site. It is an island of real medical information amidst the sea of misinformation of hais loss.

I have a question I believe has not been asked before. Can the switch from finasteride to dutasteride cause catch up loss?

After 4 years on 1.25mg of finasteride, 3 months ago I added 2.5g of avodart daily for two months, lowering the dosage to 0,5g daily after that. I mantained finasteride for the first month of avodart and stopped taking it since about two months ago.

As of now I am experiencing massive shedding all over the scalp (including the sides and donor area), with the characteristic white bulb of a telogen effluvium. Could this shedding be catch up loss from not taking finasteride, causing permanent damage, or does avodart “picks up” that protection and is just normal shedding from switching medication? Is it reasonable to expect my hair to grow back? I discussed this with my doctor, but he simply does not have your knowledge. I returned with my daily 1,25 of finasteride a few days ago, just in case, and will maintain a low dose of avodart for extra dht suppression.

Thanks for your time!

Changing many factors makes an analysis extremely difficult. I haven’t heard of a switch between medications causing catch-up loss, but I’m not sure why you were taking both medications and changing doses so much. Did your doctor prescribe this method?

Since you’re going back to your finasteride routine that worked for you before, I’d give it some time to see what happens. I’m not sure why you experienced a massive shed, and it’s particularly troubling that it occurred in the back and sides of your scalp. If your doctor isn’t knowledgeable about treating hair loss, you should try to find one that does. You should have your scalp examined and baselines measured so that you can know for sure what any treatment is doing (good or bad).

I said this many times, and it may not be something you want to hear, but in the end your genetic predisposition will win out. It is really not about total DHT suppression.


2013-03-04 15:35:59I Switched From Finasteride to Dutasteride And Now Have Shedding All Over the Scalp

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I Swear, This DHT Blocking Shampoo Is Working for Me!

I’ve been using MiN New York’s shampoo for more than a year now and I swear it has worked wonders for my hair. The ingredients are all high-quality (no sulfates, etc.) and it contains all sorts of DHT blocking compounds. It’s the best shampoo I’ve ever used, and I’ve used a lot.

I know you are skeptical of a shampoo’s ability to re-grow hair, and rightfully so. I don’t think MiN re-grows anything; what it does is create a healthier scalp environment. You can’t grow good crops in poor soil, and the same goes for hair. I use 1mg finasteride in the morning, minoxodil at night and MiN products throughout the day. My hair looks better now than it has at any time over the last few years.

MiNWell, I like that you are using standard medications (finasteride and minoxidil) with your MiN products. Without good controlled studies though, nobody can tell which drug or product is giving you the benefits you’re seeing.

The claim that this shampoo is a DHT blocker flunks FDA regulations by making a medical claim that can not be backed up by the type of scientific research that the FDA supervises in their approval process. Don’t believe everything you read.

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I Switched to Generic Propecia and I Lost Massive Hair

I was taking name brand propecia for one year with fantastic results. After one year (July of 2013) I switched to generic finasteride. In July of 2014 i didnt notice any difference in the Generic version. recently (janurary 2015 – present) I have experienced significant hair loss (My thinning has progressed to its worst point ever). I am attributing the sudden and significant hair loss to stressful events that occured around july of 2014 and have been ongoing till present day. If I obtained by generic finasteride from my doctor and through
my local US pharmacy. Am i guaranteed my dose was legitimate and my significant hair loss can be contributed to stressful events? I am currently blaming the Generic finasteride for the massive hair thinning.

In general brand name drugs and generic drugs are the same. The difference is the cost, color, or shape of the pill. The active drug ingredient is the same. I personally cannot guarantee this but most of the patients use the generic form of Propecia and do well. I hear (rather read) on occasion on the Internet and this blog that some have noticed a change when switching from a brand name to a generic. If you are noticing something different, I would follow up with your doctor and consider other options (such as switching back).

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I Take After My Father in Nearly All Traits — Will I Retain His Hairline Too?

Hello,

I have a lot of physical traits from my father’s side of the family, including body and facial hair, and I have the same color and texture of head hair as my father. I have few traits from my mother’s side. My hair is just beginning to thin at 25, and I am hoping I take after my father’s side in hair loss as well, since my mother’s side has a strong history of baldness. I don’t suppose there is much actual data on the subject, but subjectively, do you think I am more likely to avoid baldness since I take after my father in nearly all other respects? I would like to get miniaturization mapping done but I doubt I could afford it yet, so any input would be greatly appreciated!

Male pattern hair loss is genetic, but it does not necessarily follow a predictable Mendelian genetic pattern of either the father or mother’s side. There is no definite way to predict your hair loss pattern, but one way is to measure the miniaturization state of your scalp hair with a good hair densitometer at predefined areas on your scalp. Then you can periodically measure the miniaturization state and compare it with your baseline picture to see if there is a trend. A miniaturization study is free (at least at NHI).


2006-10-26 10:20:48I Take After My Father in Nearly All Traits — Will I Retain His Hairline Too?

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I Take a Cut Proscar Tablet 6 Times a Week

Hi i’ve currently been taking Proscar 5mg tablets cut into quarters I take it 6 times a week and have a 1 day break (so im intaking 7.5mg per week) I’ve been on the drug for close to 4 months. firstly is this acceptable or should I be looking to take it every single day?

Also my main question, I have alot of vellus like hairs some grow to a centimetre or so some are eternally lingering around 1mm, small and blonde my plan with finasteride is to revert these hairs back to the terminal stage, I’ve noticed my remaining terminal hairs look stronger right now but im wondering the rough timescale of when I should see my vellus hairs growing in stronger, I know everybody responds differently but if you could ball park the average for me and maybe explain what I should see process wise (does anything change to let me know etc) if the medication is working for me. Many thanks!

This should be discussed with the doctor that prescribed you the medication. In general, the recommended treatment for male pattern baldness is 1mg finasteride per day. Many patients break up the 5mg finasteride pill into four pieces and take 1.25 mg per day with no issues. The half life of finasteride (Propecia) is about 4 hours, so after 24 hours almost all of the medication is out of your blood stream (even if you took a 5mg dose or 1mg dose or 1.25mg dose). Thus, the medication is meant to be taken daily (without skipping) so that you maintain a consistent level in your blood stream. It is not a cumulative dose over a week. You cannot take a 7mg pill once every seven days and expect it to work the same as taking 1mg daily for 7 days.

Finally, without an examination I really do not have any way to know if the medication is working for you. Ideally, one would have a measurement done before you started the medication (such as a photograph, miniaturization study, or bulk measurements) and compare this with a follow-up measurement. Otherwise it is just a subjective guess.

The Propecia timeline for results can be found here.

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I take finasteride 1mg every other day

I take finasteride 1mg every other day for a year and just recently noticed that the hairline is thining. What you would think it the best thing I can do now?

I would increase your dose to daily rather than every other day. See if that makes a difference with the finasteride. You could add microneedling weekly.

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I Take Aspirin Therapy and Plavix — Can I Get a Hair Transplant?

I am a previous patient of yours. Since my procedure several years ago I suffered a heart attack. As a result, I am on aspirin therapy (325 mg/day) and Plavix (75 mg/day), indefinitely. Does this preclude me from ever having another transplant?

I would like to have a conversation with your doctor prior to going forward and then meeting with you as well. Please send me your doctor’s name and phone number.

I have transplanted people on both of these medications. The bleeding time will be longer, but the bleeding that is prolongs will not be life threatening and the clotting mechanism that is made to stop you from bleeding will stop the bleeding (it just might take longer). Fortunately, all of the bleeding areas from a strip harvesting technique of hair transplantation will be seen at the time of the surgery and the surgeon can use basic techniques to address these bleeding areas safely.

For your general information, aspirin and Plavix medications prolong bleeding times, making it more difficult for a clot to occur in the short term. Heart attacks and strokes often come about when a clot forms inside a blood vessel that has considerable plaque build-up. The point of taking these medication is to slow down the clotting mechanism for heart attacks and strokes in these areas of plaque so that the heart attack and stroke does not develop. But the clotting process is a necessary part of daily life and is not disabled. We constantly have small bleeding episodes when we ‘grunt’ or stress during a bowel movement (for example). Many people will note that they develop small clots on the legs or if they bump themselves, they depend upon the clotting mechanism to prevent any excessive bleeding. So, in effect, the clotting mechanism still works and in a safely controlled surgery like a hair transplant in the hands of a skilled surgeon, bleeding should not be a problem.


2006-06-19 08:38:47I Take Aspirin Therapy and Plavix — Can I Get a Hair Transplant?

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I Take Finasteride Daily, Dutasteride Weekly, and Use Ketoconazole Shampoo

Hello,

I am 29 years old and since 21 I’ve been on finasteride 1mg every single day. I started going bald at 14-15 years old with progressive receding of the corners. At 18, 19 years I was clearly a norwood 3. At 20 I noticed that my hair in general and mainly the frontal line was becoming more and more thinner, so at 21 I started my treatment with finasteride. I have to say that the results were better than I expected.

After 2 years I noticed my hair has become stronger and its quality improved significantly. The results were kept for more than 3 years. After that, I noticed a considerable reduction of the general volume of my hair that I could see (over strong light). I think today I am still a Norwood 3 and for people in general my balding can be hidden well, but the fact is that the genetic process is still running.

At the moment I am on finasteride every day, dutasteride once a week and ketoconazole shampoo twice a week. I would like an opinion about my situation. What more can I do to keep my hair and what is your prediction for a case like mine based on your experience over all these years? My father is bald and his process started very early too. Otherwise, my grandfather (mother’s side) has a head full of hair even in his 87 years.

You are fighting your genetics… and your genetics will eventually prevail. Sorry to tell you the bad news.

I hope you are under the care of a doctor, because dutasteride and ketoconazole do not add much benefit in hair loss treatment. You are likely doing enough by taking finasteride daily. I don’t know how I can form an opinion about your situation without seeing you, though.

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I Take Propecia and My Girlfriend Is Now Pregnant

I have been taking Propecia for 2 years. Recently my girlfriend got pregnant.. Should I be worried? Will everything be O.K.? Thanks!

Congratulations! I don’t think you have anything to worry about with respect to Propecia use and conceiving. There is no evidence that I’m aware of to suggest that it would affect your fertility or have an impact in conceiving a child.

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I Think I Had Shock Loss Even Though I’ve Been Taking Finasteride

Hello Dr,

Thanks for providing all the information you are providing to hair loss sufferers. I have a question. I had a Transplant a 7 weeks ago(Strip method) on my crown area. I was on (and still on) Finasteride prior to my Transplant. Lately I lost my native hair and I am seeing that I have less hair on my top now compared to hair that I had before the transplant. I learnt that this is because of the shock loss. But I was on finasteride before the HT. So, do you think this is temporary and can expect m native hair back. If so how much time does it take?

I try to educate my patients and readers everyday… and this must be one of the top ten things I want the public to understand.

Taking Propecia (finasteride) does not protect you 100% from experiencing shock loss — it only lowers the risk. If you have shock loss, there’s not much you can do (actually, nothing you can do)… and if it is in miniaturized hairs, it may very well be permanent! Statistics do not matter to those who have shock loss even while on Propecia. This is one of the risks of a hair transplant and you must always balance the benefits of surgery with the risks of surgery.


2009-05-01 09:12:12I Think I Had Shock Loss Even Though I’ve Been Taking Finasteride