Author: Dr. William Rassman

Good afternoon Doctor. To make a long story short just want to say I am a 28 year old male with early hair loss, and my derma gave me an rx for the drug avodart to stop hair loss. He didn’t give finasteride as he said its weak, and avodart is better. he told me about all the side affects of both drugs such as erection problems, gyno, low sperm count with avodart, etc. and basically said its my decision to pick which one, propecia or avodart so I choose the more effective one. I honestly do not care about the side affects, I’m single and I could care less if I have erection problems from avodart. My hair is more important than sex lol.

But anyways my question is that does avodart from clinical experience and studies does it work on hair loss better, or its about the same as propecia? The reason I’m asking is because avodart is more expensive, so if it the same as propecia might as well take the cheaper one. My dermatologist said it blocks type 2 5AR way better than propecia, and that the type 1 blocking ability of it will do nothing for hair loss as type is negligible and not proven to cause hair loss. From your practice, are the patients that take this drug doing better than the ones on propecia?

My first choice for a drug treatment is always finasteride (Propecia) and in the generic form it costs about $3/month. So yes, while Propecia is probably the cheaper option, it is also the only oral drug approved at this time by the FDA for the treating genetic hair loss (the other is topical minoxidil).

There haven’t been a ton of studies comparing the two for treating hair loss, but the one study that stands out in my mind is from late 2006, where 416 men were studied over 24 weeks. The results showed dutasteride was more potent and resulted in a superior hair growth count based on photos. But that is just one study over six months time, published nearly seven years ago.

One does not have to give up their sex life, nor does one have to take crazy risks with this decision. The incidence of sexual side effects from finasteride is 1 to 2%. Avodart (dutasteride) might work better in some men, but the side effect risk is much higher. I would criticize your doctor’s view on these two drug choices, and will point out that you are welcome to get another doctor’s opinion. Some doctors who do not specialize in these areas may not have all the information.

Hi I have been using Propecia for just over 6 months with no visible benefits so far. I understand that it can take anwhere up to 18 months for you to see results.

The trichologist that I have been seeing and who prescibed the Propecia has told me that the half life is such that I only need to take it every other day. Which is what I’ve been doing for the last 6 months. Is this correct?

Thanks for your site its a great help.

Half life of Propecia is around 4 hours. The half life is the time it takes half of the drug to be out of your blood stream. Let’s do the math…

6am – take Propecia (assume 100% got into your blood stream…)
10am – 50% of Propecia is in your blood stream
2pm – 25% of Propecia is in your blood stream
6pm – 12.5% of Propecia is in your blood stream
10pm -6.25% of Propecia is in your blood stream
2am – 3.125% of Propecia is in your blood stream
6am – (a day later) only 1.5625% of Propecia is in your blood stream

Realistically, all the Propecia is out of your blood stream after 24 hrs. That is why you take Propecia once a day.

Hi Doctor. I recently went to my doctor regarding an acne problem I have had for years, and he prescribed me to take propecia for it. He said that acne is caused my the same hormone that causes hairloss. Something called DHT. And that the ingridient in propecia inhibts DHT and thus eliminating acne. What do you thik about this, it seems kind of wierd to me. Please inform me soon because you seem to be an expert on propecia. I wanted to ask him more questions, but he is one of those doctors thats always in a hurry.

He was pretty condfident that propecia treats acne really well

I haven’t heard of Propecia (finasteride) being prescribed for treating acne. Acne is generally caused by bacteria on your skin and certain hormones in conjunctions with a high sebum production. I recently wrote about acne and DHT here.

So while Propecia does inhibit some of these androgens (such as DHT), Propecia is not prescribed for acne as a treatment. I would consider seeking another physician for a second opinion (mine does not count as I am not your doctor) since you are clearly not comfortable with your treatment plan nor your doctor.

After much consideration, I finally made an appointment with my physician to discuss going on Propecia to halt further hair loss. I figured that I really couldn’t lose – a drug to stop my hair loss and help reduce my chance of getting prostate cancer. A double threat – sounded like a good idea! My doctor who is very knowledgeable informed me of something I had never heard before. He said that even though Propecia (finasteride) helps to prevent prostate cancer in most men – some men do develop prostate cancer anyway, even while on the drug. He said the prognosis for treatment of prostate cancer is very good, but if you are one of the men who develop prostate cancer WHILE ON FINASTERIDE the cancer is extremely aggressive and you will undoubtably die from the disease. He said since I do not have any of the risk factors for developing prostate cancer, he did not think it was worth chancing developing an untreatable form of prostate cancer to save my hair. Have you ever heard this…that even though Propecia helps to reduce the risk of prostate cancer that if you get the disease anyway, that it is untreatable due to it being so aggressive?

The report on the study of over 15,000 men showed that although the cancer risk on 5mg of finasteride for 7 years decreased the incidence of cancer by 25%, of those who did get cancer, the classification of aggressiveness (judged by the Gleason score) is higher in some of the prostate cancers found. This is a pathologist’s description of the tumor based on appearance under a microscope.

There is some controversy on this issue, because some doctors believe that the Gleason score may not be indicative of the reality seen in long term follow-ups of these cancers, which I believe did not show more clinical aggressiveness. One medical paper discussed the overall risk to life when one compared the decreased incidence of 25% for cancers in patients on long term finasteride, with the risks to life with a possible more aggressive tumor. The claim that one risk may offset the other was in consideration. Where ever the truth lies, this finding is what it is without any final conclusions drawn at this time.

Hi Dr. Rassman

My doctor refused to give me prescription for proscar telling me that the drug will minimize my prostate and that long term use will cause me permanent libido problems. Now i consider buying the drug from internet. What’s your opinion? Thanks.

Male 24, NW2.

I would see another doctor. Finasteride 1mg will not give you permanent libido problems.

You need to be followed by a doctor and have a doctor’s prescription for taking this medication. More importantly, you need to have a good diagnosis of what you are treating before you start any medication. I do realize you can buy many medications without a doctors prescription over the Internet, but that is not a smart thing to do, nor is it exactly legal.

Time to say good bye to propecia …

after 3 years on propecia, all this venture end with a gynecomastia surgery ! According to my surgeon the breast gland size was like a lemon…

He also said to me that finasteride drug is also gives to men who want to be a female (transgender…). according to the drug compagny, gynecomastia is a rare side effect… Now i think it is more a common side effect but impossible to really know at least at the beginning of taking this drug… like me….

Anyway this is my own story, i simply want to warning those guys that might thinking of taking this drug…PLEASE READ TWICE THE SIDE EFFECT SECTION, ESPECIALLY THE “RARE SIDE EFFECT SECTION” BEFORE ENROLL TO PROPECIA.

While I’m not entirely familiar with medications transgender patients might take, consider this — most male to female transgender patients do not want male pattern baldness, so finasteride is a good choice to prevent that. Propecia is not a medication to make you transgendered. In other words, transgender people do not take Propecia to make them “more” transgendered.

One of the potential side effects of Propecia is gynecomastia. This side effect is rare (my recollection is 1 in 300 or 500). Most of the time it is reversible, at least in my 14 years of experience… and most men will complain of breast enlargement when it is early, way before their breast turns to the size of a lemon.

In general, for older men (not taking Propecia) the prevalence of gynecomastia is 24-65% (source: eMedicine). But statistics aside, if it happens to YOU it is 100%, right?

Drugs other than Propecia that can cause gynecomastia are:

• Cimetidine (Tagamet), ranitidine (Zantac), to treat heartburn
• Nifedipine (Adalat, Nifedical, Procardia), to treat high blood pressure
• Spironolactone (Aldactone), to treat high blood pressure and heart failure

Dear Doctor,

Your website has been extremely helpful in dealing with my hair loss. I began losing my hair at 21. By age 22 i began taking propecia, and it has worked great thus far. I regrew almost all the hair i lost. I am now 28, and last year i developed a mild case of gyno (I think). I went to my prescribing doctor and had the lump evaluated. He sent me for a mammogram & ultrasound. Nothing showed up, however i can feel a lump. The doctor said I shouldnt worry about it, because i have several fatty tissues all over my body. I was not diagnosed with gyno because the lump was not under the nipple.

Recently, I have notice another lump in my chest (other side). Does this sound like gyno? Should i continue taking propecia if i am developing breast lumps? I know it sounds silly, but id rather have benign lumps in my chest then baldness. Will reducing my dosage help? I am currently taking 1mg daily. Your feedback will be greatly appreciated!

You had a mammogram and ultrasound, and were told you didn’t have gynecomastia, so I am not sure what more I can contribute. I haven’t examined you, nor am I your prescribing doctor.

From the few cases of gynecomastia I have seen from Propecia, they have been painful, however, there still could be a connection. If you are looking for a second opinion or reassurance, the Internet is not the place. You need to see another doctor for an in-person exam to get a second opinion. I suppose in the most extreme circumstance you can have the lumps removed, but I have no idea if what you’re experiencing is even related to taking Propecia. Reducing the Propecia dose may or may not help, because again, I do not know if it is related to the lumps.

Many men (not on Propecia) still have fatty breast tissue. This is a sensitive subject for them and some men undergo a cosmetic procedure to remove the lumps. My point is that this is a difficult decision that you should talk through with your doctor.

Hi Doctor Rassman, I have a question, I know med advice is not given on the internet, but all I need is just an expert opinion from someone like yourself who is an expert in hairloss industry.

I am 28 years old male in perfect health. No drinking or smoking at all. I have been on brand propecia 1mg for 2 years exactly as prescribed by my dermatologist. in the 2 years I have not got the best results, hair looks almost the same as pre treatment with propecia, but doctor said looks like I am slightly below baseline. so he said for me to keep taking propecia 1mg daily because it has slowed the rate down, I have not experienced any side affects at all on propecia.

Since I have not experienced any side affects from finasteride, my dermatologist also wrote me a prescription for avodart 0.5 mg. he told me avodart is a stronger dht blocker and told me to use it ever other day at the 0.5 mg level. He suggested I still take the 1mg finasteride daily, but just use avodart 0.5mg every other day, basically 4 times a week. He told me not to drop finasteride as maybe I might experience a loss of hair that finasteride was hanging on to. I asked if this was safe and he said yes, and not to worry. Basically in your opinion do you have any positive results from patients that use avodart? do you think its better for hairloss?

I really do not know the details about you. I generally think that if Propecia (finasteride) is working, then just keep to it. If your hair looks the same today as when you started Propecia 2 years ago, that sounds like it’s working just fine. Not everyone will see substantial regrowth, and just keeping the hair loss at bay would mean the medication is successful.

Avodart (dutasteride) added to the Propecia routine makes no sense to me, as both medications work in similar ways. I’ve prescribed dutasteride in rare cases for patients that saw results from Propecia dissipate over the years… but in your case, it sounds like the Propecia is working just fine. I have no idea why your doctor would prescribe both drugs to you.