Author: Dr. William Rassman

The top of my hair looks like it’s thinning when it’s wet or when you apply gel (can see the scalp). Currently I’m 24, and when I looked back to pictures from 8 years ago, it seems that I had the same thing. I went to a dermatologist who mentioned mild miniaturization and pushed propecia.

My question is it possible my hair has always been like this, and there is no hair loss or miniaturization at all? He did not want to look at any pictures from my young age. I recently took notice because I have friends losing hair and became fixated on it. When my hair is dry you cannot see my scalp.

Propecia is an elective medication you take for treating androgenic alopecia. If you do not believe you need it, do not take it. If you do not want to take it, do not take it. If you think your doctor is wrong, then get a second opinion. I’m curious to know why you saw a doctor for thinning hair when you didn’t think your were losing hair.

Some hair styles can cause your hair to look thinner. Direct light can also do that. Perhaps your hair gel is sticking your hair together and causing more scalp to show through, giving the illusion of thinning. I really have no way to know.

I travel abroad a good deal, often for long periods and for indeterminate periods, I therefore regularly miss my propecia intake for a couple of weeks up to a month every, for example 6 months. Am I increasing my chances of side effects or the drug becoming ineffective by doing so?

I do not believe you would be increasing the risk of side effects by failing to take Propecia for several weeks, but you may be increasing the risk of the drug not doing its intended job (of keeping your hair). Perhaps you should make a note to pack your medication on your travels.

I have been taking avodart for about 4 years, previously on propecia for 6 years. I believe avodart has worked great but for a long time have always felt that their have been sexual side effects from both meds. I am switching back to propecia to see if they resolve and actually only taking half a pill instead of a full one. My question is:

1. in the long run, does propecia prove about roughly as beneficial for maintaining hair loss as avodart, (or should I expect a large/small shedding of hair from the switch)?
2. will propecia be less likely to have sexual side effects compared to avodart?
3. should I expect the side effects to resolve/ or permanent and how long (2 weeks, month, ect) till I would notice?

1. I don’t know. Your guess is as good as mine.

2. Yes, and a half a pill will be better than a full pill to lessen side effect risk… but no guarantee.

3. Avodart (dutasteride) has a 5 week half-life, so it might take months (in the order of 20-25 weeks) for the side effects to reverse. It may occur earlier. Propecia (finasteride) has a 6 hour half-life, so this drug’s side effects are less long lasting as a rule.

Snippet from the article:

Men who take the hair-loss medication Propecia and develop sexual side effects may be at risk for severe depression and suicidal thoughts, a new study suggests.

In the study, 64 percent of men who developed long-lasting sexual side effects from the drug also reported experiencing moderate or severe symptoms of depression, and nearly 40 percent reported suicidal thoughts.

Low libido and erectile dysfunction have been reported in men taking Propecia, and in some, the side effects persist after the medication is stopped. It is not known how many men experience long-lasting sexual side effects from Propecia, but it is thought to be a small percentage.

Doctors and Propecia users should be aware of the potential serious risks of the medication, “especially as it is being used cosmetically, to alter a normal age-related process,” said study researcher Dr. Michael Irwig, an assistant professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C.

Read the rest — Hair-loss drug linked to severe depression in men

I’ve already received a couple dozen emails from readers sending me links to various articles written about this (and some links to press releases from law firms seeking out people looking to sue). I really am having difficulty here in that the report cited: “Irwig interviewed 61 young men whose average age was 25, who had previously used finasteride (the generic name for Propecia). All the men had experienced sexual side effects for at least three months after they stopped taking the medication. They had not experienced sexual problems before taking the medication, and did not have a history of mental illness.”

Reports that I have read from other countries don’t seem to report the severe sexual side effects or depression as reported in this article, so I am certainly confused. With 100% of those interviewed for this study reporting lasting sexual side effects, there appears to be a bias in the reporting and I have to wonder if these were among the same group of patients that were also interviewed from the Propecia complaint forums (like the last media blitz from Dr. Irwig’s interviews).

With that said, from my readings and from an occasional patient who reported mood alterations from Propecia, I have little doubt that in a subgroup of patients, the 5-alpha-reductase blocker does impact some brain function, perhaps enough to be a cause of depression. On those patients who had some alteration in mood, the symptoms went away in a few days after they stopped the drug.

Certainly, this latest wave of media coverage is alarmist. The article notes that “the findings are preliminary, and further research is needed to confirm them” but that isn’t going to stop the swarms of ambulance chasers looking to make a buck.