Author: Dr. William Rassman

I am a 50yr old male that has had six strip surgeries over the years. I have continued to thin and even the transplants have seemed to thin. Most noticeably is the mid scalp area. I would like to try low dosage Dutasteride (Avodart 1 pill weekly) along with propecia, which I have been on for about 15 years. The problem is I can not find a doctor willing to write a scrip, and I have been to several Dermatologist as well as my primary care doc. All say they are not comfortable with it. The low dose seem reasonable. I feel I must give this a try before it is too late.

Any advice? Thanks very much!

If you are continuing to lose hair, it just may be from your genetic predisposition to male pattern (androgenic) balding. All drugs have limitations and drugs alone cannot completely stop hair loss. There is a reason why most doctors (including me) do not routinely prescribe dutasteride. Dutasteride is not FDA approved for treating androgenic alopecia and it has a higher side effects potential than Propecia.

As for your continued thinning, including the transplants — this is unusual. I haven’t seen your before/after photos and I haven’t seen your case file, but if the grafts were taken from the donor area (and not higher or lower), they should not fall out with your hair loss progression.

Snippet from the article:

This baldness cure was a bust. For nine months, William McKee took the generic version of Propecia, the pills that promise to halt hair loss. But the drug had radical side effects: Instead of becoming a better-looking man, he started becoming a woman, he claims.

“My rock-hard chest from the gym began to soften . . . reaching the point where I had noticeable ‘breasts’ even under my clothing,” he says.

Among other changes, the 38-year-old software engineer claims, “my shoulders were literally falling into a more feminine position, and my hips were loosening and becoming wider, as on a woman’s body.”

McKee, who says he wasn’t inclined to cross-dress before, began feeling like a woman. He is now only attracted to men.

Read the rest — NY Post – Software engineer claims generic version of Propecia turned him into a woman

Wow. The article starts with calling Propecia a cure that didn’t work, so the story itself begins with a loss of journalistic credibility right off the bat (there is no cure for hair loss). The story and the source are highly suspect, and this is hyped up BS. I have an extremely difficult time believing an ounce of truth to this. The guy said he bought a generic finasteride online from India (probably without a prescription), and now he is frustrated that he can’t sue Merck… so this is the story that gets spun and published.

For all that Propecia has been blamed for, this is a new extreme. Propecia does not turn you gay and it doesn’t make you want to dress like a woman. But I guess with all the hysteria out there, Propecia becomes a convenient catch-all excuse for anything and everything.

This is not a personal question but a more general one. If i’m not mistaken, those who suffer from MPB have a variation of a gene that makes their scalp sensitive to androgens, while DHT is potent androgen – it’s still just one hormone. Why isn’t stronger anti-androgens being used? Obviously, you’d have to be castrated to fully eliminate the risk of going bald.

My question is, who or whom decided that DHT is where the line is going to be drawn? What made them not go further down the road, as there’s still loads of money to be made for the pharmaceutical companies.

I don’t think anyone necessarily just decided that DHT was the sole cause of hair loss. It is just one piece of a puzzle not yet fully solved. As I have said many times in the past, DHT is not the sole cause of hair loss. Your genetics are also the cause of androgenic hair loss. DHT is just one factor that we have discovered for men who have the genes for balding. If you do not have the genes for balding, DHT does not matter.

Big pharma and other companies are still working on various ways of treating hair loss with varying degrees of success.

dr.Rassman/Pak

is inhibiting type 1 alpha 5 reductase also important in combating hairloss?

Studies have shown only type 2 is the cause of hairloss, as the peusohermaphrodites had normal levels of type 1 and still had to hairloss or prostate problems. whats your thought on type 1 as well?

people say dutasteride block more DHT, and in my opinon thats becuase of its ability to block type 1 as well.

finasteride 5mg blocks about 70% of DHT. Dutasteride 0.5 mg blocks about 90% DHT. Merck did have an experimental drug called mk386 that inhibited type 1 as well. In the clinical trials in produced no benefits to hairloss. The only reason dutasteride block 90% at 0.5 mg is because of the type 1 inhibition as well. if dutasteride does not inhibit type 1 then it would block DHT just like finasteride.

You state the science as I also understand it. The value of dutasteride seems to be a more complete block of DHT than finasteride and that is probably why we see better response in some people who are resistant to finasteride.

The MK-386 study I remember was from the mid-1990s on macaques, and while it did lower serum DHT, it didn’t have much of an effect on hair weights. I found another study from 1997 involving MK-386 on humans, which concluded that: “The current findings are consistent with the hypothesis that an inhibitor of 5αR1 may benefit conditions associated with excess skin androgen activity, such as acne, androgenetic alopecia, and hirsutism.”

I don’t know if anything was published about MK-386 beyond that, but I’m hopeful that some readers out there can point us in the right direction if they’re familiar with more studies done.

I’m 22 have some heridatory hair loss in my family.

I can noticeably see miniaturization on my hairline and the corners receding. my front hair is thin, but the rest of my hair is thick. most like norwood level 3.

I have spent hours trying to find the right product to thicken my frontal hair and too stop any further receding. but theres so many products out there I cant decide. for a young person in the first signs of frontal balding what would your advice be on a product to prevent it.

thank you

There are no products that are guaranteed to thicken the hairline, but Propecia has worked to regrow hair on rare occasions in that area. I wouldn’t count on it regrowing the hairline, though. I would expect it would at least slow the loss down (particularly in young men with early hair loss, such as yourself). It is a prescription medication and you’ll need to talk to your doctor about it.

There are a lot of products out there that claim to do things they just can’t do. After all… if they worked as claimed, you probably wouldn’t see so many men out there with receding hairlines.