Hair Loss InformationI’m Worried About Initial Shedding from Finasteride – Hair Loss Information – Balding Blog

Hi there,

Thanks for this blog it really is so helpful to many of us! I am 24 and definitely going bald, all the men in my family on both sides have MPB. Although I am going bald, at the moment I am hiding it pretty well with what I have but it’s getting to the point where I can’t hide it any longer, so I plan on going on Finasteride in the hope I can conserve what I have.

My only concern is that I have heard some awful stories about Finasteride actually causing an initial shed, or at least worsening the hair loss before it makes it better. In your experience have you encountered this with patients? Although I am determined to put a stop to it I would be devastated if taking Finasteride made my problem rapidly worse even if it would help in the long run.

Thanks for your time.

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I have not seen patients in my practice who shed hair after starting Propecia (finasteride), though I have seen patients who shed initially after starting Rogaine (minoxidil). I’ve also seen patients who continue to lose hair while on Propecia, but it may just be regular genetic balding that is outpacing the medication itself. I really haven’t seen a case where someone has accelerated hair loss after starting Propecia. Either way, both medications do help most men in treating their hair loss.

If you are worried about these issues, please discuss them to your prescribing doctor. When you take ANY medication or partake in ANY medical treatment, you need to consider the risks and benefits and understand why and what you are treating. Just being scared will not solve any problem without a good solid assessment of what you are trying to do.

Here are some recent past replies about finasteride shedding, if you’re curious:

Hair Loss InformationIn the News – FDA Warns That Unapproved Autism Drug OSR#1 Causes Hair Loss – Hair Loss Information – Balding Blog

Snippet from the article:

A product promoted to parents of children with autism is not a harmless dietary supplement, as claimed, but a toxic unapproved drug that lacks adequate warnings about potential side effects, including hair loss and abnormalities of the pancreas, the U.S. Food and Drug Administration has warned in a letter to its maker.

The FDA’s June 17 letter to Boyd Haley, a retired Kentucky chemist and hero to the autism recovery movement, details five violations of the Federal Food, Drug and Cosmetic Act related to his product, OSR#1. Failing to correct such violations can result in fines, seizure of products and even criminal prosecution.

The Tribune in January reported that the compound, sold as OSR#1, had been developed to treat mining wastewater, and that it had not undergone rigorous testing to ensure it is safe and effective. The report was part of an investigation into unproven autism therapies offered by health providers who say they can reverse the disorder.

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OSR1Read the full article at the Chicago Tribune — FDA warns maker of product used as alternative autism treatment

Wastewater treatment turned unproven autism therapy? Wow. Just wow.

When the Tribune first broke the story about this industrial chemical (sold as OSR#1) being fed to autistic children, the maker of this “supplement” stated that it was tested on 10 people before being sold to the public, yet provided no proof of even that much. You can find that earlier report here.

Betamethasone Dipropionate Prescribed for Treating Hair Loss? – Hair Loss Information – Balding Blog

Hello Doc, I am an underweight person (25 years,55kg ,height 176cm)of South Asian origin and i don’t have a family history of hairloss. All my siblings have great hair but I have been loosing hair since last two years.I tried Fin but it gave me the side effect even with the lower doses(o.5mg).I started using minoxidil(5%) a month ago but the loss hasn’t reduced a bit. My dermatologist has advised me to use betamethasone dipropionate (0.05%) on effected area. What’s your take on it? Should i use betamethasone dipropionate lotion or not coz after few applications it appears that the loss rate has gone up instead of decreasing.

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DiprosoneI can’t give you specific advice about what medication is right for you for multiple reasons, but the main one being that I do not even know what you have. What is your diagnosis for the hair loss? Do you have male pattern baldness (MPB), or do you have an autoimmune problem?

Propecia (finasteride) and Rogaine (minoxidil) are the only proven drug treatments for MPB. They are not perfect and by no means a complete cure, but they do work if given time. I don’t know how long you were taking finasteride, but you’ve only used minoxidil for a month and that’s simply not enough time to see any benefit.

Corticosteroids like betamethasone (marketed as Diprolene or Diprosone) are used to treat psoriasis and other skin irritations, but have never been proven to help with MPB. In fact, it might make your hair loss worse. I’ve written about betamethasone before here.

If you need a second opinion, I would make an appointment with a doctor who can explain these things to you in detail.

Is Accutane Hair Loss Permanent? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

Thank you for maintaining this site, it is by far the most informative hair-loss site on the net I have come across.

When I was 22 I noticed that my hair line was starting to recede and I had a little bit of thinning in the crown. When I was 24 I went to see a doctor and was prescribed Propecia. At that point my hair loss was still in the early stages and was probably only noticeable to me. In January 10′, after about a year and a half on the drug… I felt like my hair-loss had stabilized, was thicker than my hair had been in a long time, and I was genuinely happy with the results.

This brings me to my problem. Along with suffering from hair-loss, I have also been fighting acne for over 10 years. In February I finally decided to take accutane to hopefully put an end to it for good. I am currently in month 4 and my acne has cleared and is continuing to get better. Unfortunately I feel my hair is in the worst condition it has been in years. The hair is overall brittle and thin. The hairline has receded in the past few months, and the crown has thinned considerably.

My question is this: If I was to assume that the accutane is what is having a negative affect on the hair…once the drug is stopped, will my hair improve? I have heard that loss while on accutane is temporary but in some cases accutane speeds up MPB. Have I done myself a huge disservice by taking accutane after having been on Propecia?

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Accutane (isotretinoin) does work well for treating acne, but unfortunately one of its many side effects is hair loss. I suspect hair loss from Accutane is temporary, but it may accelerate the male pattern balding process. Only time will tell. I really do not have much experience with patients taking Accutane (nor do I prescribe it), so you should talk with your doctor as he/she may be a little more versed.

Weren’t you given all the warnings and waivers before a doctor prescribed you Accutane? I mean, have you read all the other side effects of Accutane? I know this isn’t doing much to boost your morale, but my point was to illustrate to all readers that things should be put into perspective and take medications with an informed decision. Always weigh the benefits with the risks of any drug you take.

Digoxin and Hair Loss? – Hair Loss Information – Balding Blog

I have been taking digoxin for a short while and have noticed clumps of my hair in the bath drain plug, on my pillows and basically everywhere. I am extremely worried about this and would like to know if this is reversable? kind regards.

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LanoxinDigoxin (also known by its brand name, Lanoxin) is a heart medication that shouldn’t cause hair loss as a side effect, but if adding this medication to your routine was the only thing that has changed prior to clumps of hair coming out, there might be something to it. That being said, I would discuss your hair loss issues with your prescribing doctor and explore the possibility of other undiagnosed conditions.

I couldn’t say if the loss is reversible without knowing why you’re losing hair. For men in general, hair loss occurs in specific “male patterns” and this is due to genetic balding.

Propecia is Causing All of My Hair to Fall Out! – Balding Blog

7 months and 6 days and im seriously thinking of giving up on propecia. I am quite vein and when I seen my hairline had receded a tiny bit I decided to go onto propecia, I really wish I hadn’t, every day since month 3, my hair falls out, loads in the shower, loads on my pillow case and loads as I pull on my hair very slightly, propecia has without a doubt made it worse, I have just decided to take 0.5 instead of the 1mg i was taking to see what happens, if I continue shedding then Im getting off. I am 100$ convinced this made me worse, I have read its impossible and ive even been told by my doctor it doesn’t make it worse, but it has. I am jeopardising any chance I could have of a hair transplant, because the hairs that are falling out are all over, back and sides as well as the top, and for a transplant they take hair from the back and sides which are falling out rapidly. Why is this happening and what should I do? It’s so frustrating

There is no way for me to understand what is happening to you without an examination. What you are describing makes no sense unless your Propecia is counterfeit (a not uncommon problem). Sure, sometimes the medication might not show much benefits, but to make the hair fall out all over, including the donor area… that particularly makes no sense.

Basically, you need a good doctor to tell you what is happening and this can not occur over the internet.




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Hair Loss InformationSkin Atrophy from Oral Spironolactone? – Hair Loss Information – Balding Blog

I am a 33 year old woman with a diagnosis of AGA. I have found out that skin atrophy is a very rare side effect of oral spironolactone, one which I am experiencing on my facial skin. This is frustrating as spiro is definately working for me. Do you think topical spiro would have the same effect? Also, it seems Cyproterone Acetate can have the same effect so that isn’t an option for me. What do you think of trying Bicalutamide, as it is a non-steroidal antiandrogen? Many thanks.

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I wish I could offer some real help, but I don’t know much about the side effect risks of spironolactone beyond what I have read, as I do not prescribe it (or the other medications you mentioned). Spironolactone is a prescription medication, and as such if you’re seeing skin irritation you should immediately notify your prescribing doctor about this.

Cyproterone acetate lists hair loss as a rare side effect (as possible with many medications), but bicalutamide has hair loss listed as a common side effect, so I don’t know why you’d take that as a hair loss treatment.

Hair Loss InformationDilantin and Male Hair Loss – Hair Loss Information – Balding Blog

Dear Dr. Rassman, My question is about dilantin. I know that it is often cited as a possible cause of hair loss in women. Can it cause hair loss in men and if it does does it manifest itself as slow diffuse thinning all over.

thanks for your time.

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DilantinIf the hair loss is from a medication (rare), it can happen in both men and women. In rare cases, Dilantin (phenytoin) is even known to cause body hair growth.

Slow diffuse thinning all over does not sound like male pattern baldness, but slow diffuse thinning can be from many other causes as well (and not only from medication). What I am saying is, you need a good medical diagnosis. At this point, it seems you are trying to establish a cause and effect relationship that may or may not be related. For those patients on Dilantin, it may be impossible to stop or switch the medication, but this is a decision for the patient and his/her prescribing doctor.

Hair Loss from SSRIs – Hair Loss Information – Balding Blog

Hi, I would like to request clarification on something. I saw a post where you mentioned Sertraline causes hair loss as well as Zoloft. I also saw on some posts where SSRI’s are said to cause hair loss. The questions is how common is this? I have seen different sources use different percentages to represent how rare or often this can occur. I ask this because online it appears as a significant amount of people have voiced their concerns about Sertraline or Zoloft possibly contributing to their hair loss. However, there have to be many people who simply will never come to these forums because they are not affected. Also, how long does the hair loss take? Some posts mentioned period from 2-8 days, while some people blame the meds after they have used them for 4-6 years.

I have been told by several physicians that hair loss with SSRI’s is simply an alergic reaction which is rare. Do you agree with that? Thank you for your help.

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PillsHair loss from SSRI (selective serotonin reuptake inhibitor) drugs are relatively uncommon, but they can occur. First and foremost you need to find out if there is a pattern to your hair loss. Is the hair loss everywhere or just confined to the front/top (in a pattern)? If the hair loss is happening in a pattern like those shown here, then it is most likely not from the drug. Hair loss from drugs will often impact the donor area, which is what we generally refer to as “permanent” hair not susceptible to genetic factors.

Most doctors (and even the doctors that treat hair loss, such as myself) do not know the exact mechanism of why some people lose hair from certain medications. We must believe the patient when they say that they are noticing some correlation with the timing of starting these medications and the hair thinning, but these things are often very difficult to narrow down. It is just not that simple, as the patient may also have underlying genetic hair loss as well. Remember that more than 50% of the population have some form of genetic balding which has nothing to do with SSRIs or other medications! I do not think hair loss from SSRIs (or other medication in general) is an allergic reaction, but more of a rare side effect. If hair loss is caused by a medication, I do not think it would happen in the time frame of a few days, but more likely several weeks to months.

Finally keep in mind of the big picture, rather than focusing only on hair. You are taking a certain medication for a reason, such as the SSRI to treat depression. What you are experiencing with respect to hair loss may or may not be related, but the reason of WHY you are taking the SSRI or other medication is real and the pros and cons (risks/benefits) need to be discussed with your physician before taking any action.

Have You Seen a Case Where Propecia Makes Hair Loss Worse? – Balding Blog

Dear Dr –
I know there’s quite a lot of anecdotal, somewhat brutal indictment of finasteride on the web, some perhaps more grounded in reality than others. And of course, part of this revolves around frontal hair loss and so-called hyperandrogenicity, blah blah. You’ve given quite a lot of first-hand, practical and scientifically-based advice to folks who may be scared off by these reports.

My question for you is the following: Have you yourself witnessed in your thousands of patients any number of these patients taking finasteride see their hair loss situation get substantially WORSE (particularly in the frontal regions) given, say, a year of regular finasteride treatment? And, if so, is there any case in your patient-load where you might speculate that the finasteride treatment itself accelerated the situation?

I have seen hair loss progression even while a patient was on Propecia, but I do not believe that taking the medication caused the loss I saw or accelerated it. I can’t think of any case where I’ve speculated that the reason for the hair loss was the medication prescribed to treat it.




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