Drugs – Page 101 – Balding Blog

July 6, 2010

My Cut Proscar Is Stored Improperly – Hair Loss Information by Dr. William Rassman

Hello Doctor,
I am a 30 year old male who has been taking propecia and/proscar (2 months propecia and 10 months 1/4 proscar) for a year. My partner who is a physician first noticed my hairloss when I was sitting down about a year ago. It is only in the Crown, so I was a bit shocked because I could never see it. I went on the medication and within a few months my partner noticed an improvement (looking back at pictures, I had been thinning in the crown for at least five years before). I also tend to blow dry the spot as it fills the hair out more and is barely noticeable.

Questions
1. At about 11 month mark, I noticed about 5-7 hairs on my pillow in the morning of mainly longer length (about two inches). I’ve also noticed that when I shampoo my hair in the shower on the top back, I have about 5-10 hairs come out. They are longer but not super thick – I don’t have really thick hair anyway. Does this fall under the definition of “shedding”?

2. If so, is it a sign my genetics are overtaking the medication?

3. I’ve been under a lot of personal stress over the past few months as well, the weather has gotten considerably warmer and I haven’t been storing the cut proscar properly (just realized this) – I’ve been cutting like 6 pills and leaving them cut in the pill cutter in the cupboard (no pregnant women or children nearby), could this be impacting the effectiveness?

Thanks

Stress does accelerate hair loss, and improperly storing your cut Proscar pills could limit the drug’s effectiveness. You need to have a good relationship with a doctor you can trust to answer your questions. Hair loss does, at times, accelerate. The drugs do not always work to stop the loss and that is why you need a good doctor who can perform a miniaturization study, get a baseline on the loss process with a measurement he/she can compare as finding like yours appear without explanation.

If you’re seeing a few hairs here and there, that may reflect normal hair cycling, not frank hair loss.

Paid advertisements (not an endorsement):

July 6, 2010

Understanding Shock Loss – Balding Blog

Hi,

I had been on propecia for 5 months and after suffering from a lack of erection I talked to my doctor and told him of my fear of being on this regime. We decided best that I shall have a hair transplant once it gets really bad.

I would like to know – if after hair transplant the patient MUST take propecia ? What will happen if the person does not take that pill. Will it cause the transplant operation to fail ? Could you shed more light on taking Finasteride after a hair transplant o/p ?

Thanks

Taking Propecia either before or after a hair transplant means simply that the hair loss will slow and possibly stop. If you do not take it, then whatever is normal hair loss for you will happen on your genetic clock. Shock loss seen in young men who had a hair transplant and are not on finasteride, just means that the hair loss process accelerates from what it might have been without the drug.

Propecia isn’t a requirement following a hair transplant, but you’re running the risk of the transplant causing accelerated hair loss around the transplant area, basically leaving you with a similar thinning problem following the surgery. Talk to your doctor about possibly cutting the dose if you’re considering a transplant.

Paid advertisements (not an endorsement):

July 2, 2010

Hair Loss InformationFemale Hair Loss After Using Contraceptive, So My Doctor Put Me on Propecia – Hair Loss Information – Balding Blog

Hello,

I have some questions. I am a 36 year old female who has had hair shedding since my 20’s (my dad lost his hair at 21). I have all the signs of androgenic alopecia. However, I use to have alot of hair so it didn’t cause me much concern until the last few years. At the age of 30, I lived overseas and took the Birth Control Pill, Diane 35 which was wonderful for hair, but when I moved back to the US I stopped it since it was not available here. 3 weeks after I stopped, I noticed a large amount of increased shedding that went on for months until my thinning was very noticeable. I tried 2 % Rogaine and saw even MORE excessive shedding. I lost a huge amount of hair and it was very noticeable and devastating. Finally, I was able to stabilize my hairloss with 100 mg of spironlactone and have been on it for a year. I started also using 5% rogaine after stabilization and I also saw an improvement. I was basically content.

Well 3 months ago, I took Plan B the backup emergency contraceptive. 3 weeks later, I started noticing a large increase in shedding again. This time I was on 100 mg of Spirolactone and it didn’t stop it (I even saw myself develop acne.) I tried 5% Rogaine to only see my hair fall out even for excessively like before. My doctor has now put me on Propecia. I am worried about this “hyperandrogenicity”. I do not have much hair left and I hope the propecia does not make it worse since I am obviously going through some type of “withdrawal” from the hormones in the birth control. However, nothing seems to stop this withdrawal anymore. I’m very worried and sad. Any feedback would be very helpful.

Thank You

Block Quote

Your treatment plan doesn’t make complete sense to me. I don’t follow why you are taking all these medications and doing what you are doing.

Lets start with the facts:

Hair loss from Plan B (progestin) is a less common, but known side effect (see here).

Rogaine can cause initial shedding which scares people into stopping the medication. If you continue on with Rogaine the shedding will eventually stop and hair will grow. 2% Rogaine is same as 5% Rogaine — the only difference is the concentration. So I don’t understand why you would say you lost so much hair on 2% Rogaine then started 5% Rogaine to have the hair loss stabilize. Then later start the 5% Rogaine and have more hair loss. Maybe you are not using the medication correctly. Once you start the medication, you need to use it for life. If you stop it, the hairs that grew or the hair that were stabilized will fall out. And if you restart it, you risk the initial shedding (the way you saw with the 2% Rogaine a long time ago) all over again. Could the Rogaine be working for you, but you aren’t using it consistently?

Spironolactone is a blood pressure medication that has an effect on blocking androgens, but it has never been proven to grow hair or slow down hair loss unless you had an excess of androgens like women with polycystic ovarian disease (PCOS). I realize many patients use it and doctors prescribe spironolactone, but I would need more information on your hormone analysis. If you are using Rogaine and spironolactone, how do you know which is working or not?

Finally, Propecia only works for androgenic alopecia (more specifically, hair loss related to DHT hormone). I do not know if you are one of the very rare women who have male pattern baldness, and even if you do, I do not know that Propecia would work for you. Regardless, Propecia is NOT recommended for women because it can cause birth defects if you are or may become pregnant. I see you are of child bearing age, and you are obviously sexually active (as you had to take the Plan B “morning after pill”). I personally would never recommend Propecia to young women who can get pregnant. If you must take it, you need to be on a birth control pill, but this is something you and your doctor need to talk about.

Unless you have strong male features, I would think that hyperandrogenicity would not be something you should worry about. My point being that hair loss is not the only symptom of hyperandrogenicity. But that’s just my guess.

You have a complex problem and even the cursory discussion I gave here will not really help you. You need to have a doctor who is focused on hair loss and if your doctor has such an interest, then you need to know why he is doing what you described here. Sometimes, hair loss is self limiting and whatever you are doing or NOT doing may or may not stop the hair loss.

My final thought is you should see your doctor for a good diagnosis and a comprehensive treatment plan.

July 1, 2010

Do I Use the Rogaine Dosage All Over My Scalp or Concentrate on the Crown? – Hair Loss Information – Balding Blog

I have a question regarding rogaine. I have thinning in the crown and front of the head too. I have read that rogaine can be beneficial for retarding additional hair loss anywhere there is hair. Thus, I split the 1 ml dose throughout my scalp rather than just concentrating it on the crown.

Would this stop the effectiveness of rogaine? I suppose I am not supposed to use more than one ml.

Block Quote

Rogaine I would use the dose listed in the directions that came with the product that you purchased. You can put Rogaine on your crown and front area of your scalp, but it should only be placed in the areas where you want the benefits and not put in areas where the hair is good. As you know, it has not been shown to be as effective in the frontal areas.

I suspect you can use more than 1 ml, but there is a small risk of your body absorbing too much and you experiencing systemic side effects (such as headache, fainting, etc). I would think this risk is low, but it is something to think about.

If you are concerned you should ask these questions to your doctor and get a good medical physical examination to make sure you will have no issues. I am not your doctor and this is not a place to get personalized medication use advice, simply because I do not know your medical history.

July 1, 2010

Accuracy of MPB Predisposition Testing? – Hair Loss Information – Balding Blog

Hi Dr, I’m a regular reader of your blog and have honestly found it both reassuring and informative in equal measure, so thanks for the great work.

My question is regarding the new test for determining a patients predisposition to MPB. I know it has been made available by a very reputable British Dr, but it seemed to me that if such a test were accurate and completely reliable it would be absolutely industry standard? Have you any insights on it and it’s reliability?

also as a ps, I wonder if you have any safety pointers to look out for when purchasing generic propecia online?

many thanks again

Block Quote

All tests have flaws with a margin of error. There is no completely perfect, 100% accurate test. The genetic balding test like HairDX gives you a probability score, not a blanket YES or NO answer. It is not an industry standard, because any good physician can diagnose MPB without a blood test.

I don’t have hands-on experience with generic Propecia, as it isn’t legal in the US yet due to patent laws… so what I know about the generic brands has been limited to just learning all the names. As for safety pointers, well, the biggest pointer would be to not order medication from an online pharmacy that you don’t have previous experience with. I am not an advocate of ordering medication online anyway, as many of those pharmacies ignore the law and don’t require a prescription when necessary.

June 29, 2010

Hair Loss InformationNurse Told Me to Stop Propecia for 8 Days After Chest Discomfort – Hair Loss Information – Balding Blog

Hi, I have been taking Propecia 1mg for a little over 4 months now. About 3 months in, I thought I noticed some slight discomfort in my chest (although it may have just been in my head). Now, a month later, it seems much more evident that I am experiencing breast discomfort/tenderness. It is not constant, although I do feel it many different times throughout the day. I am worried that this will lead to breast enlargement. Are breast tenderness and breast enlargement related? Or are the completely independent of each other?

I am 22 years old and have had puffy nipples (I don’t think it is actual gyno) since I was about 16. I don’t want this to get any worse. I spoke to the nurse at my dermatologist’s office and she told me that even though the discomfort could be something completely unrelated to the Propecia, that I should stop taking it for 8 days (until I go in for my appointment). Will these 8 days off Propecia undo the progress that I’ve made or is it safe to go without it for a week? Thanks a lot for all the help!

Block Quote

Chest discomfort You’ve had puffy nipples long before taking Propecia, but if you are experiencing discomfort and tenderness in your chest after taking Propecia, I would highly advise you to discuss these symptoms with your doctor. In our experience, Propecia rarely impacts men’s breasts, but the appearance of new symptoms while on the drug such as gynecomastia or painful breasts/nipples should be addressed in a thorough examination.

The symptoms you report are a valid and known side effect that occur in less than 1% of men, but they are reversible after stopping the medication. It just might be that you are not be a candidate for Propecia with these side effects.

Breast enlargement and tenderness could be related. Stopping Propecia for 8 days should have no major impact on your treatment course, and is probably the safest way to go about this until you can meet with your doctor for the exam.

June 29, 2010

Hair Loss InformationUsing Minoxidil Once Every Other Day – Hair Loss Information – Balding Blog

Hi,
I am a 24 year old male and have begun the early stages of MPB. My doctor has prescribed Minoxidil 5% and I know your suppose to apply it twice a day but that doesn’t really fit into my schedule, so I have only been applying it about once every other day. My question is, is there any harm that can be done applying 5% Minoxidil once every other day or is it simpy not as effective as using it twice everyday? Thanks.

Block Quote

Rogaine You shouldn’t need a prescription for minoxidil 5% topical for use in treating hair loss, as it is available over the counter (at least in the U.S., though I can’t say for sure in other countries).

The recommended dose as you know is applying it twice a day. There is no harm is using it once every other day, but you will not be using it the way it is recommended and you may not get any benefit from infrequent use. I suspect poor compliance and/or not following the recommended directions are the main reasons why patients give up using minoxidil, because they don’t see a benefit.

June 25, 2010

Hair Loss InformationFamily History Shows Men Losing Hair Later, So Why Am I Losing Hair at 19? – Hair Loss Information – Balding Blog

My father start to lose his hair at 45 and my uncle at 35-40, and no grandfather have hairloss problem. I have 21 now and for 2 years i’m fighting to keep my hair with avodart, kirkland and some vitamins named forcapil, but this seems that not work very well for me. Why i begin to lose my hair at 19 if my father start to lose at 45. I can make something else for my hair?

Block Quote

Forcapil Family patterns do not necessarily follow either by the degree of balding or the onset of balding. Sometimes they can be used as a guideline, but it’s not a guarantee. So why did you start losing hair at 19 years old? I guess you can attribute it to bad luck.

You’re young with early hair loss and you’re using multiple treatments. Let’s break down your regimen:

Avodart (dutasteride) — I assume you don’t have a prescription, as I’d expect most doctors would not prescribe this strong prostate medication to a 19 year old with early hair loss. Avodart is not approved to treat hair loss at this time. Although there is evidence it works to treat genetic hair loss, most doctors would not be comfortable prescribing this until at least dosing and safety data is available. If you do have a prescription, you should be talking to your doctor about this.

Minoxidil (I believe this is what you meant by Kirkland) — This is fine, but I don’t know if you’re following the dosing instructions. Apply it twice a day to the area that you’re losing hair. If you’re losing hair in the frontal hairline, it probably won’t be much help there.

Forcapil (vitamin supplement) — Their site describes it as a “special formula combining vitamin B complex, sulfurated amino acids, zinc and vitamin D3“… which means if you’re taking it with hopes of regrowing your hair this is probably a waste of time and money. I hadn’t heard of Forcapil before, but it appears to be made by a French pharmaceutical company and not sold in the US. I found the dosing instructions are to take 6 pills a day for the first 2 weeks, then 2 pills a day for the next 6 weeks… so I hope you enjoy taking pills.

June 25, 2010

Hair Loss InformationAnastrozole and Propecia – Hair Loss Information – Balding Blog

Hi doc! Thank you for your excellent and informative blog! I’ve been hearing things recently about using the very potent aromatase inhibitor anastrozole to prevent the ‘estrogenic’ side effects of finasteride. Anastrozole drastically reduces estrogen levels in men and, unsurprisingly, raises free testosterone as well. Would you be comfortable with one of your patients adding anastrozole (‘Arimidex’) to his propecia regimen, or would you see this is opening up a whole other ‘can of worms’, and potentially serious side effects?

Block Quote

Arimidex (anastrozole) is a anti-breast cancer medication for post menopausal women. There are no clinical trials in men. You would basically be experimenting with your body without any knowledge of the consequences. I would recommend against this. Especially since I’ve seen the complaints/worries people have about side effects from Propecia, you would be just adding fuel to the fire.

According to the Arimidex website, some of the most common side effects seen with the drug include, “hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache”. Also, a less common side effect of Arimidex is hair loss.

June 24, 2010

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.

Block Quote

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: