Category: Drugs

Dear Dr. Rassman,

I understand the debate regarding the appropriate dosage of finasteride to be taken seems to have no end. I am currently taking 2.5mg (half proscar since 3 years ago where Propecia stopped working as well), so far so good. I would not say propecia stopped responding, but more of my genetics are catching up. Anyway, by upping to 2.5mg , hairloss has stopped drastically but still very gradually.

My conclusion is that, any amount of finasteride is better than none when it comes to fighting hair loss. And according to scientific results, 1mg vs 5mg has similar effects on hair loss prevention. Therefore 2.5mg should be a safe and worth-trying dosage provided no major side-effects are present. Hence, I think its ok to recommend to people who has stopped responding well to propecia to try 2.5mg (half proscar), even though there is no guarantee that it might work better – ultimately, any finasteride is better than none?

Thank you for your thoughts. In general, more does not necessarily mean better and the recommended dose of finasteride for the treatment of male pattern balding is 1mg a day. As always, please discuss your treatment options with your prescribing physician.

Hi Dr. Rassman,

I first noticed a thinning of my frontal hair around April of last year. I am 26 years old Asian male. Hair growth slowed down and the front half of my scalp started to feel thinner than the rear.

In January this year, my dermatologist confirmed presence of early MBP and prescribed me finasteride (Proscar quartered daily). At that time I also started to use Minoxidil 5% nightly. It is now mid-June and I feel like I am still thinning rapidly. The frontal thinning is becoming visible now and I feel all the hairs on the top of my head have gotten much softer than the sides and back, which I suspect is because of miniaturization and the hairs growing thinner.

Its been almost six months. Shouldn’t finasteride have made a dramatic difference by now? Is there no hope? At this rate, I will be bald before I’m 30 and it’s a very, very, very saddening and scary prospect.

How long does finasteride take to show its effects visibly in the hair? I would be happy just to see this hair thinning halt and stabilize.

Here’s a graphic I grabbed directly from Propecia.com that might help —

 

So really, the value of finasteride takes at least a year to see, and I’d say the full benefits may take 2 years to see. Some people might see less hair loss around the 6 month mark, but hair grows out at 1/2 inch per month… so after 6 months the hair that is 3 inches long will have just started to be exposed to the drug when it was formed.

Please understand these facts:

1. There is no cure for genetic male pattern hair loss. Medications such as Propecia (finasteride) and Rogaine (minoxidil) help, but neither will stop hair loss completely or forever. For some men the medications can dramatically slow the progress, but eventually your genetic predispositions will win out.
2. The front hairline is very difficult to treat with medication alone, as Propecia and Rogaine are not officially recommended for that area since it really doesn’t seem to help in clinical studies. Many patients still use these medications in hopes they’ll help that area a bit, and in some patients it may actually help to some degree.

Hi Dr. Rassman,

Dr. Jerry Cooley in North Carolina has said that taking Propecia three times a week is a practical dosage, and that most of his patients are on that dosage with good results. I’ve read a lot of your responses about reducing Propecia dosage and you are very adamant about the 1 mg/1 pill a day dosage and not any less.

I don’t want to put you in a tough position but in all fairness, it seems quite reasonable to think that Dr. Cooley is making a valid point. Why not jump on the wagon and start advocating the same thing? The more and more I think about it, the more and more it seems like Merck has got you secretly locked in to a deal with them. Frankly, Dr Cooley has made a believer out of me. Even my doctor in Korea has me on Propecia four times a week and he told me that three times a week is also good. I have some minor side effects, not of the sexual nature but for me it’s the dark circles. I’m curious to see if going on 3mg a week EOD will help get rid of my problem. And if so, would you care to know about it?

Here is the link to what I read: Regrowhair.com

Thank you kindly

Dear conspiracy theorists all over the internet:

I advise and treat my patients based on standard medical practices and recommendations. I have no loyalties to Merck, other drug companies, or bandwagons. In fact, Merck probably does not like me so much, because I have no problem telling patients and readers of this site about the generic finasteride that ends up costing about $70 a year, instead of $90 a month for the name brand.

Our goal here on BaldingBlog, as well as in our private practice, is to empower patients with education. If you search enough through this site, you can see that we have been pretty consistent with this over the years.

Last time I checked, the standard recommended dose of finasteride for treating androgenic alopecia is 1mg a day. I realize some doctors prescribe different doses to their patients and rightfully so (because they have a medical license to treat their patients). I also realize there have been studies that support taking less than 1mg finasteride a day. In fact, some of my patients do take less than 1mg of finasteride a day… and *gasp* some of my patients take more than 1mg of finasteride a day. Each patient is unique and with different circumstances.

In general for most of my patients, I prescribe 1mg finasteride a day because as I said, that is the general recommended dose for androgenic alopecia supported by research.

Anyone interested in treating their hair loss needs to see their doctor, discuss treatment options and dosing of medications, and go by what their doctor recommends. I am only here on this site to give general information, not medical advice. You have every right to agree or disagree with my views, but this is my site and these are my views.

Doc..I am a pharmacist..37 y/o male..I was started on propecia approx 2 weeks ago and noticed that I have become moody and irritable. do your patients complain of similar sx? is this common? does it resolve or should i consider stopping? thanks

You are a pharmacist, so your post-graduate training has been the study of drugs. You do not need me to tell you about side effects and how Propecia works. In fact, you are one of the rare few that can read the entire drug profile insert that came with the medication and actually understand it!

If you are asking me if I have personally seen anyone with your complaints at my private practice, I would say yes, on rare occasions people have discussed personality changes with me and mood swings. This is not a common complaint, and I don’t have information about whether it goes away or not. If you do enough research on the Internet to see if people have complained about your possible symptoms, I am sure you will find it.

I have come across a Neuroendocrine Physician, Dr. Alan Jacobs, and he wrote an interesting blog post on his site that you may wish to read.

Doc,

It’s hot and humid outside! what’s the best way to store your generic finasteride in these hot months? I keep it in a drawer away from light and try to keep my non AC room as cool as possible. Thanks a lot!

I would say store it in the bottle it comes in, and only cut one 5mg pill at a time. The situation you describe sounds reasonable for many people. It sounds like you’re doing the right thing in terms of medication storage. I doubt there would be any problem with the finasteride effectiveness if it is kept in a drawer with limited light and kept as cool in the room as possible.

Here’s some more tips on storing medication.