I’m a Very Early Norwood 1 – Hair Loss Information – Balding Blog

First off, I just want to say that I love your blog and I thank you for your willingness to offer advice to the general public. I’m a 24 year old male who recently stopped taking Propecia after 1 month because well, basically I began to experience sexual side effects and let’s just say I’m not man enough to risk losing my manliness for good. You’re well aware of the information available on the internet, so I won’t go too much into detail. There have been in-depth studies in other countries and I trust their scientists know what they’re doing.

I guess what I wanted to know is what my other options are. Right now it looks like the next best option would be Rogaine, but coupled with diet and exercise and overall good health, is there any thing else that I can do to prevent further hair loss? I’m a very early NW1, so my main goal is to maintain my hair.

Thank you

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NW1I’d wonder why your doctor would prescribe Propecia to someone with a “very early” Norwood Class 1, which isn’t even considered balding. That causes me to think that you weren’t prescribed the medication to begin with. I won’t lecture, but I sincerely hope this isn’t the case. If you had these side effects, perhaps you should’ve gone back to the prescribing doctor and gone over your options (lower dosage, etc). Or maybe you went to an inept physician. Regardless, don’t start trying to treat something that isn’t there.

Get your hair and scalp mapped out for miniaturization and find out if you have any real balding going on. Everything else follows a proper diagnosis, which you most certainly need. As for treatment options, you’re correct in that the next best would be Rogaine (minoxidil)… but again, I do not recommend that you start using hair loss medications preventatively.

As for your claims that “there have been in-depth studies in other countries and I trust their scientists know what they’re doing” — how in-depth are we talking here, and does that mean you don’t trust studies performed in the US? If you’re referring to the Swedish Medical Products Agency study from 2008, I wrote about that already.

Increased Semen Volume from Propecia? – Balding Blog

Hi Doc. Rassman. Thank you for this blog! The best!

I’ve been taking propecia for 10 months. Ok results. But I was wondering. Have you ever heard about people who have seen an increase in the amount of semen when ejaculating? In the last 3 months I’ve seen an massive increase in the amount of semen.

Best regards

SemenNope, I have not had any reports from patients that the amount of semen increased with the drug Propecia.

There is a known side effect of decreased ejaculate volume from finasteride, though I believe that was only found in less than 1% of users.




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Does Minoxidil Have Sexual Side Effects? – Hair Loss Information by Dr. William Rassman

Hi Doctor

Can topical Minoxidil affect the sex desire, impotence or the erections ability of someone? Are there any facts, or have you heard something about that?

Thank you in advance.

Nope, sexual side effects are not from minoxidil. Chest pain, rash, increased heart rate… those are related to minoxidil. A full list of side effects can be found here.

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I Started 3 Hair Loss Treatments At the Same Time – Balding Blog

Dear Dr Rassman,

I have been reading your posts for sometime. Thank you for your informative answers to many questions that I myself have had in the past but have never asked.

I am a 38 year old male who noticed diffuse thinning approximately 2 years ago. This was accompanied by a greasy scalp and some itching as well, particularly in the evening when the greasiness was at it’s worse. I had NEVER had a greasy scalp prior to this. My wife cuts my hair so she noticed my hair was definitely thinning for the past 2 years. I started propecia 8 months ago, nizoral 1% daily as well as polysorbate 80+tsal(3% salicylic acid shampoo) daily. I started to notice results after approximately 4 or 5 months. My wife has noticed that my hair has definitely thickened up and is no longer showing the “see through” that it used to in the past. She estimates that my hair has improved by 50% in terms of thickness and texture.

My question is…is it only the propecia which is causing this stabilization/regrowth or is the nizoral+polysorbate having some effect. I have DEFINITELY noticed that after approximately a month of using the 2 shampoos, my hair was no longer greasy as it used to be. I have read articles on the internet on polysorbate 80 and was wondering what the general consensus is on the material. Thanks!

Crystal ballI am not a fortune teller. You started 3 separate hair treatments and now you are stuck not knowing if one, two, or even all three were the reason you saw improvement. Still another possibility is that none of the treatments worked and it was just a matter of being patient while the hair regrew, because maybe you didn’t have genetic male pattern baldness to begin with. Maybe you had telogen effluvium and it was self-limiting and the hairs grew back on their own (as it typically takes 6 to 12 months).

In other words, I really do not know… and this is why I generally recommend only using one treatment at a time, or you’ll end up “addicted” to all of them, too worried that if you stop one you’ll lose the benefits. This is also the reason why I tell readers to start with a good diagnosis. See a doctor before starting medications. Scientifically document before and after with a miniaturization study. I suppose if you are brave, stop one of the three and see what happens.

As for polysorbate 80, I’ve commented on that before here.




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If I Stick With Finasteride, Will the Side Effects Eventually Go Away? – Hair Loss Information by Dr. William Rassman

Hi Doctor. I have been on a generic finasteride that I bought from Mexico (manufactured by SBL Pharmaceuticals) for about three weeks now. I think I’m suffering from sexual side effects. But I’m not sure if it’s due to psychological stress or finasteride. My question is can I beat the side effects of the pill if I stick with the daily regimen? My biggest problem is getting and maintaining an erection (I have also lost morning wood). Thanks for your reply.

I am not familiar with finasteride from Mexico (sounds like the same stuff I wrote about recently), but I will assume it is the same as Propecia (finasteride 1mg).

The side effect you are experiencing occurs in 1 to 2% of men who take finasteride, and are reversible once you stop taking it. The side effects could also go away if you continue taking it over a period of weeks or months, but you won’t know until you try.

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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.

The Finasteride FDA Probe Has Triggered Intense Anxiety! – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

The latest news regarding the FDA and Propecia has triggered some intense anxiety in me. I have been using Propecia for 5 years, and have always had a little concern in the back of my mind. The fact is, its still a relatively new chemical.

In response to a question regarding the FDA looking into potential dangers of Propecia, you replied “In my opinion, Avodart and Propecia are both safe medications when used as directed…under the supervision of a physician.” You also quoted from the Merck spokesperson who referenced that there was already mention of male breat cancer in the propecia literature.

1. Shouldn’t we take this news as a warning flag that perhaps there is more to long-term use of Propecia than we might have originally thought?
2. You probably have had a number of patients taking Propecia for close to 10 years, or longer. In fact, you probably have a pretty decent sample size of patients using this drug. What have you seen in patients with regards to side-effects over the years?
3. You frequently answer questions about the hair-loss catch-up phase if someone stops taking Propecia. I am curious as to why someone would stop taking Propecia if they have been on it for several years or more?

I am sorry you have so much anxiety with the news, but at this point it is just an investigation. There is no link that Propecia causes breast cancer so don’t jump on the hysteria bandwagon. I would strongly recommend that you speak with your prescribing doctor about your concerns. Make educated and well informed choices, weighing out risks and benefits.

In my private practice of 10+ years of treating patients with Propecia, I have not seen a patient who presented with breast cancer. We have treated thousands of patients with Propecia/finasteride.

Most of my patients do not stop taking Propecia after several years, and many of them have been taking it for 5-10+ years with no issues. People might stop taking any medication for a variety of reasons, and the questions I post here are usually not from my patients so I’d have no way to know if there were medical reasons, financial reasons, etc. We should wait for any word from the FDA that points to real risks that we are unaware of at this time.

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Why Is My Hair Changing from Blond to Black? – Hair Loss Information by Dr. William Rassman

Drs –
I have been on finasteride for about 3 months for mostly frontal thinning and receding. One thing I’ve noticed on close inspection of my fine, darkish blond hair (and this could pre-date my finasteride treatment, of course) is the presence of a few coarse, jet black strands coming in and even the color of existing strands darkening remarkably towards the root. Is there an explanation for hair color anomalies? Could this be related to finasteride treatment? Is this a sign of something sinister going on hormonally or otherwise? And lastly, could this be viewed as a positive development in my treatment?

There is an excellent review of the genetics of hair color here. There is mention in this writing that some people will go dark after having light colored hair in younger days. Maybe the pigment for black hair gets turned on genetically in rare older people. Or perhaps these random hairs have occurred from time to time, but you’re only noticing them now because you’re more focused on your hair looking for finasteride benefits. I’ve not heard of finasteride causing black hairs to grow or turning blond hair into darker hairs.

It seems you’re not alone with these random coarse, black hairs, as I found others asking about the same thing (see here). Unfortunately, I don’t have an answer.

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I’m a Woman and Was Prescribed 5mg Finasteride Daily – Hair Loss Information by Dr. William Rassman

I am a female, aged 68 years. My doctor just put me on finasteride 5mg daily. Is it now safe for women? And is the dosage too high? If I cut the pill into fourths, would that still be too much?

I would ask this question and your concerns with your doctor. If you need a second opinion, you need then see another doctor.

Please understand this from a medical perspective and I’m not just trying to brush you off. You provided your gender and your age, but I cannot advise you with just that information. For example, is there a breast, ovarian, or cervical cancer history in your family or have you had one of these cancers in the past? There are many variables, so that is the role your doctor plays in these decisions.

Finasteride is not FDA approved for treating female hair loss (I assume that is why you were prescribed it), which means that your doctor prescribed it to you off-label and you need to ask him/her about this. For men, 1mg is recommended for treating hair loss and 5mg is for treating the prostate… so it is unusual for a doctor to prescribe 5mg finasteride for treating female hair loss.

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Propecia and Avodart on the FDA Safety Probe List – Hair Loss Information – Balding Blog

Dear Dr Rassman,

First off let me say what a very informative website you have, it’s allayed a lot fears I have had about Propecia which my Doctor in the UK is unable to answer. I’m a Propecia user and have came across this article when browsing Reuters.

Link: FDA probes risks of HIV, prostate, other drugs

My questions are: Has Propecia ever been on the FDA’s List of Safety Probes before? What’s your view on Propecia being put on the list?

Must admit I’m surprised, I’d read a few things on the web but dismissed them as they weren’t certified medical opinion. I look forward to your reply.

Best Regards

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FDAThis is the first FDA safety probe relating to either Propecia (finasteride) or Avodart (dutasteride) that I’m aware of, and it is looking into a link between male breast cancer and 5-alpha reductase inhibitors. Any FDA probe certainly is in the best interest of the public, but as the article points out, “Merck spokeswoman Pam Eisele said the prescribing instructions for Proscar and Propecia already mention cases of male breast cancer seen in clinical trials.” No relationship has been established though, so we’ll have to wait to see what is discovered in the FDA’s investigation.

In my opinion, Avodart and Propecia are both safe medications when used as directed (for their intended purpose) under the supervision of a physician. Avodart is a similar type of medication to Propecia, but it has a much longer half life, which is the time it takes for half of the drug to be cleared by your body. Avodart’s half life is in the order of months, whereas Propecia’s half life is in the order of hours. In other words, if you have side effects from Avodart, it’ll take a while to get rid of them. Plus, Avodart is not at this time FDA approved for the treatment of hair loss.