Category: Drugs

Dear Drs,

I’m concerned about the rebound effect of stopping finasteride.

I was having a look at some website, I should stop searching about hair loss as I’ve become so lost, but one website had a comment which gave me some concerns. This is what they had to say about finasteride. Basically it means that whoever takes it and then stops it, will be in a worse situation than if he never took finasteride in the first place. Is that true? If I take it for a year or few years, then decide to stop, would hair shed as it would have naturally or is there be a rebound effect where I would go balder than if I never used finasteride?

Thanks a lot

The internet is a great resource, but it does not always mean it has accurate information… and as you have found out, it can be very confusing.

What you are describing is “catch-up” hair loss from stopping Propecia. In brief, if you stop taking Propecia after months or years of use, you will lose any benefits you saw and go back to what your hair loss “would have been” if you never took it in the first place. So if you never took the medication and were destined to be a Norwood Class 5, then you’ll see a Class 5 hair loss pattern emerge. This does not mean you will be worse off than if you never took it.

Dear Dr. Rassman,

This is a story, not a question, but I thought you might want to put it on your site because you often talk about the unproven effects of Avodart and why you don’t prescribe it. I had a very bad experience with Avodart and wanted to put it out there where people would be able to read about it.

I took Propecia for 3 years, then switched to Avodart (at my doctor’s suggestion) because I was still experiencing some hair loss (possibly due to stress at the time). I took Avodart for about 6 months, but I developed almost total impotence during that period. I told my doctor that I wanted to go off Avodart entirely, but instead he prescribed Viagra and told me to just switch to a 1/2 dosage as “I would lose a lot of hair if I switched back to Propecia from Avodart.” However, I was still experiencing impotence after 4 months on a 1/2 dose of Avodart, though, so at this time I became so frustrated that I ignored my doctor’s advice, stopped seeing that doctor, and switched to Propecia.

Over the next 8 months I lost a *lot* of hair — substantially more than I’d ever lost before. I don’t know for sure, but I assume that it was because of the increased testosterone flowing in my body in reaction to the Avodart, and the Propecia being unable to counteract it. My sexual function has been restored, though.

Obviously I probably acted rashly and made a mistake ignoring my doctor’s advice about quitting Avodart, but I feel that Avodart put me in an unbearable Catch-22 situation: either endure partial impotence for the rest of my life (or pay for Viagra, which I felt I shouldn’t be taking as a 32-year-old man), or switch off Avodart and lose a lot of hair. I realize that many people take Avodart without any side effects, but it was a really depressing situation to be “one of the 5%.” I’d advise anyone out there who is considering Avodart to think twice and be ready for potentially devastating side effects.

Thank you for sharing your story. Sex vs hair… it’s a tough choice for some men!

Granted, many men that take Avodart (dutasteride) likely won’t see the severe effects like you saw, but until the medication and its risks are fully studied I can do not advocate the use of Avodart in my practice. It’s hard enough the dispel the distrust of Propecia’s side effects, and that is a medication with known side effect risks.

I have used minoxidil7% (2mL/day)and finasteride for 13 months with good results, including a period of shedding 10 months in. Then, suddenly, I felt burning on my scalp so discontinued minoxidil. I returned to the minoxidil after 2 months but can tolerate only 0.5mL/day). I have been back on for 3 weeks. In that time I have noticed a loss of density.

My questions are:

1. might 5% minoxidil be right for me?
2. is 0.5mL minox 7% likely to be ineffective?
3. could this recent loss of density be due to resuming the minoxidil, albeit at a reduced level of application?

Many and sincere thanks for your time and expertise.

Really, the only way you can know if 5% minoxidil is right for you is by trying it. Generally, I do recommend the 5% minoxidil if you want to use a topical. Higher percentage is not necessarily better, as you’ve found with the irritated scalp. Are you applying it twice daily, as recommended? As for the hair loss you’re seeing, it could be due to using only 1/4 of what you previously used, but there’s really no way for me to tell.

I have just started taking Propecia on Tuesday (5/11/10) and almost instantly my beard has been growing slowly. Usually I shave on Monday mornings and Wednesday mornings… Instead I have the amount of stubble on my face that would amount to 2 days of growth except it has been nearly 4 days..

What you’re describing is highly improbable after taking Propecia for just a day or two. While there’s been no identified link, some people do report slower facial hair growth after taking Propecia in very rare cases, but this would take weeks or months. And even then, I haven’t seen any proof that this occurs.

Look on the bright side, if Propecia does indeed slow your beard hair growth you will save 50% on your shaving supply and needs!

I just switched from Propecia to generic Proscar (cut into fourths). The pills I am cutting are extremely small, and thus difficult to cut! Always be sure consult your pharmacist about the size of generic Proscar before filling your script!

Consulting your pharmacist about the size of the pill is great advice. Let the pharmacist know that you’re going to be cutting the pill. Different generic drug makers could have different pill sizes for the 5mg finasteride. Fillers are often used to make the medication easier for the patient to handle or to make production easier.

Do you know the maker of the generic you got? There’s a partial list of generic finasteride names available here.

Hi Doctor,

Given the longer half life of Avodart would you expect catch up hair loss – due to stopping drug – to be delayed more than Propecia (i.e 3-6 months)?

Thank you for your time.

That’s an interesting question. I do not know for sure, but I suppose in theory the catch-up hair loss with Avodart (dutasteride) may take a bit longer considering the long half life.

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