Category: Drugs

Hi Doctor –

I was using propecia (Finax 1mg) since Nov’2009 till Feb’2010, I was also using minoxidil 5% tropical solution. During Dec and Jan I experienced palpitations and Feb I felt stress around my face and chest which turned out to be high blood pressure 145/90. This did not happen for a month and then again suddenly I have started palpitations and sometimes feel stress. I have stopped the usage of both the medicines since 3 weeks but nothing seems to work.

Please help me out with how much time it should take to get rid of these side effects, do I need any medication that can help me wash this off easily… I have developed sleeping disorder as well. My physician who advised me for this is not ready to believe that these medicines can cause these issues.

Looking forward for you help. Thanks

Here are the listed rare side effects for topical minoxidil — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in hearing or vision; difficulty breathing; excessive, sudden weight gain; fainting; lightheadedness; increased chest, arm, or shoulder pain; increased heart rate; pounding heartbeat; swelling.”

And here are the listed rare side effects for finasteride — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast enlargement, lumps, pain, or tenderness; nipple discharge; testicular pain.”

So what you describe as stress in your face could be an allergic reaction to either medication, but this doesn’t explain your blood pressure spike. In fact, minoxidil is taken in pill form to lower blood pressure. Stress is a likely reason for any abnormal sleep patterns, and the stress itself could be from your health. What troubles me is that you still are experiencing issues even after stopping the medication, leading me to wonder if your symptoms are unrelated to your hair loss treatments and could possibly signal a serious (undiagnosed) underlying medical issue.

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I’m planning to travel out to LA for a consultation [from overseas]. How far in advance do you recommend booking an appointment.

One final question. A few folks have mentioned nasty sheds that are associated with rogaine, and in particular with rogaine foam. If you read the blogosphere, it’s enough to scare one stiff. In your experience, how frequent are the sheds and do they often result in a negative cosmetic change in the short term?

Thanks

The more notice you can give for an appointment, the better… but if you’re in from out of town with a fixed schedule, we’ll do our absolute best to fit you in whenever you can stop by. I look forward to meeting with you.

As for minoxidil shedding, I think its pretty rare but I honestly haven’t kept much referential data on it. Since it is an over-the-counter medication (meaning a doctor’s prescription is not needed), I don’t have much follow-up with patients regarding it. If the shedding does happen, it should stop within a few months… but it doesn’t happen for most people.

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Been using rogaine and propecia for 2 years now and the results have been great, and I feel as my area is a littl. I thought about my applications and on average do about 80-90% of the rogaine applications, and probably about 90-95% of the propecia prescriptions. Do you think this could explain the loss ( however much imagined, I haven’t seen my doctor in a while).

I guess I’m wondering all of this because I’ve done some reading and it seems as one gets older (I’m only 24), the dht overrides the treatment. Is that usually the case, or do you find propecia and rogaine can often sustain the same amount a hair through middle age?

You should probably see the doctor that prescribed you the Propecia to get his take on it. It’s always good to talk with your doctor about results (or lack thereof) from medication he prescribed. Hopefully he made notes about your hair loss the last time you were there so you can compare to your current results.

Many people find that Propecia has been holding off their hair loss for many, many years, but sometimes the genetic balding is stronger than the drug. This is the tug of war type situation. I wouldn’t expect it to occur after only 2 years, but each person will react differently to the medication so I can’t say for sure. At 24 years old, you wouldn’t fall into the “older” category, as your hair loss is likely still early enough to see maximum benefits from the medications.

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Some of the posts on this site about minoxidil frightening! I have used this for 2.4 months and this scaly bumpyness has covered my ears and spread down my forehead to nearly my cheeks. This has pretty much entirely happened in the last 1-2 weeks. It is uncomfortable and looks bad and i hope it goes away! someone said this could be permanent in one of these posts. Any idea here?

More important question: After 2 months of treatment the lymph nodes on my neck front and back have swollen up, mostly on one side. They havent gone down and its been 2 weeks. Also parts of my head are sore to touch – this came on suddenly so i cant be sure if its a reaction or an unrelated medical issue.

Any advice or feedback – at what point do i need to go to a doctor? Thanks

It could be allergic reactions to an ingredient(s) in the minoxidil, but really just from your descriptions alone — “scaly”, “swollen lymph nodes”, “sore”, “spreading” — you should’ve seen a doctor by now. What are you waiting for?

Rash or hives are a known rare, but severe allergic reaction to this medication… however, it’s odd that you’ve been using the medication for months and just started to see these symptoms in the last couple weeks, which makes me wonder whether it is coincidental. Any of these things might unrelated to your minoxidil use, and there could be other medical issues you have to worry about. See your doctor!

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From your practice, what is the worst progression of balding that you have seen with someone taking only Propecia and not anything else like Minoxidil? Like what Norwood was he before and after and how long was he taking it and how old was he?

I routinely prescribe finasteride for all balding men, so progression is not evident as the process slows down considerably. In the days when Propecia was not available, the balding process was very evident in a matter of a few years, but now when Propecia is used, I just have not seen the radical changes in balding patterns.

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Hi Doctor,

Thank you for maintaining this great and informative blog and answering all our questions.

I was on propecia for 9 years until last year I was prescribed Avodart because propecia was losing its effectiveness. I decided to go off avodart after a year and go back to propecia. The dermatologist told me to give it a year before deciding to switch back. It appeared to me that my hair loss had increased slightly on avodart and the side effects built up after a year were a bit too much – slight loss of libido, slight ED. After a week of switching from propecia my hair loss accelerated substantially. Could this be catch up hair loss – maybe avodart was not working for me – or could this be a shed as of a result of restarting propecia.

Thank you.

There is no drug in the world (yet) that completely stops hair loss. Avodart and Propecia work in similar ways (the two drugs are not drastically different in the mechanism of action) although there are reports that Avodart is better at stopping hair loss, particularly when Propecia benefits have been exhausted. I personally have not seen a worthwhile benefit of taking Avodart because:

1. My patients that have taken Avodart have not noticed a significant change in hair gain/loss.
2. Sometimes the risk (of sexual dysfunction, etc) outweigh the benefit of (marginal) improvement over Propecia.
3. I rarely prescribe Avodart, so my personal experience is admittedly limited.

While I will never know what is going on with your specific case, your experience is real and there may be the correlation you are asking. However I would not think your hair loss is from “catch-up” hair loss for not being on Propecia as you were still taking Avodart and you only noted the hair shedding after starting Propecia. Coincidence? Maybe.

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Dr. Rassman,

Thanks so much for this valuable site.

I am considering Propecia. It is the possible sides, not the $$$, that has me hesitating. I have done the research on Clinical Studies, Dr. Frankel’s article, your posts, etc. The data seems to indicate, and you’ve agreed that .5 mg is roughly 80% as effective for hair growth/retainment as a full 1mg. My question is, are the side effects proportionally decreased? Is there any data out there?

B/c of the efficacy of the .5mg dose, and because the decreased DHT/Serum levels appear to stay in the same range for almost 72 hours, my plan is .5mg Merck Propecia every other day, in order to decrease any chance at both short and long term side effects. Does this sound logical to you?

I really do not see your logic. I mostly see your fear… fear that the drug can give you side effects. Is it worth the risk (for you)? Maybe you should question taking it altogether. There is a phenomenon known as the placebo effect… and it goes both ways. If you are preoccupied that a drug will give you a side effect, then you will likely see that side effect because that is what you believe will happen. If you don’t try it you will never know if you will have a side effect.

I don’t know if there is statistical data available that shows decreased side effects with decreased dosing, but I’ve seen that to be the case if a patient has experienced side effects from the full dose. If you have genetic androgenic alopecia and Propecia is recommended by your physician, then I would start with the recommended dose. If you end up with a side effect then you can just as easily not take it and the side effects would be gone.

Hi Dr, I was reading a number of your responses to the queries posted here and was really pleasantly surprised by the straight ahead and honest answers you provide.

I have a query related to what precautions should be taken in one’s sex life when taking propecia, apart from avoiding potential pregnancy. Could the drug be potentially damaging to a man’s partner otherwise? ie during regular sexual intercourse? or, for instance, in oral sex?

I realize these questions may sound ridiculous to someone more informed in the actual working of the drug, but there is a certain amount of vagueness surrounding these issues with propecia that I think a lot of people would like to have clarified.

many thanks. all the best

It’s not ridiculous to ask questions. If a pregnant woman gives oral sex to a man that has been taking Propecia, I would doubt that there was any side effect possible with this related to the drug (the same goes for sexual intercourse). Have fun and you can even return the favor, as there is no risk the other way around either.

For further confirmation, you can refer to a statement from the drug’s manufacturer (Merck) that I published a couple years ago related to this very topic — Propecia’s Effect on Sperm and Pregnancy.