Category: Drugs

I am just following up on a recent post I read on your Blog – I am 44. I have been on Propecia for almost 4 years – starting off as a Norwood 2.5, I have probably progressed to a Norwood 3 over this time. My hairfall seems to be less than a few years back, so I am not going to risk getting off Propeica – it is probably doing some good.

My question however is about the impact on body hair – I have probably seen a 30-50% reduction in body hair over the 4 year period. Is this likely to be related to Propecia, or is their some other factor. (FYI I am a regular smoker and accept that this may be impacting the benefits of Propecia)

It very likely could be the Propecia is causing your reduction in body hair. People have reported body hair loss with Propecia, and one rare occasions I have heard it go the other way. I wish I’d experienced the loss of body hair when I was taking the medication, but I wasn’t that lucky. I’d expect most patients would prefer to have this side effect, particularly those with excessive hair in undesirable areas (back, shoulders).

Hey Dr Rassman
First of all I would just like to recognize all the the individuals who help make this site what it is. Its great. I love it! To be honest it distracts me at school a lot. I keep saying to myself, okay read one more post and thats it! But now for the serious part. I’m just wondering about the progress which is being made in the development of new drugs for male pattern baldness. I know you are probably getting sick of these questions, but are companies researching the working mechanisms of the approved drugs minoxidil and finasteride and building off what they already know?

Also, who is the youngest person that you have performed surgery on, not including young children with burns, but with male pattern balding and if so what do these results look like? I am also pleased to say that I will be scheduling a visit with you in May to meet with you….. I’m very excited as I am from Canada and have never been to LA before. I hope it lives up to the hype!

I don’t know much about new drugs in the drug pipeline of the pharmaceutical companies, but as I do find out anything I try to post it on this site quickly. Sometimes I get emails from people alerting me to medications in the pipeline that I hadn’t heard of before. Contrary to popular belief, I’m not a drug insider that knows timelines on when medications are coming to market. Treating hair loss is a billion dollar business, so while I don’t know this to be 100% the case, it would make sense that some drug companies are working on the next possible medication to regrow hair.

In the treatment of male pattern baldness, I made a mistake once by taking on a 17 year old patient with strictly frontal balding. He had a very fast moving hair loss progression and eventually went on to a Norwood class 7 pattern. This was around 1993, years before Propecia was on the market and it was early in my hair career. Today, I generally wait for:

1. Advanced pattern progression that does not respond to Propecia
2. Ages of 22 or higher
3. Adequate or high densities of the donor hair
4. Maturity… and many other characteristics tied to hair and skin color, hair density, coarseness of the hair, character of the hair, and family history

I look forward to meeting with you. Los Angeles is a great city and I am sure you will enjoy it if you gave yourself enough time for touring.

A recent publication in the New England Journal of Medicine shows that Avodart (dutasteride) reduces the risk of prostate cancer along the same lines as finasteride did in earlier studies. The study also shows that in those men on Avodart, there was an increased incidence of heart failure.

Here’s a snippet from the Associated Press article:

Full results of a big study testing a drug for preventing prostate cancer show a higher risk of heart failure, a surprise finding that could dampen enthusiasm for expanding its use.

On Monday, GlaxoSmithKline PLC asked the federal Food and Drug Administration to approve its drug Avodart as a cancer preventive for men at higher-than-normal risk of the disease. The drug is already sold for urinary problems, and no heart failure risks have been seen with that use, doctors say.

Results of a study testing it as a cancer preventive were given at a medical conference last year, but the heart risk information had not been analyzed at that time so only the main results of the study were presented, a Glaxo spokeswoman said. Full results are being published in Thursday’s New England Journal of Medicine.

The study involved 6,700 men with high scores from PSA blood tests but no sign of cancer on biopsy. They were given Avodart or dummy pills and new biopsies four years later. Prostate cancer was found in 25 percent of those on dummy pills and 20 percent of those on Avodart.

Read the full article — Study finds possible heart risk with prostate drug

As the article does mention, the heart risk could be a fluke, but it is important to study this further. Just another reason why I can’t endorse dutasteride for users that wish to take it for treating hair loss.

Hello,

I am a 25 year old male, and I’ve been experiencing very slow hair loss over the last four years or so. Last August 2009, I decided to finally ask my doctor for a Finasteride prescription for hair loss (5mg cut into 1mg taken once a day).

Over the course of three months, I could tell a noticeable improvement in the way my hair looked and felt as well as a significant decrease in the amount of hair I would see on my hands when showering. Unfortunately, this came at a cost of side effects in the form of decreased sexual drive and weaker erections. I stopped taking Finasteride 1mg in late December 2009 and have since recovered from all side effects.

Given that I was going through high stress at the time (relationship, employment, relocation), I want to be fair to the drug and it’s potential effect on me. Would you recommend restarting daily Finasteride at half the dosage? I realize this would make the drug roughly 80% effective; however, would there also be a chance I see reduced side effects? I’m curious if you’ve seen patients re-start daily use at lower dosages (or remaining at 1mg) with a lack of side effects the second time.

Alas, it could be wishful thinking. It would be a shame as the drug was working great for it’s intended use (my hair).

Thank you!

Thank you for a fair self-assessment of finasteride (Propecia) for the readers out there.

You are right, it may just be a coincidence that you experienced those side effects, as you were going though a lot of stress, but I agree it may have also been the drug’s side effect. Stress itself can cause issues with libido and erectile dysfunction. So to be fair, I would try the full Propecia again and see what happens since the drug was working so well for you in your hair loss battle. If you experience the side effect again, then you can try 1/2 dose. Either way discuss this with your prescribing doctor and good luck!

Dr Rassman, I have been using minoxidil 2% for 12 months and have found it quite effective on my crown. But in the last 3 months its having a strange effect on my eyes making them red and my facial skin is looking more grainy with larger pores. I have read other reports of this but of course they may be incorrect so a professional opinion would be appreciated. Thanks

Assuming that you do not apply the minoxidil to your face or get it in your eyes, I do not know what is the cause of your problem. It may not be related at all, or perhaps you are having a systemic reaction to the drug. I would follow up with your physician.

I have not heard of minoxdil making pores larger and eyes red, though I did get an email that I posted about a year ago from a reader that claimed the medication was giving him black rings under his eyes.

Dear Dr. Rassman –

This blog is really a terrific resource. I’m 27 caucasian guy with thinning hair. Frankly, my thinning not super noticeable when my hair is dry; however it looks pretty bad when the hair is wet.

I’ve tried Propecia, but sadly, I’m one of the rare guys who got side effects (FYI they completely went away when I stopped taking the drug). My question is whether or not you think stand alone Rogaine foam is a decent alternative for us guys who can’t tolerate Propecia. I’m fine with applying it twice a day. The issue is that I just don’t want to commit to lifetime use of a medication that you think is, on balance a waste of time.

Thanks very much for your reply.

I’d say Rogaine (minoxidil) is a good alternative, though it doesn’t inhibit the DHT that causes hair loss. I wouldn’t say it is a waste of time, but it just works differently from the Propecia (which does block DHT). Minoxidil is FDA approved to treat hair loss, and you might see some decent regrowth. I won’t make any guarantees to how much growth you might see, but is worth a shot.

You might also consider taking a half dose (0.5mg) of Propecia, as some patients with side effects have seen some benefits and no side effects from going this route, though you should discuss this with your prescribing physician. Also, a quarter of the dose will produce half of the benefit of a full dose.