Category: Drugs

Since starting propecia 7 months ago, my hair loss has become significantly worse. In the 3 to 6 month period, my temples and mid-anterior scalp became noticeably thinner. Although “shedding” in these frontal areas slowed down/stopped at the 6 month stage, my crown is now thinning even though I had not noticed any hair loss in that area before beginning propecia. I have 3 questions:

1. is it possible that propecia is making my hair loss worse-has this ever happened to a patient of yours before?
2. is it possible that this shedding is a positive sign because I am young and in the early stages of hair loss i.e. as the drug has a lot of hair to act upon? Doctor Bernstein states on your website that shedding is fairly common and can be a positive sign.
3. is it common for propecia to take over 6 months to yield noticeable effects i.e. stopping hair loss and/or creating regrowth, or should I stop the drug and save my money?

Thanks

1. Your hair loss on Propecia probably has nothing to do with the drug, but rather the progressive nature of your genetic hair loss which (based on what you wrote) seems to be aggressive. Shedding at 9 months is not a good sign.
2. At 1-2 months shedding can be a positive sign as we interpret this as an acceleration of the normal hair cycling, but that acceleration should not occur over 9 months. Most people will see a reduction in shedding by the 4th month.
3. It generally takes about 6-12 months to see the difference after starting the medication. So you’re still in the time frame and I wouldn’t suggest stopping the medication at this point unless you have experienced any side effects that you can’t deal with.

The effect of finasteride on spermatogenesis

I was wondering if you had see this study on hampsters? It concluses that animals treated with finasteride showed significant changes to the testicular seminiferous tubules as well as on spermatogenesis when compared to the control group.

Sounds scary! Is it something to worry about?

Link: Study

OK, but how did their hair look? If you have a pet hamster who is balding and you are concerned that he may not reproduce on finasteride, then you have a real problem.

In all seriousness, this might be interesting to some degree, but it isn’t enough to even consider being worried about. I’m not a veterinarian, but I can clearly see there are vast differences between humans and hamsters. Besides, the study says they gave the equivalent of 5mg finasteride to the hamsters… and unless you have prostate issues, you shouldn’t be taking that much anyway (1mg is for treating hair loss). And for those men with prostate issues (which usually occur later in life), getting a girl knocked up isn’t high on the to-do list.

Note: I believe these were from two different people, but the questions are related so I’ll answer them together…

Email #1

Now doc , i have a suggestion to make just like you do.You write “Every person will eventually lose the benefits of this drug, but the open question is when” – there is no proof for this , or you do have one ? Even if this statement is based on your experience , you are aware that this is not official and there is not way to be.The official one is that after 5 years only 10 % of the people lose some hair , and please attention – more of teh 50 % of the rest CONTINUED to improve even after this.So unless you can prove the opposite ,please flag those ones as “my opiniion ” or “may” or “might ” , but please do not make statements which are neither proven nor stuided in the medical literature – 10x

Email #2

Why do you recommend Propecia to people that come to you for hair transplants if the effect is only temporary? I just ask because you emphasize a master plan for long term benefits, and it seems like as soon as the drug stops working, the hair it saved will fall out and the patient will have that embarrassing pluggy look -bald head with transplanted hairs. Isn’t it setting up people for more misery to take a drug that temporarily grows their hair back, only for it to fail and then they experience going bald again?

Thanks for your time

Read the official study posted at Hairlosstalk.com and you can draw whatever conclusions you want from it. I believe that this drug has a forever component, but that does not mean that it will hold all of the initial benefits forever. Each person will react differently and I can’t give an exact timetable for when you’ll start to see thinning continuing (if ever). So yes, the medication does work “forever” as long as you continue taking, but the benefits may eventually appear to be less. It could be 5 years, it could be 20 years. The only facts at our hands are in the official Merck/FDA studies.

Propecia’s benefits aren’t quite temporary. It’s not just going to suddenly one day turn itself off 100%. The entire point of a Master Plan is to create a roadmap for a worst case scenario of hair loss so that nobody is taken by surprise if the progressive nature of MPB becomes more evident a decade after you start Propecia. With the modern hair transplantation, the “embarrassing pluggy look” you described shouldn’t occur.

Propecia is a miracle drug for many people, as it gets them some (or a lot) of their hair back… and it largely slows or stops the hair loss. Many of my patients swear by this medication. This is a type of medication in that if it grew hair back and stopped or slowed hair loss, them some benefit will probably last ‘forever’. Of course, you can test this by just stopping the drug and seeing what happens. Most people who saw substantial benefits and then stopped the medication saw hair loss, which suggests that the drug had some residual value. The alternative is that you can elect to take your natural balding process to its conclusion, reflecting your genetic makeup. Your choice, of course.

Dr Rassman, I have been using minoxidil 2% for over 12 months with ok results but have noticed a change in my eyes. The lids are thicker and my eyes look darker, tired. The skin above my eyes also seems less smooth and hangs lower. Do you think is could be Minoxidil or something else. Thanks

I don’t know how to answer your question without knowing more about you. How old are you, for example? If you are 60, maybe you are having changes that are age related and are now just noticing it. If you are 20, well that is a different story… but without seeing you myself, I don’t know.

Minoxidil should not impact your eyes or skin color on your face, but there are comments on an old post that would tend to disagree with that. Take those comments with a grain of salt, as none of them are independently verified and could just be people messing around or confused about the cause of their change in appearance. There might be something else going on, so I’d talk with your dermatologist.

Drs

I have recently started a course of Propecia. Based on what I’ve read, I understand that the drug can, in rare cases, cause sexual side-effects, namely decreased libido, reduced ejaculate and even erectile dysfunction. I’ve found that it has had the reverse effects on me, that is, it has heightened my libido and increased my ejaculate, as well as the frequency with which I get erections.

Does that mean that the drug will, in my case, also have a reverse pathology on my hair loss (that is, make me lose more hair instead of arresting the hair loss process)?

Congrats! You are one of the few people with a good side effect appreciated by some men (but not all women married to those men). The results on saving your hair have no correlation with the sexual side effects of finasteride one way or the other.

Paid advertisements (not an endorsement):

I was recently prescribed propecia(finasteride) for hairloss. I am 24 years old. My hair is still thick but I have mild thinning at the crown of my head and some thinning in the mid scalp. I do have a receding hairline. Can Finasteride aggravate more hairloss at the front and hairline? I have read on numerous websites that it can cause more hairloss at the hairline due to the rise in testosterone. is that true? I dont want to take finasteride if it will make my hairline or hairloss even worse. Why do people claim that propecia makes there hairloss worse sometimes.

Why would merck make a drug designed to help hairloss, instead it make sit worse. Are these claims true? Does Testosterone on its own cause hairloss, or does it have to be converted to DHT to cause hairloss? For example, hypothetically lets say some has genetic balding in there genes and hypothetically he has 0% DHT, but he does have testosterone, can the testosterone on its own cause hairloss?

I asked my derm this question and he has no clue, and I have no idea how he he is qualified to be a dermatologist, so thats why I am asking you these questions. You seem to be an expert on hair restoration.

Propecia (finasteride) won’t produce more balding in the traditional sense. On rare occasions, there have been reports that some hair shed may occur in the first 2 months of taking this drug, and if/when this occurs, it is thought to reflect an acceleration of normal hair cycling. That’s what I mean by it not being hair loss in a traditional sense. The shedding is short term and after the 1-2 months that it has been observed, a significant reduction in shedding occurs as the benefits kick in over the next many months.

Testosterone is converted to dihydrotestosterone (DHT), which has been discovered as one of the keys to the male pattern balding process. Without DHT, you’re not likely to lose hair… but it’s not possible to attain 0% DHT, though drugs like Propecia block much of it.

I’ve been on finasteride for about 4-5 years now. In addition to that, my doctor recently told me to start using the liquid Rogaine drops once a day. (I have frontal balding/thinning & am 29 years old.) I started with Rogaine a few weeks ago. Almost immediately I started noticing dry, flaky skin in that area of my hair. It doesn’t really resemble dandruff (which I’ve never had) so much as the kind of skin that sheds after a sunburn heals.

Is this normal? How long do you think this will last? (I am experiencing no other side effects so far.)

Known side effects of minoxidil (Rogaine) include itching, redness, dryness, and scalp flaking, so what you are reporting is not out of the ordinary. It may last for as long as you use it. It is sometimes dose related, but I’m not sure what strength you’re using (common is 2% or 5%). If you’re using the 5%, you may be able to tolerate the 2% better.