Category: Drugs

Good day Dr. Rassman,
I´ve read many of your posts considering Finasteride as generally safe treatment and that IF side effects occur they are withdrawn by discontinuing the drug. So, you imply that any problems caused by Fin are not permanent.

After browsing through propeciahelp.com and reading literally thousands of very sad stories, I must blame you for not mentioning some very important informations, including prevalent loss of libido, impotency, brain fog, muscle atrophy and many other serious complications which exist many years after taking the last dose, and it is not known if they will ever subside. Why are you so very keen on recommending Fin despite these facts?

To say it bluntly, do you sacrifice one man´s balls, muscles and brain so another 99 can have their hair?

Have you already forgotten your Hippocratic Oath?

your reader

I’ve written about this issue many times before on BaldingBlog (some examples are here, here, and here). There are no peer-reviewed, published studies to back up what you’re claiming, and anonymous people on internet message boards just don’t cut it. Anyone can go on and complain about issues they have that might be real, but unrelated to the use of the medication. Don’t get me wrong, forums can be a great place to discuss things (I have my own hair loss forum), but you need to take the information you gather from anonymous people with a grain of salt. If some random guy you’ve never met just walked up to you on the street and screamed that Coca-Cola was made out of cabbage, you’d just dismiss him as crazy… but if someone posted it in an online forum, you might give it some consideration (or research it further). I wonder why that is, but I hope you get my point. The claims of permanent side effects are unproven and seem to be popular amongst forum posters that look to point the finger without basis or just folks trying to steer you to another product that they just happen to be selling.

I’m keen on recommending the medication because I’ve seen it work. Make no mistake, I don’t downplay side effect risks… but the truth is, those risks are quite low and reversible in every case I’ve seen. It’s also important to remember that while I do recommend finasteride for treating hair loss, it is ultimately up to the patient and his prescribing physician to decide if it is the right course of action. To sum it all up, nobody is forced to take this medication (it is elective — hair loss isn’t a death sentence), and there has not been any proof to your claims of seeing side effects “many years after taking the last dose“.

I’ve been using Minoxidil for a number of years but wasnt sure if it was working. I definitely lost hair in the crown area even though I was using the product so I got hair transplant. I called the makers of Rogaine to see if using the product would be an issue with the transplants and was told it only works for the crown area anyway. With that in mind I figured I would stop using. That was probably a mistake as I now see the rest of my head thinning out rapidly and can only assume its from stopping using Rogaine. Would you suggest going back on Rogaine and what should I be mentally prepared for if I do? I would be devastated if more hair is lost as a result of going back on it. They do say to expect hair loss at the beginning of use. Please help! thanks

Minoxidil, when used and then stopped, can result in “catch-up” hair loss. Since you were already using the Rogaine for years, it was probably retaining your crown — if you hadn’t used it, your crown hair could’ve been gone already. It’s hypothetical, of course, since I have no way of knowing what might’ve happened to your scalp had you not used the treatment for so long.

I don’t know what type of mental preparation you should try, but just hope for the best. These medications don’t work the same for everyone, so I can’t tell you for sure what will happen. The hair may or may not come back, but there is little downside for trying. Keep your fingers crossed and your hopes high.

Hello,
I have been taking Propecia now for about 2 1/2 years and believe it has slowed my hair loss down but has not stopped it. In the last 6 months I have noticed significant hair loss and thinning. What can I do? Also is Avodart or any other promising drugs soon to be approved to treat hair loss by the FDA? And if so when? Thank you for your time

Propecia does not show the same benefits forever. Every person will eventually lose the benefits of this drug, but the open question is when. Avodart might be more effective in people like you, but as you know, it is not FDA approved for use in treating hair loss. I couldn’t say when or if it will be approved for this, nor do I have any inside tips on upcoming drugs that are pending approval. There’s a lot of money to be made if a medication can be proven safe and effective, so I’m sure there are companies out there trying to find the next best treatment. I just don’t know who they are…

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This is continued from my response an hour ago about finasteride and the Swedish Medical Products Agency (MPA). The question was:

What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?

As I said in my earlier response, “If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious.”

What that boils down to is that I’m not going to try to convince people to use a medication if they’re already so convinced it’ll do them harm. I’m not a sales rep and it isn’t my job to make guarantees about medications or provide incentives for you to take it. It’s an elective medication. You don’t have to take it if you don’t want to. If you’d rather believe message boards than published reports in medical journals, then by all means that is your choice to make.

But I’ll elaborate more with some interesting tidbits from the Swedish Medical Products Agency (sources: here and here). Some key points I found:

1. In clinical studies, single doses of finasteride up to 400 mg and multiple doses of finasteride up to 80 mg/day for three months (n=71) did not result in dose-related undesirable effects.
2. Drug-related sexual undesirable effects were more common in the finasteride-treated men than the placebo-treated men, with frequencies during the first 12 months of 3.8% vs 2.1%, respectively. This means 3.8% of men taking Propecia had undesirable sexual effects and 2.1% men taking a fake sugar pill had undesirable sexual effects. The incidence of these effects decreased to 0.6% in finasteride-treated men over the following four years. Approximately 1% of men in each treatment group discontinued due to drug related sexual adverse experiences in the first 12 months, and the incidence declined thereafter.
3. People that are up in arms about the Agency listing “persistent difficulty having an erection after discontinuation of treatment” as a possible side effect should also realize this is listed under the “frequency unknown” section. In other words, they received complaints about it (how many hasn’t been established), but it is not a proven effect.

Hi,

Like a previous case, I’m a vegetarian who takes Dutasteride (Dr Reddy’s) 0.5 mg one dose daily for hair loss. I have seen better results with this medication than with finasteride (no results at all). The trouble is I’m unhappy with the fact that the capsule itself has gelatin contents.

I understand that it’s advised to have the capsule swallowed whole because of some sort of risk of irritation. However, would it be permissable to empty the contents into a full glass of water and take the medicine like this?

Any help and advise would be most appreciated.

Kindest regards.

You are asking about using a different method for taking a medication that is intended to be swallowed. I suppose you can try it, but I don’t know if that would compromise the efficacy of the medication. You can try contacting the Dr Reddy’s Laboratories here, but I’d assume they’d tell you that the capsule should be swallowed whole.

I’m not an expert on generic dutasteride and its variations, but there might be another company out there that makes a pill that isn’t a soft gel capsule.

Hello, i know that minoxidil is supposed to be used every night before bed. My question is, due to my extremely busy lifestyle and lack of routine i sometimes go a week without using minoxidil. If i use it for three days then dont use it again for a week then use it again for three days in a cycle, besides it not working well enough as it needs to be everyday is it actually making my hairloss worse in the sense that if its causing shedding (which is a sign its working) then not using the treatment again for a week, is it basically just shedding my hair and because im then not using it again for a week the hairs that ‘would have been’ stronger and healthy because of the minoxidil are just the thinning hairs that are not being protected by minoxidil. Am i just basically shedding my hair faster?

thank you

To my knowledge, minoxidil will not work on an irregular schedule, particularly one that fits into your lifestyle. Either use it regularly or forget about using it. If you’re seeing continued hair loss, it’s more likely that its just your genetics continuing the process (which was the reason you were using minoxidil in the first place).

Hello Dr.

Do you have any opinions on chewing up Propecia vs swallowing it? Is it true if you chew it, there is better change of all getting absorbed? Or would chewing it somehow ruin in the inherent chemical makeup? Thanks.

Some medications are meant to be chewed, but if the medication is meant to be swallowed, I would swallow it as it is written in the instructions. Propecia is one of those medications that was meant to be swallowed. I really do not believe it would help with the absorption if you chewed it, plus, I don’t think it would taste all that great.

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