Category: Drugs

Hi Doctor, I am 32 years old and have been on 1 mg propecia for 4 months now and have experienced good results. My question and concern is that days after starting propecia I noticed a major decrease in the amount of semen (about 50%) after ejaculation.

Would you recommend using .50 mg of propecia daily instead of 1 mg or would continuing with 1 mg be safe? Also, in your experience, is this a major side effect that could get worse?? I would greatly appreciate your reply. Great Blog by the way!

Decrease in the volume of ejaculate is a possible side effect of Propecia. It has nothing to do with safety or the potency of your semen. Speak with your doctor about your side effect issues and about whether you should change your dose.

Will taking propecia with a hot drink in the morning be less effective than with a cold drink?

There’s no difference in efficacy when taking it with hot or cold liquid.

I have been on propecia for about 4-5 years with success. I have recently been getting rapid thinning and spoke to my doctor who said I could take generic finasteride at 2.5 mg per day to see if this would help.( the generic approach was to save some income at a higher dosage as 2 propecia pills would be way too expensive)

Have you seen anyone get any benefit from the increased dose? I know on your blog there has been talk of increasing but no word on if it has helped. Also is there any advantage or disadvantage to taking 1.25mg twice daily or 2.5mg once daily? Thanks so much and keep up the work. I also will be contacting you soon to make an office visit to look at future options. Thanks again.

I’m sure most everyone on this site knows, but just to make it clear for the few that may not… The recommended dose of finasteride is 1mg daily for the treatment of genetic androgenic alopecia. Propecia is the brand name for finasteride in 1mg strength. Some patients take the 5mg finasteride and break it into quarters (taking 1.25mg daily) since this method can save them hundreds of dollars a year (over the brand name). There is no clinical difference if you take the generic medication and break it up in quarters as long as you take it consistently daily.

Taking an increased dose of the medication will likely not do much for hair loss/growth. Some doctors and patients have tried it, but there is no evidence that this really helps. Taking it twice a day is also not a recommended dose, and probably would not have any benefit. In the end, it’s not the dose or the frequency of taking finasteride that determines its efficacy. 1mg a day everyday is good enough. If you believe the drug is not working as it should, then it means your genetic predisposition is winning out over the medication’s limit.

If you still feel taking more of the drug will help, talk with you doctor. I can’t say that I’ve seen any additional benefits in patients who have taken double the dose.

I heard that if I apply dexpanthenol before using minoxidil makes it more absorbable on the scalp…therefore i can use minoxidil once daily instead of twice daily. Thanks

I realize there are many anecdotal claims and reasonable sounding methods, but I do not know of any shortcuts that really work. Some people believe that dexpanthenol will increase the absorption of minoxidil; however, I have no experience with the agent. Try at your own risk.

Hello Doctor, I wanted your opinion. I been of Finasteride for about 2 years and it worked very well for me the first year. But the past 6 months I been shedding a lot more than normal. Does Finasteride lose its effect after a while? I checked my blood work on everything and all good but my TSH levels were low 0.053. Can that be it as to why I am shedding so much? Also what is your take — should I switch to Dutasteride since Finasteride is not helping me anymore.

Thank you

I assume when you say that you’re on finasteride, that you’re taking the standard 1mg/daily dosage. The finasteride might be losing the hair loss battle to your genetics, but I have no way to know that for sure. Have you seen your doctor for a follow-up since the shedding began 6 months ago?

The switch to dutasteride may help, but the decision to use an off-label drug that is not approved by the FDA for treating hair loss (it is a prostate medication) is a decision for you and your doctor.

I don’t know if your low thyroid levels are related to the shedding, but that could be a possible reason. Are you having that treated?

Hi, apologies if this question has already been answered. I’m a 22 yr old male with what I believe is mild recession and thinning at the temples, creating more of a widows peak. I started noticing the recession and thinning (really only on the right side) within the last year and it is slowly but I believe surely, getting worse and at a quick pace.

My question is, assuming what i believe it true, is it worth starting on propecia or do you think it won’t do anything?

Well, considering I haven’t examined you at all and have no medical history about you, I have no way to know if Propecia is worth starting. It’s a prescription medication, so you will need to see a doctor to find out if you should take it.

At 22 years old with early loss, it could be beneficial to halt the progression further. But if you don’t have genetic hair loss (let’s say you’re just seeing your mature hairline form), then Propecia probably isn’t worth starting. This is why you should see a doctor to help make that determination.

I have heard many times people say finasteride loses its efficacy over time. However, you have said its just the naturally balding process taking over. Does that mean then, finasteride never loses efficacy and its just the balding gene taking over?

Think about a tug of war — one side (finasteride) pulling against the other side (genetics). The genes will eventually win the tug of war in most people (using a multi-decade time scale). Remember, the balding pattern you are inheriting can be almost any pattern. The worst pattern, the Norwood Class 7, is only present in 7% of the population.

Balding is progressive, but the speed and the degree of the balding process varies. There is no doubt that finasteride works constantly against the balding process but sooner or later, the balding pattern you inherited MAY be achieved.

Hello doctor,
I’m 23 years old, I started losing my hair at 22, became very depressed and immediately sought out a transplant. I’ve seen a dermatologist in my area who is qualified for transplants and tells me I’m too young and my hair thinning is not so bad to even consider surgery. I was prescribed Propecia 1mg daily, and like some of the previous questions I’ve read, I’ve experienced an increase in libido for a short period of time. Its now month 9 on propecia and I no longer have the ‘morning wood’ and am experiencing decreased sexual appetite and desire. I am going off of propecia immediately, is there anything you can recommend for my situation?

Propecia can cause sexual side effects in 1 to 2% of the men that take the drug. If you are one of them, you need to inform your doctor and consider your options (including stopping the medication, which I guess you already did). It’s interesting that you had an increase in libido followed by a completely opposite effect months later. Did you notice any hair regrowth while you were on the medication? Have you talked with your prescribing doctor for a follow-up lately?

Besides Propecia, the only other FDA approved medication I recommend is Rogaine (minoxidil), but I really cannot give you an specific recommendations since I do not know you and I have not examined you in person. I can only give you general factual information. Whether you’re a candidate for surgery is also something I can’t tell you without an examination and more information about your hair loss. At 23 years old with early loss, I would usually recommend trying medications before opting for a surgery.