Category: Drugs

Hello Doctor,

For the past year I have noticed more hairs in the shower and also when I comb my hair. I am 22 and my hair loss does not seem to stop or slow down. I have noticed over the past year that my hairline has receded in the temple area. Also, the sides seem to be thinning and receding. I went to my doctor and told me the hair loss may be due to stress since he found no pathology from my blood test and he said I may use Rogaine. I have not used Rogaine. Based on my observation I am at Norwood Class II. I am worried my hair problem will get worse but not sure if I should start medication. Are these symptoms of MPB? Propecia workes best at the vertex yet I do not have much thinning or hair loss in that area. What would you recommend I do? I know that the earlier I deal with hair loss the better, but if I start early will Propecia still have its effects 10 years or more from now? Also, I do not have much money so would you recommend I take a generic of Proscar?

Thanks

You’re in LA, I’m in LA. You can come in for a free consultation and find out about your hair loss for sure. I can test your hair for miniaturization and we will be more certain if you are really balding and where you might go with it.

I can’t make drug recommendations without seeing you, but I can provide general info. Propecia does work best at the vertex, but it will halt or slow the hair loss all over the scalp. Rogaine also works best in the vertex. Propecia will still have effects for as long as you take the medication, but as hair loss is progressively a game of tug-of-war, the Propecia will possibly not be able to hold on to as much hair as time goes on. I’ve had patients that have been taking it for a decade without problems, and then there’s some that I’ve increased the dosage for due to lackluster visual benefits after 5+ years. Everyone is different. Generic finasteride 5mg (Proscar) is a lot cheaper than Propecia and is the same medication.

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Dear Dr Rassman,
According a study done on behalf of Merck, patients treated with 0.2 mg finasteride showed approximately an increase of 61 hairs versus an increase of 77 hairs in 1 inch square treated with 1 mg of finasteride over the 6 month period. So can we say that taking 0.5 mg of finasteride may yield nearly the same results with 1 mg treatment

You are correct. We have known about this for many years (and have reported it here), though the standard dose is 1mg. For those who have unwanted side effects, taking 1/2 of the standard dose of Propecia should be considered, which we have been advising for many years.* Some of the original studies suggest that 1/2 the dose can be 80% as effective as the full dose and 1/4 of the dose could be half as effective as the full dose.

The original Merck study wanted to know the best and most effective dose, and the statistical data suggested 1mg. This was across a large population and if you assume that there is a bell curve, there is a wide range of responses. That also may mean that as many people as impacted by 1/2 the dose with 80% effectiveness, one might see that a sizable proportion of the population may require a higher dose than 1mg. When we see the response fall off, or a poor response, we are now recommending doubling the dose provided that the side effects do not appear.

*As always, discuss any changes to your prescription medication dosing with your prescribing doctor.

Dr. Rassman,

Good info is provided in this blog, I want to ask you a question regarding a previous posters comment on Generic Finasteride. Your response to the blogger was to purchase Generic Finasteride at Cosco or Wallgreens instead of ordering generic Finasteride online. How is this possible when Merck was granted an extended patent until 2013 (See Wikipedia on Finasteride)?

Also do you think its safe cutting the 5mg into 4ths which will be 1.25mg approx? Thanks!

Generic Propecia (1mg finasteride) isn’t legally available in the US due to the U.S. and International patents held by Merck, but generic Proscar (5mg finasteride) is available in the US and that’s what I was referring to. When cutting the 5mg pill, you’ll likely have some crumbs, so it might be a little less than 1.25mg. Regardless, I don’t think it’ll be a problem. If you can cut it into 5 equal pieces, that would be ideal… but not practical and the dose clearly does not have to be exact (as discussed elsewhere on today’s posts).

hello doctor,

My question is ive been doing both rogaine and propecia for almost ten years. All of a sudden a couple months ago i started to get some dandruff (mild case). i am now using dhs zinc shampoo. the dandruff is still there but im controlling it and its not too bad. should i stop using the rogaine as it may be causing the dandruff? and if i use rogaine having some dandruff will that cause hair loss? (i did see my dermatologist and he didnt seem to concerned about me having the dandruff plus using the rogaine)

Thank you for your time

Rogaine (minoxidil) can cause scalp irritation and give you flaking. The use of zinc shampoos like Head and Shoulders works to control dandruff, so you’re on the right path. You will not develop hair loss from the dandruff.

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Have you ever seen anybody end up going completely bald while on Propecia?

Interesting question. Some men start Propecia when they have advanced balding patterns and few start when they have a full head of hair with early miniaturization. Those that started Propecia with a full head of hair (with some miniaturization) are slowing losing hair to some degree, but I do not recall anyone that became completely bald. I suspect that there are patients who will develop a Norwood Class 7 pattern of balding even on the drug, but these are few and far between. This does not mean you are guaranteed to not go bald on Propecia. I suspect I have not followed someone long enough in the last 10+ years to have seen it (or if they became bald, they never followed up with me).

Dr Rassman,

I’m in my mid-30s and have been experiencing hair loss for the past 5 years. I feel like I’m at the stage where I need to decide if I want to take finasteride or not. My biggest concern is the side effects.

It seems that more and more I hear (both on the news and from friends who are doctors) how doctors are seeing a greater prevalence of male gynecomastia. The often sited reason for this is due to the increased use of finasteride (both for prostate treatment and hair loss treatment). Of course, it could just be that gynecomastia in men makes for an interesting story on a slow news day…

My question is, do the number and types of side-effects experienced by your patients on finasteride agree with published studies?

In reading this blog you do make mention of how some of your patients experience side effects, but you’ve never made mention if the number of side effects you’ve seen clinically are more, less, or the same compared to the numbers posted by Merck.

I’ve had 2 patients in the past 2 years that had gynecomastia. Both stopped finasteride and it went away. Most of my patients are on Propecia/finasteride. I would tend to agree with the statistics published by Merck.

Let me start by saying this is a great site. I have gotten so many answers from here. I am 21 years old with a receding hairline, and excessive shedding. I also think my crown is getting thin, but nobody else seems to think so. Anyways I started taking generic finistride about 4 months ago. I order through a discount website, and I have heard that some websites send out placebos labeled as finistride. Being as how I have been taking it for 4 months and I still haven’t noticed any difference I was wondering if there is a way to tell if my pills are the real deal or just placebos..

Thanks alot

Here’s the best way to tell — buy it from a reputable pharmacy. Seriously though, I don’t know of an easy finasteride test you can run on your medication to authenticate it. Generic finasteride 5mg tablets cost about $20 from Costco or Walmart, which brings the cost down to about $5/month… so why buy it from an unknown source? If you’re not in the US and don’t have access to either of those stores, I’m sure your pharmacy has the generic finasteride at a pretty decent price. Have your doctor prescribe the 5mg generic and then cut the pills into 4 pieces to get the same benefits of Propecia.

Those various “discount” websites that sell prescription drugs (in many cases without a prescription) aren’t high on my list of things I trust. Sure, the price might be great… but at what real cost? It could be real finasteride that you’re getting, but is it worth the risk of losing your hair if you’re just getting a placebo in foil wrapping? I just found an article from late last year that might be of interest — Fighting Fake Drugs in India.