Category: Drugs

Could switching Finasteride products possibly be dangerous on my hair? I’m currently on 1mg Propecia, but when my prescription runs out I may to switch to 5mg Finasteride tablets and cut them into 1/4ths. I’ve read that switching medications like this, despite having the same ingredients, can bring on a sudden and serious shed. Is there any truth to that and should I perhaps get another renewed prescription for Propecia instead?

No, I don’t believe you’ll see a shed from switching. Most people who switch from Propecia to Proscar do it for economic reasons, as the 5mg pill is substantially less expensive (particularly the generic 5mg, since there is no generic 1mg legally available in the U.S.). I wish the drug company, Merck, would get that message… and maybe they will, as this blog is frequent reading by their sales force.

Propecia is a brand name for a drug called finasteride in 1mg strength and Proscar is the same drug in a 5mg strength. Splitting the pill into 4 or 5 pieces is a cost saver, but as long as you are taking 1mg finasteride daily it is the same thing for treating hair loss.

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Dear doctors, keep up the super work. This is my story below.

I worked crazy 12-14 hour days for the past 2 years, and I practically skipped my meals, or had them very irregularly. I lost a lot of weight, and looked good in clothes. Essentially I was malnutritioned. But 1 day I woke up, and noticed easily 20-30 strands of hair on my pillow. I dismissed it as normal, and over the next few weeks, it was the same scenario everyday. It still failed to sink into me.. because I was always healthy. I had a friend who laughed at me, and said that I had a receding hairline. But I ignored him, because I have had a very high forehead / high hairline since birth. One day I looked in the mirror and realised to my horror, that YES I was losing my hair. I immediately ordered Propecia thru the internet.

I have been on Propecia for the past 9-10 months, and I have seen a slowing in the loss of hair. However I’m not really sure if there has been any significant re-growth. There are definitely side effects for me. I no longer get ANY morning wood.. and I need to be significantly aroused before I can have any sex. In the past, it wasn’t the case. (Easier to be aroused). Currently I’m a Norwood 2 – 3. (Can see my widows peaks easily.) By doing the frown test, I can see my hairline has receded half an inch, while my sides have receded 1 inch.

Now for the question:
I can see tiny vellus hairs at the part where my hair has receded. Should I attempt to apply Rogaine just along that 1/2 inch area of tiny vellus hair? Or should I continue my Propecia treatment and hope for the best? It’s really quite sad to see my hair go this way.

I thank you for all the help you have rendered all the brothers here. I feel happy that we can find support in your blog. I wish you and your team all the best always.

You can apply Rogaine at the hairline, but I’m not sure it’ll do much good there. Worth a shot, I suppose. Vellus hair does not turn into normal adult terminal hairs.

I really hope you didn’t just order a prescription drug via the Internet without a doctor’s prescription, because that is what it sounds like you did with Propecia. Regardless, regrowth from Propecia doesn’t occur in everyone, but just halting the hair loss is a positive sign. Arousal issues could be from the medication, but I don’t know what other issues you have in your life — it could be age related, stress related, alcohol or substances, etc. I don’t know enough about you, and this is why a doctor’s appointment should be made to discuss these issues (preferably with the same doctor that prescribed you Propecia).

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Dear Doctor:

This is in response to a post that I saw regarding grapefuit juice and Propecia/Avodart absorption. Grapefruit juice inhibits the Cytochrome P-450 intestinal enzyme CYP3A4. It does not affect the hepatic enzyme apparently. Dutasteride is metabolized extensively by this enzyme. The serum level of any CYP3A4 substrate, such as Dutasteride, will be elevated in the presence of GF juice. Additionally, grapefruit juice takes quite some time to leave the body, so it’s effect is cumulative. If someone drinks 1 glass a day for 5 days, CYP3A4 will be significantly reduced. Additionally, one 8-oz glass of grapefruit juice inhibits CYP3A4 as much as 2-3 double strength glasses, so you don’t need much. Ketoconazole is also a very potent CYP3A4 inhibitor. Now, I am sure most readers would not be against elevated serum levels of Dutasteride/Finasteride as the effects of dutasteride (at least) is dose-dependent. However, many other drugs such as antivirals, statin drugs, antihypertensives, antiseizure medications, and many allergy medications are also CYp3A4 substrates. Elevated serum levels of these drugs can prove deadly, so as a general rule, patients should check with their doctors regarding any drug/food interaction.

Just my 2 1/4 cents. Thanks!

Thanks for the information. There are some medications that do not do well with grapefruit juices, but here some other links to explore about this —

• Grapefruit Juice And Medication Can Be A Dangerous Mix
• Grapefruit juice squeezes more out of some medications
• Drug – Grapefruit Interactions (Review)

And there’s more links in a previous blog post here.

Dear Dr. Rassman,

I know there is no standardized evidence to say one way or another, but in your opinion is 2 mg of Propecia (1 mg taken in the morning, 1 mg taken at night) more effective at preventing hairloss than 1 mg Propecia?

The reason I ask is I have been taking 2 mg Propecia daily for almost 3 years now, and have started to experience “clumpy” semen and painful ejaculation. I am thinking this is due to a side effect of Propecia. I am kind of in a dilemma now because I don’t know if my fight against hairloss will be affected by cutting down the Propecia to 1 mg or altogether. I am 26 yrs old and single so hair is very important to me.

Thanks Dr. Rassman!

I would reduce the dose of Propecia to 1mg taken in the mornings. The higher the dose, the more side effects you are likely to see. The 1mg dose has been shown to be just as effective as higher doses in the formal studies of drug dosing done by the manufacturer. I recently saw a patient with a similar complaint, and he halved the dose and the side effects went away. He was taking 1mg and reduced it to half a pill of Propecia, which has been reported to be about 80% as effective (0.5mg vs 1mg). In your case, you’re taking too much of the medication to begin with. 1mg a day is fine.

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Hi Dr. Rassman!

I have a question regarding DHT and its effect on estrogen.

Isnt it true that DHT is essential to keep estrogen levels at bay? And by removing up to 70% of DHT with a drug like finasteride youre exposed to amounts of estrogen not normal to a male body. That could make for ex building muscles harder, cause you to develop gyno (male breasts) and or other feminine atttributes? What can be done to keep the estrogen levels normal when youre on a drug like finasteride.. or does it matter much if estrogen is roaming freely? whats your opinion Dr. Rassman.

This is a huge concern of mine. Thank you

Your questions are all over the map and many of your facts just don’t fit together. You do not wipe out 70% of DHT, you just block 70% at the hair follicle level. There is no feminizing effects of taking a DHT blocker and if by rare chance you got breast enlargement, it is thought of as an idiosyncratic reaction, not a feminizing process.

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I have read through this blog but cannot find a question that is very similar to mine. Much appreciate an answer.

I’m 40, been balding slowly for many years now, and when the middle part of the scalp started showing up, decided to do something about it. The dermatologist prescribed fin-minoxidil combo. But I have been only on minoxidil for over 6 weeks now. For the first five, I’ve been applying about 1.5ml twice daily; then I realized I was reading the meter on the injector wrong, and have been doing 1 ml twice a day since.

My hair has thinned at a much faster rate after starting the treatment. I know that some people experience minoxidil-induced shedding initially, but here is what perplexes me: I did not notice any visible shedding. By ‘visible shedding’, I mean that I did not see hairs falling off, but the appearance on the scalp is one of heavy loss. In fact, visible shedding has come down quite a bit. My hairs are thick, and prior to beginning the treatment, I would see a lot of hairs on the floor at workplace, or on the pillow, or in the bathroom sink. I see far fewer hairs now after minoxidil. Yet, overall, my hair definitely has thinned at a much, much faster rate.

I am not sure what to attribute this to. Should I assume that minoxidil is working, and that thinning has happened because I shed miniaturized hair that naked eye couldn’t quite spot well? Or am I experiencing a rare adverse reaction due to first 5 weeks of overdose?

Is it possible that minoxidil can cause permanent hair loss that wouldn’t otherwise have occurred without the drug? Thank you very much.

First, you should meet with the doctor that recommended the treatment. I would have mapped out your scalp for miniaturization so without those baseline measurements, I would not know what is going on with you.

Is the finasteride/minoxidil combo a 2 step approach (oral finasteride, topical minoxidil)? Either way, two months is a short time for these medications to give you an effect, but your doctor should check you out to be sure you are not harming yourself (doubtful).

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How come people can’t get a grip?

There is so much hysteria out there about the sexual side effects of Finasteride on all the balding forums and blogs that I though I should link a couple studies that might calm some of this down.

1. Medscape (*Editor’s note: requires login)
2. Journal of Sexual Medicine

Both of those independent studies were done with the 5mg dosage and both are aimed at explaining the occurrence of sexual side effects from taking the drug. The second one is especially interesting because it involved splitting users into two categories, ones who were told about the sexual sides and one who were not…big surprise; the ones who were informed of the sides reported side effects at a MUCH greater frequency then the people who were oblivious.

Both studies conclude that side effects are very rare and in most cases are psychological. Archives of Dermatology (PDF file)

Then there is this study done recently at the University of Bologna by Dr. Antonella Tosti where:

“The IIEF, a brief, reliable questionnaire, was self-administered to 236 patients taking Propecia® and 236 age-matched males attending the Department of Dermatology of the University of Bologna”

She concluded that sexual dysfunction is actually less common then reported in the literature and there was no real statistical difference in sexual dysfunction between the men on Propecia and the men who weren’t on anything.

I am someone who was considering taking Propecia but I was on the fence after all the horror stories I read, finding these articles really helped put my mind at ease and I hope they can help others as well.

I thank you on behalf of all the visitors to this site who are in a panic or undecided about this subject, which you so nicely elucidated!

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Ive been using minoxidil for some months now then I started experiencing prolonged chest pains. Reading the other questions posted here I’m just wondering: Has anyone died from using minoxidil? Or at least are there cases when users developed drastic health problems from its use?

I’m not aware of any reported deaths from using minoxidil, but I did find that there was something published in the Journal of American Academy of Dermatology over 20 years ago titled, “Deaths associated with topical minoxidil therapy“. The problem is, I can’t find any text from it, nor have I found anything referencing minoxidil related deaths since then… so the title could be misleading. It has been reported to kill cats though.

Minoxidil was originally an oral blood pressure lowering medication. When you put it on the scalp, it can be absorbed in to the blood stream and cause low blood pressure related symptoms which could restrict coronary and brain blood flow (in theory) causing a heart attack or stroke. If you are having chest pains, it may not be related to minoxidil and could just be coincidental… or you may be unmasking a serious heart related issue. I would urge you to go see your doctor and have your heart checked out.

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