Category: Drugs

I just have a quick question,

I know that both you, and Dr. Pak have used, respectively, several of the treatment options that you recommend. Why don’t you use before and after pictures of yourselves to disarm the pessimists, while at the same time making a very compelling case as to why you feel so strongly that finasteride is the strongest treatment option available at this time?

The only oral medication that has been FDA approved for treating genetic balding in men (androgenic alopecia) is Propecia. So as the default, I guess it is the “strongest” medical treatment option at this time. This does not mean it will reverse or cure balding. In fact there is no cure! We are physicians. We prescribe medications based on scientific evidence as well as clinical evidence we see day to day. In the end the consumer (the patient) has the choice to take this medication, but he should consult with the prescribing doctor instead of strictly reading Internet postings that may (or may not) be true!

As you mentioned both Dr. Pak and I have personally taken Propecia daily (as well as our family members and friends) without any of side effects. Neither of us has seen dramatic hair growth, but we haven’t seen dramatic hair loss either. In the end, you are looking at the after pictures (on the right). Ultimately though, we cannot satisfy everyone. If you think something bad will happen, then it just may. The power of suggestion can be quite powerful. If you think the medication will not work, then its your choice to simply not take it. We’re talking about hair loss here, and as important as hair is to many men, it isn’t a death sentence if left untreated. We’re educating and informing about a proven treatment and I’ll leave disarming pessimists up to the drug manufacturers.

Dear Dr. Rassman,

Article at hairlosstalk.com includes the following statement of “Spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles. As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body.”

1. Is it sufficient just to block scalp DHT levels, or serum DHT reduction also necessary to combat MPB? If scalp DHT inhibition is sufficient for MPB, is serum DHT inhibition dangerous for the body as claimed by this doctor?

2. You’ve told in one of your comments that propecia is a anti-androgen, but the prospectus states that it does not have an anti-androgenic effect. Could you please clarify?

3. It’s mentioned that Androcur is the best against MPB. Is this the case?

Your reply will be much appreciated.

Finasteride needs to go through the blood stream to get to the hair follicles. When it gets to the hair follicle it then fixes to the tissue and blocks the DHT. Finasteride is not dangerous to the scalp.

Finasteride blocks DHT and when it does this, the testosterone levels often rise. If the body would not produce testosterone in response to a DHT block, then one would say it is anti-androgenic, but it is foolish talk like that because testosterone needs to be present to have DHT made by the body (DHT being a byproduct of testosterone).

Drugs like Androcur are good blockers of androgens and can produce major side effects on the male sex drive, something I would not recommend for patients with male patterned genetic balding.

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Hi Dr Rassman,
I’m 29 yrs old and have been on propecia since 1st Aug 08, so its just coming to 7.5 months now. My hair growth has gone from strength to strength since then, mainly on the top and cranium of my scalp where the hair was thinning. However i’m suffering from sexual side effects mainly erectile dysfunction (ED) and a libido drop. I got them in the 3rd month but i thought I had to give it a fair period of time to see whether it was a passing phase. But the problem has persisted and the volume of semen has gone down and my erections are not as full as before I started taking it. I have decided to half the dosage. What is the best way to incorporate this? Shall i stop taking propecia for say 3 weeks or perhaps longer or shorter and then start taking half a pill on a daily basis instead?

Also, I never tried minoxidil but I have read people complaining about dark circles and skin roughness on the face as permanent side effects. And apparently the results are nowhere near as good as propecia? Is this true? Also, does it also cause ED & drop in sex drive? If i do decide to go on Minoxidil would you recommend the 5% solution or the 2% solution?

If you have just erectile dysfunction (ED), Viagra might help. If you can not solve your libido problem with Viagra, you may have to stop the Propecia. Cutting the dose in half often helps and even 1/4 of the dose might help further. You should discuss this with your prescribing doctor.

Rogaine is not a DHT blocker and as such, stopping your Propecia will cause a significant hair shed even if you take Rogaine at the same time. Rogaine does not have the sexual side effects you are experiencing with Propecia, but it also doesn’t work to halt the hair loss (though it can grow hair). You can start with the 2% and go up to 5%, but it’s up to you. Both are available over the counter (at least here in the U.S.).

Dr Rassman,

I thought you would be interested in this study, if you have not already seen it: ScienceDaily

This study reports that small doses (0.5mg/day) of dutasteride have indeed been proven to be effective for hairloss. It would seem the study only followed a single pair of twins, but from what I’ve seen you report about dutasteride, you don’t seem to be aware of any such study.

Does this change your attitude about dutasteride even slightly?

Before I would prescribe Avodart (dutasteride) I would want to see an FDA clearance on safety. In previous posts I believe I’ve referenced that at the 0.5mg dose, Avodart is no better than Propecia. This was based on early information received, but I’d need to see a more extensive study than the one referenced in the article you sent. The article isn’t clear about a lot of things… like even mentioning how wide the study was. There have been studies done on effectiveness, but I’m also looking for safety.

As of today, Avodart is not FDA cleared for treating hair loss and my insurance company would not cover me if a complication should occur like sterility. I’m not anti-dutasteride — I just want to see the facts spelled out before I treat my patients with it.

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Locally, there is a product on the market called, “Minoval” which is a 2% formula of Minoxidil. There is nothing said about having to have a family history of balding to use it. It is highly recommended by many which report remarkable results without a family history of balding. Do I really need to have a family history of balding to use the Rogaine for men or women? And what will happen, other than facial hair (5%) if I use it and I don’t have a family history of balding?

Minoval is another product out there that contains minoxidil as the active ingredient to regrow hair, and the biggest difference with this one is that it is produced in Haiti. Along with the hair growth, minoxidil can also cause small drops in blood pressure (producing fainting).

Minoxidil should have no effect on normal hair. I am not sure why a person would use it if they are not balding, though.

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Hello Dr. Rassman,

Great blog and thanks for taking the time to help out so many people at not only no cost to us, but at the expense of extra time and effort on your part. It’s very appreciated.

Anyways, I am a 25 year old male with an equally diffused pattern of MPB that has been increasingly noticeable for less than a year. I have a couple detailed questions about Propecia. I understand that 10-17% of males on propecia still experience hair loss, but are those who experience a slower rate (but still losing) in hair loss included in this 10-17% or in the other 83-90%? Also, if I experience a Propecia side effect like chest soreness/pain/tenderness and I am I willing to live with the discomfort, is this actually going to hurt my body?

Keep up the great work!

I’m not sure where you got the 10-17% statistics, and I wouldn’t know how the figure was even calculated. There are percentages at the Propecia.com site and they explain how those numbers came to be — see here.

I do not expect that Propecia will produce chest pain of any type. I would hope that with these pain symptoms, you would seek out medical care from your primary doctor looking for real diseases that cause chest pain.

If propecia blocks DHT and DHT causes hair loss, why doesn’t this drug work for everyone who takes it?

The genetic elements of the balding genes influence the degree to which finasteride works. I would imagine that taking the new HairDX (RxR) Genetic Test for Finasteride might shed some light on who finasteride might work for best. Although it is a press release, this link contains a lot of good info about why Propecia works better for some — check it out here.

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Hi Doc,
I’ve been taking about 0.25mg of Finasteride for 2 months. Due to paranoia, I was on the look out for sides. I noticed my erections, despite being just as hard, could not be ‘tensed’ quite as well. And didn’t feel as intense as a year or so ago (But I’m not sure if it was like that before I started the treatment). I’ve come off Propecia for 2 weeks with no change. Is it safe to say Finasteride was not the cause of this minor change, and it could simply be related to aging/diet? (I’m 22). It doesn’t cause me any problems as my erections are still easily hard enough for intercourse, it’s just I’d rather be at ‘100%’ if possible.

Thank you.

It sounds like you have an erectile problem which should be addressed by your doctor. It is generally safe to assume that once you are off finasteride for 2 weeks, it is essentially out of your system (if there is some tissue fixation) and should not be contributing to your problem. Plus, you’ve been taking only a fraction of the recommended dosage and say that you’re paranoid and looking for side effects (which could lead to a psychosomatic illness).

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