Category: Drugs

Dear Dr. Rassman,

Before talking to my doctor I wanted to get your idea on my problem because of your expertise. I am 31 years old guy who had HT four and half months ago.I have been on 0.5mg propecia per day almost 2 months. The amount of shedding during this period has been incredible. I just got what people mean when they talk about propecia shedding. From your blog I know that this is a very good sign that propecia is indeed working. My problem is with “puffy areola”; I have always had a little bit gynecomastia, but it was not disturbing and when I put on weight it was just little bit noticeable. But I never had “puffy areola” which I have now and makes gynecomastia more visible. I believe that propecia will do a great work on my head and I don’t want to quit it. Here are my questions;

1. Is puffy areola a symptom of developing larger male breasts if I continue to propecia or will it remain as puffy areola? (which is more bearable)
2. What if I reduce the amount of propecia from 0.5mg/day to 0.5mg/every-next-day do you think propecia will still work for me and not cause this side effect?
3. I have had a quite amount of shedding during this period. If I quit propecia completely does this mean I lost them forever or will they grow back and I will lose them in time?

Regards

1. I would not know about your areola problem without examining you myself. A doctor must have prescribed Propecia to you, so you should go back and see that doctor. Small amounts of weight gain do produce changes in the male breast, more in some men than others.
2. With regard to dosing adjustments, get that from your doctor and you can read some of my previous posts on the subject — here, here, and here.
3. If you stop Propecia and you had benefits, you will get “catch-up” hair loss. For more on that, see here, here, and here.

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I have a question regarding to the use of 0.5mg or 1 mg propecia.

I’m a 23 year old male and i started using 0.5mg propecia since september 2008. Its a pitty that my hairline havent grown back, but my hair looks thicker and much healthier. And the hairs are not falling out anymore. And the side-effects are minimal to none, so thats great!

But I started using 0.5 mg instead of 1 mg because I thought i can begin low and when its needed i can always increase later. But now im actually curious what the results are when i increase the medication. Do you think its worth the try? And can there be any problems when i go back to 0.5mg later (that the drug then maybe isnt working optimal anymore because my body is used than to 1mg or something?)?

Also I just want to note: Because of the many negative news on the internet about propecia side-effects. I doubted for almost a year to begin with using propecia. Since I use it, i can almost shoot myself that i didnt begin with it immediately. I could have saved probably so many hairs!!

Thanks

Thanks for sharing the positive results with Propecia, even with just half a dose. Often times the success (or positive) stories of Propecia aren’t expressed on the Internet forums and websites because of our human nature. We seem to express our anger and share negative experiences in public more often.

I would discuss your results and goals with the doctor who prescribed you the medication. There are studies that show that a half dose may be 80% as effective as a full dose. While I am happy with your results, there are things about your story that trouble me. First, you are driving the process by the side effects you MIGHT get, not the optimal dose of the medication. Propecia generally does not work for restoring frontal hairline loss. At best Propecia may slow down a receding hairline. Drugs (like Propecia) do not just “stop” working. It is often difficult for patients to understand that Propecia may still be working as it slows down hair loss. If you are taking Propecia thinking that it will regrow hair or reverse hair loss completely, you are in for a big disappointment. In the end if you are going to go bald you will go bald. Propecia will slow this process down, but not stop it completely. In other words, Propecia will continue to work even if you notice that you are losing hair.

Finally, you are experimenting on yourself by changing medication doses around and asking for medical opinions without a physical examination (miniaturizationstudy). I cannot give you a recommendation one way or another because I don’t know if you even needed the medication in the first place. Hair loss is a medical and physiologic process. As such, I recommend that you discuss dosing with your doctor.

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Dr. Rassman, generic finasteride is available in india manufactured by Cipla and other pharma companies. the name written in them are Finasteride tablets USP 1mg (eg: finpecia from cipla). A search in internet for USP returns “the United States Pharmacopeia (USP) is an official public standards–setting authority for all prescription and over–the–counter medicines and other health care products manufactured or sold in the United States.” Link: http://www.usp.org/aboutUSP/

so does that means these generics are approved by FDA or are they keeps the standards set by US law? thanks

There are some companies outside the US that make generic drugs that are marketed in the United States and they are legitimate. There is a difference between when the manufacturer meets FDA manufacturing guidelines and the company’s ability to sell the drug in the United States.

In the case of finasteride 1mg tablets, the restrictions are enforced through the laws that govern patent protection. If company ‘X’ decided that it wanted to sell a drug in the US that is covered by U.S. Patent, the patent owner can get a court to supply a cease and desist order to company ‘X’. The owner of the patent can also file for triple damages for lost revenues under existing patent laws.

Dr. Rassman,
Thanks for your fine blog and the wonderful service it provides. In your experience, how common is oily skin as a side effect of propecia, when does it present, and does it resolve itself over time under continued treatment. I took my first dose of Propecia this morning and even now (12 hours later) my skin seems much more oily than normal.

30 years old. Thinning in front and just starting to thin in the back.

Thanks

I am unaware of Propecia (finasteride 1mg) producing oily skin, but there is some logic that it could make the skin less oily. Propecia blocks dihydrotestosterone (DHT); oily skin is caused by DHT. Here’s a page that has more info about oily skin — Dermadoctor.com

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Doctor,

Have you ever heard of Propecia causing TE?

No, I have not.

Dear doctor,
I have few questions about Proscar.

1. Do you think it is safe to cut proscar to 4-5 pieces?
2. Do you think that it is safer than buying generic finasteride?
3. Do you think that small differences in cutted pieces could have some negative effect?

thanks

And here’s a few answers to your questions about Proscar:

1. Yes, it is safe to cut Proscar into 4-5 pieces. Just cut one pill at a time.
2. I don’t think it is safer or less safe. The generic should be the same, just cheaper.
3. I don’t think the effect would be much, if any. This is why if you’re going to cut a 5mg pill, you should try to cut it into 4 equal pieces — much easier than cutting it into 5.

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Minoxidil is a vasodilator and is topical. Nitric oxide (Arginine-alpha ketaglutarate) is a vasodilator and oral.

I am having a hard time understanding why Minoxidil can grow hair (although I don’t know if it’s the same kind of hair and not just small hairs) while nitric oxide and massage typically aren’t viewed as hair loss treatments right now? You said before that Minoxidil probably works in that it prolongs one of the hair phases, but if they’re both nitric oxide based, what makes Minoxidil so different?

Minoxidil has hair growth as a side effect of the drug and I believe that it has nothing to do with its vasodilating properties. Minoxidil’s reason for growing hair is still not entirely clear.

My role on this blog is to explain what is known in research and clinical medicine, but the use of nitric oxide is not known as a hair loss treatment and to my knowledge has not been scientifically studied. You can sponsor it if you wish, but the drug companies that do this work are apparently not paying for the research.

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