Category: Drugs

hi doc
i have serious miniaturisation but the doctors i met didn’t even look at my hair closely and gave me some vitamin pills. what can mpb sufferers do if the doctors wont prescribe drugs like proscar? i seriously doubt those docs have heard about fin

The answer seems pretty obvious to me, but if the doctor you went to won’t prescribe you finasteride to treat your MPB, seek out another doctor. It might be possible that you don’t have genetic hair loss, in which case, finasteride wouldn’t be necessary.

Finasteride has been available for over a decade, so I don’t know how your doctor might’ve not heard of it. It sounds like your doctor didn’t understand hair loss if he didn’t even examine your scalp.

I should also point out that if you were looking specifically for a Proscar prescription to treat your hair loss, your doctor should prescribe it with the direction to cut the pill into 4 pieces. Propecia is for treating hair loss, Proscar is a higher dose for treating the prostate.

Hello Doctor,

I’m a 25 year old male- who has an identical twin brother. We’ve both had shoulder length hair for about 10 years.

In the past year I’ve noticed my hair around my temples and sides thinning out a lot, and noticing my scalp more after a shower. The hair on my crown has also thinned out a bit but not as bad, and the hair on the top feels much less dense and thick than the hair at my sides and back of my head, even though I have fine hair. My brother’s hair has thinned out less, but I do stress more than he does.

I finally plucked up the courage to see my doctor who gave me topical rogaine 5% and proscar 5mg to be divided into 4 (rather than propecia due to cost).
Is it safe to take the two together? And is it ok to take proscar instead of propecia?

I’d very much appreciate your advice as I’m a bit embarrassed to ask my doctor this.

We have known for years that stress accelerates the impact on balding for genetic hair loss. Your brother may eventually catch up with you, as you both age further.

It is perfectly safe to use Rogaine and finasteride at the same time, and splitting a Proscar pill into 4 pieces is equivalent to taking Propecia.

Hi Doctor Rassman,

Thanks for all your great work you do answering people on here. Just wondering about what time I should take finasteride, and if my current regime could make it less effective? I have been taking finasteride for about a month and a half, so it’s obviously too early to tell if it’s working, but I have had no discernable side effects. I work evenings, so because of my routine I wake up around midday, and take the quartered 5mg then. I have heard that it’s best to take it very early in the am. Is testosterone highest in men generally in the early morning, or is that just because it’s when the average man wakes up? Should I wake up at 7 to take the pill then go back asleep?

Hope to hear your answer,

Thanks again

There’s no need to wake up early just to take finasteride.

I used to tell patients to take it when they woke up, but that was really just because it would help them to remember to take it as part of their morning routine. Really though, there is no evidence that finasteride in the morning or the evening is better one way or the other, as long as you remember to take it regularly each day.

I am a 26 year old man with male pattern baldness. I have had had three 1 mg doses of Propecia over three days – normal course. After the second day, I was able to get a normal erection pretty easily. On the third day, I came home terrified I wouldn’t have an erection, as I had been reading so much about potential side effects, and on the fourth day I seem unable to get one.

I have never had this kind of issue before. It might be psychosomatic or real. Should I see it through for a few more weeks or days, cut dosage, stop, etc.?

Some men are highly suggestible, so I would not be surprised if you talked yourself into the problem. The power of suggestion is a very real thing. Reading and worrying about the side effects could’ve given you anxiety, which in turn could cause the same problem you’re describing.

I am not your doctor, but you should make it a point get his/her advice. Propecia is a prescription medication, so before you cut the dosage or stop the medication, talk to the person that prescribed it to you.

Dr. Rassman, hi again.

I’m a long-time follower and fan of your blog. Besides enjoying the quality of the information you share, I really admire your realistic and down-to-earth approach when making comments about new treatments and current research. Some people consider your view to be pessimistic but I find it downright sincere. Thanks for the great job.

My question today refers to something I find in your comments quite often: the idea that even if someone has been on Propecia for quite a while, he will eventually lose the battle against hair loss. Now, assuming my understanding is correct, Propecia will keep DHT levels low for as long as the patient takes it, correct? If that’s a fact, why do we eventually “lose the battle”? Is it because the % of DHT that is not blocked by Propecia is enough to eventually affect the hair we retain or is it because besides DHT, there are other root causes still unknown to us?

Thanks a lot, Dr. Rassman!

Propecia generally impacts only 70% of the DHT by a process called competitive inhibition. This means that the drug competes with DHT at its receptor site. We really do not know much more about this competitive process, but we know that some people get great responses from the drug at the 1mg dose, while others do not. I think that the sensitivity of the receptors varies as the genetic process advances.

I have discussed apoptosis in the past, which is cell death, and this hits the hair follicles at the end of their lives. The drugs can not give back the life that the process takes away. Take a look at the various posts in the past that discuss apoptosis here.

Hello Doctor,

My question is: Ive been taking proscar 2.5 mg for a while with good results, after some time i felt that it wasnt working that good anymore. Regardless, one day i visited a local hair surgeon and after a brief talk about surgery the discussion moved on to hair medications, which he told me that i should switch to avodart (which he’s taking as well) so i did.

The first few weeks was awesome, after that i am experiencing major shedding which continued for the past 2 months (i’ve been on it for 2 1/2 months) so i dont know whether to switch back to finasteride or wait to see what happens with the avodart?

Honestly, you need to ask your doctor. This is a prescription medication that I did not prescribe to you. I can’t tell you whether you should switch between medications. Sorry.

avodart, dutasteride, finasteride, propecia, hairloss, hair loss

Hello Doctor,
I’m currently taking finasteride for male pattern baldness and i would like to know if DHT is the only androgen responsible of hairloss ? Since testosterone is an androgen too could it cause by itself hairloss too if taken at supraphysiologic dose even if DHT is kept at low level ?

Many Thanks

Testosterone is metabolized by the liver into dihydrotestosterone (DHT). It is the DHT that is most effective at causing balding and by competitive inhibition of finasteride at the target organ, the impact of DHT is reduced when a person is on finasteride.