Category: Drugs

I’m currently taking propecia, and have been doing so for nine yeras with good effect. My question is, can I expect not to lose any more hair due to male pattern baldness as long as I’m taking propecia, or will the effect fade with time? That is, if I’m genetically destined to become a NW7, can I prevent this from happening by taking propecia for the rest of my life, or will I only delay the time to get there? Will my genetics eventually catch up with me, although I take propecia?

Forever is a long time, and unfortunately I am not a fortune teller. As I’ve said time and time again, the drug works differently in each person that takes it, so without an examination (miniaturization mapping) and a follow-up or two, I can’t make that prediction for you. So while I do not have any other-worldly prediction talents, it seems that you are doing the right thing by staying consistent for 9 years on the medication.

In all seriousness though, my best guess is that Propecia will delay the inevitable Norwood Class 7 (if you are actually going to go that far), but I couldn’t say how long or how strong the delay will be. As anyone could tell you, forever is a long time. I do know that if you stop taking Propecia (particularly after 9 years), your genetics will catch up quite quickly.

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hi there.

I ve been on propecia for six years with great results. The last couple of months i noticed a lot of hair loss. about 100 pieces of hair per day. Do you think it stopped working? maybe I should take 2 pills per day? or switch to another drug. or even go for hair planting.

Thanks so much

Propecia does not stop working. It is just that your genetic hair loss pattern may be showing. Propecia is continuing to work by slowing the hair loss. If you stop taking Propecia at this point you will notice a more rapid hair loss. If you increase it, it may have value at double the dose. The way to determine the effect of Propecia is to do comparison miniaturization studies over time. Then you know when and if it stopped working. Counting hairs does not do it for me. Discuss the possibility of increasing your daily dosage with your prescribing doctor.

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Dear Dr Rassman,

I know this has been asked more than a couple of times in your splendid blog, but you have never gave a definite yes or no answer to this dosing question.

I have been on finasteride for some time and although it worked well for the early few years, im starting to recede pretty aggressively this year. Will increasing the dosage from propecia (1 mg) to taking half proscar (2.5 mg) or even 5 mg even helps at all to fight the losing battle?

Thanks so much for your time!

I thought I’d answered this many times before, but if I was too vague, I’ll try it again –

The FDA says that 1mg finasteride is all you need to treat hair loss, but perhaps 2mg for those people who are losing the effect of the drug may be better (discuss this with your prescribing physician). Side effects must be titrated. Try it and see. If there is no increase in side effects (and with your doctor’s knowledge), you might go for it. The more finasteride you take, the higher the risk of side effects.

I have been using Rogaine foam for 2 months. I have also been on a lower sodium diet for about 3 months. I’m seeing a really nice improvement in my BP (I have been in the pre-hypertensive range). The question, I know monixidil in pill form is a high BP medication, but can topical Rogaine foam also contribute to a lowering of BP? Or should I just chalk it all up to lowering my sodium intake?

Thanks

Low blood pressure can be just as dangerous as high blood pressure, but if you have had borderline hypertension that has dropped to normal levels on Rogaine (minoxidil), then there may be a connection for you. Rogaine Foam should not lower blood pressure in general, but I suppose it could be a side effect. I would definitely follow up with your doctor regarding your concerns.

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I saw you recent post on finesteride. There is a new study by Redman MW et al that looks pretty positive for those on the drug. Check it out!!

Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer: A Bias-Adjusted Modeling Approach (PDF file)

You’re referring to the post from last week — My Doctor Said Finasteride Makes Prostate Cancer Untreatable!

In 2003, the New England Journal of Medicine published a study (the trial was called the Prostate Cancer Prevention Trial — or PCPT) that concluded a daily 5mg dosage of finasteride reduced prostate cancer risk by 25% (see Finasteride Reduces Prostate Cancer Risk). In fact, the number was actually closer to 28% — and that has since been revised to nearly 30% in the study you sent from the American Association for Cancer Research. An article published in ScienceDaily about that later study points out:

“From a new analysis of PCPT data using advanced statistical modeling techniques and a complete assessment of prostate tissue biopsies, they concluded that these concerns are now resolved: finasteride actually reduced the risk of developing prostate cancer more than researchers had originally thought, did not increase development of more aggressive cancers, and the majority of tumors prevented were those that could spread and cause death.

Thanks for the reference, as it goes along with my way of thinking. And just for clarification, Propecia is a hair loss treatment that is 1mg of finasteride; Proscar is a prostate treatment that is 5mg of finasteride.

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I am 18 and experiencing hair loss in the past month. I have hair loss all across the top of my scalp. My scalp is also itchy in that area. My doctor prescribed me minoxidil 5%, even though I still have full scalp of hair. Is it safe for me to apply it considering that I’m 18 and that it’s still unknown how it works (what if in about 10 years, study will show that it actually causes some serious disease)? Would it be better to take minoxidil 2%? Thank you for your answer.

I think either 2 or 5% minoxidil is relatively safe to use, as it has been used to treat hair loss since the 1980s. However, why are you using something without firmly knowing what you are treating? For those who follow this site on a regular basis, you can imagine what my next sentence would be…

Get a miniaturization study to know what you are treating and if you have miniaturization indicative of male pattern baldness, then Propecia is the best, best, best drug to treat it — not minoxidil. Also, minoxidil is an over-the-counter medication (sold as Rogaine Extra Strength, among other names), so there is no need for a doctor to prescribe it.

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I am 25 and I started taking propecia about 5 years ago. around two years ago however I took a prohormon called methasterone to increase muscle mass, totally unaware of the side affects. I developed gynocomastia soon after. My question is I no longer take prohormons but I still have gynocomastia with quite a bit of tenderness. Is any of caused from the propecia even though i didn’t have it the first three years of taking it?

That is interesting, and I’m surprised it would start years after the fact. You might want to consider stopping the Propecia for 2-3 weeks and see if the problem goes away. Definitely talk about this with your prescribing doctor before stopping the medication, though.

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I read on your site, that when you stop using finasteride after several years, you will lose many hairs because your genetic aging will catch-up, to the point where you would be when you never used it. But is this right? Because I would think that your DHT-hormone, after being suppressed for several years by the drug, and when you stop using it, it will go “over-producing” (like for example: 200%) and that would make your hair losing rapidly. Can I be right about that?

Yes, I suppose you could be right, but somehow it does not make sense to me scientifically. Testosterone is the source of dihydrotestosterone (DHT), and after you have been on Propecia (finasteride 1mg) for several years your testosterone levels should be normal. Therefore, one can potentially make the leap that the DHT will also be normal after you stop taking the Propecia.

I really can’t get into all the genetics and biochemistry aspects of why Propecia works or why you can have rapid “catch up” hair loss if you stop taking it. If you want to know the exact reason, well, it’s been many years since I took my biochemistry courses, so I’d not feel qualified to get into it (hey, I’m being honest). As a physician who treats patients and sees patients who lose hair when they stop taking Propecia, I can tell you that this happens.

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