Category: Drugs

I am 37 years old and have fine thin hair. I have been using propecia for seven years and have been happy with how it has helped me retain my hair. However, lately I have noticed some thining of my hair. Should I start using rogaine along with propecia to stop any further thining or loss of hair, or is too late for me at age 37 to start using rogaine with propecia ?? Thanks.

Adding minoxidil may be worth a try. It isn’t too late, but it will take a full year to know if the second medication is working.

NOTE: A physician-scientist reader that has provided some fantastic emails in the past has sent in the below post about prescription drugs sold over the web illegally. I believe it is in response to our post about Xandrox15 Plus. Again, the following (below the line) was not written by myself or any of the other BaldingBlog editors, but it provides some very useful information and is important to read for all U.S. residents.

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Balding Blog Patients: Buyer Beware

Contributors to the Balding Blog often ask about the benefits and risks of various drugs sold over the internet. Some of these drugs are (a) approved (such as finasteride) and available without a prescription, and (b) reformulations of approved drugs (e.g. minoxidil) that normally do not require a prescription but have high concentrations that are not approved by any regulatory agency or have undergone any clinical testing to determine risk/benefit ratio. Readers should know that providing prescription (“non-over-the-counter”) drugs over the internet by a physician without a proper medical evaluation is illegal in the US. The reasons for this follows, with information that has been nicely summarized and adapted from Annals of Internal Medicine, 7 December 1999 | Volume 131 Issue 11 | Pages 861-862):

1. Sale of drugs on the Internet without a prescription is illegal. At present (2008), the FDA and state licensing boards are underresourced, and are able to pursue the most egregious complaints related to misconduct and public safety (and typically only following a consumer complaint). As a result, the presence of this activity should not imply its legality. Both the FDA and state medical boards have intervened to close many sites where this practice is common (including suspension of the physician’s medical license).
2. The main reason why this activity is illegal is that it bypasses the normal risk-management system inherent in a physician-patient relationship. The concept of a “prescription” drug is to ensure an evaluation by a physician to determine whether use of the drug places the patient at increased risk for adverse effects, to determine and educate the patient about the risk/benefit ratio, and to evaluate for potential dangerous drug interactions. Congress requires that the FDA classify certain medications as prescription drugs for a reason: a practitioner’s supervision is essential to safe use of these drugs.
3. Beyond the illegal practice of prescribing certain drugs on the internet without a medical evaluation, internet prescribing of new formulations that involve high concentrations of approved drugs without a medical evaluation is also illegal. In addition to the inability to evaluate the aforementioned factors, this practice also increases the possibility of contaminated drugs during manufacturing.
4. Many “baldness drug sites” do nothing other than require the consumer to click a button and supply address and credit card info to obtain certain prescription drugs (e.g., finasteride). However, internet prescribers who supply prescription drugs solely on the basis of a questionnaire also are acting in an inappropriate manner and do not meet the standard for the appropriate care of a patient. The American Medical Association formally adopted the position in the early 1990’s that any health care practitioner who offers a prescription to a patient solely on the basis of an on-line questionnaire without having ever examined the patient has not met the appropriate medical standard of care. The FDA agrees with this position, and more than a dozen states have already taken action against practitioners who prescribe drugs in this manner.
5. However, the most egregious situations are where physicians supply prescription drugs (such as finasteride) over the internet without either a questionnaire or direct evaluation of the patient.
6. In general, patients should not buy drugs from Web sites that offer to prescribe a drug for the first time without a physical examination, sell prescription drugs without a prescription, sell drugs that are not approved by the FDA, sell approved (over-the-counter) drugs in formulations that have not been approved, do not offer the opportunity to ask questions of a registered pharmacist, require that you link to another Web site to purchase the drug, or do not provide a U.S. telephone number and address to contact with questions.
7. The “Balding Blog” website can play an important role in educating patients about dangerous practices on the Internet related to obtaining drugs for baldness under these circumstances.

I’m a month shy from becoming 22 years old and yet have already early signs of frontal hair loss. And nobody had hair loss in my family except my father but not until his 30s! So I got a miniturization study done by Dr. Bernstein and he said it’s signficant for my age. He did tell me that Propecia will work for me and my hair should reverse to how it was up to 1 year ago (it was really good then). I don’t doubt the doctor but even if Propecia does work for me, can it retain what I have for many years till I’m like 30 or so? Or is that too big of a dream?

Some men report that Propecia gives them long term results, while others report some reduction of value where it seems to be less effective around the 5-6 year mark in retaining their hair. This doesn’t mean it stops working, but that your body is progressing along its genetic track for hair loss. On the other hand, I’ve had patients that have been taking it for 10+ years without any progression of the balding. So what I’m getting as is that each person is different, and I couldn’t say one way or another whether you will have great results, no results, lasting results, etc.

I’d expect that if you’ve seen Dr Bernstein and he says Propecia is a wise choice for you, that you should follow his advice.

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I can’t afford Propecia, will minoxidil work as well. I am 28 years old.

Minoxidil may work for you, but if you are a male under the age of 35 and you have hair loss from genetic causes, Propecia (finasteride 1mg) is absolutely the best medication to treat your loss.

To save money, you could try Proscar and cut the pills into quarters and reduce your cost almost to the level of minoxidil. Proscar is 5mg finasteride (for treating the prostate), Propecia is 1mg finasteride. Your doctor will need to be willing to prescribe Proscar to you, though. You just need to cut the 5mg pill into 4 pieces (it’s easier than cutting into 5 equal parts), and enjoy the cost savings. The Propecia pill has a protective coating on it and the exact 1mg dosage without dealing with pill cutters or storing cut pills, so there are advantages to having the genuine Propecia. On the flip side, there is a generic Proscar available (see image for one brand), which drops the costs even further. There is no generic Propecia at this time.

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Hello again Doctor,

About 3 months ago, I switched from taking Propecia to Proscar. I found the pills to be difficult to slice into 4 pieces, so I just took 1/2 of one instead (the pharmacist only charges me a $10 co-pay, so I can live with spending an extra $5 a month). I asked Dr. Bernstein if this was OK, and he said yes. The problem is my hair has been falling out more rapidly and I’ve become extremely frustrated. My question is this – is this coincidental or should I go back to taking Propecia? or is it possible that I am taking too much?. Thank you for this website and for your time.

I doubt that the higher dose (2.5mg finasteride) that you’re taking will work less effectively than the lower dose of Propecia (1mg finasteride) and cause you to rapidly lose hair. It might just be a coincidence, but you should discuss this with your prescribing doctor.

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What about Regaine Minoxidil 2% thats sprays the hair. Is it effective? This way I avoid having the side effects of the propecia.

Minoxidil is effective on its own, but for men, I’ve seen a greater response to Propecia and it is what I recommend for my patients. Minoxidil (available over the counter without prescription) is not a substitute for Propecia (by doctor’s prescription only).

If you’re considering switching from Propecia to minoxidil and have been on Propecia for a while and saw benefits from it, I have no doubt that you will lose lots of hair if you swap one for the other. It should be noted that both medications have their risks of side effects, although quite small.

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