Category: Drugs

Thanks so much for writing this blog. When ever I have hair loss questions, I always start be searching your blog. I recently received an email from my doctor about his own brand of finasteride. In his email and on his website he refers to it as “compounded finasteride.” He also states that it is not an overseas generic and that is custom-compunded by a US Pharmacy. A quick google of “compounded finasteride” shows that there a few doctors in the US now offering this.

I was wondering if you knew anything about it? I’m all for saving money but I want to make sure I’m getting the same stuff. What exactly does “compounded” mean?

There are more and more “compounded” versions of finasteride on the market today. Most of these versions have the important medication, finasteride, along with other ingredients that when combined allow the physician to claim his or her own brand of finasteride. The important point here is that in most these concoctions, finasteride is the only FDA approved medication to combat hair loss and all other additives are very unlikely to help and from an effectiveness point of view, it must be taken orally as there is no science to support other ways to take it (skin, inhaling, or rectal use).

In most states, doctors are allowed to mix their own medications so if they know what they are doing and it is legal in the state that they do it in, then I guess it is legal. I know nothing about mixing medications. Some interesting historical reading includes:

• Encyclopedia: Apothecary
• A Physician’s Lexicon: The Art And Words Of The Apothecary
• History 1450-1789: Apothecaries

Hi Dr. Rassman,

I just wanted to say thank you for providing some very useful information and answers to questions on your website.

Although I have full coverage, I have been experiencing thinning hair throughout the top of my head since my early 20’s (Im now 25). Finally, I decided to visit a dermatologist last year. After asking questions about my family history (my father has experienced hair loss), he recommended that my hair loss is from genetic factors and prescribed Propecia. However, there was no miniaturization performed.

My 6 month experience with Propecia has been fairly unique. Within the third month of taking Propecia, I experienced a pretty good shed. I also noticed after a few weeks that my hair was becoming very oily (I have never had oily hair in my life). Around that same time, I was noticing that I had some abdominal bloating which was very uncomfortable. In the 4th month, I stopped taking the medication (due to the stomach pains) and within a week these pains went away.

My dermatologist encouraged me to resume propecia as I was simply “connecting the dots” to link cause and effect. After doing so, within a couple of weeks the stomach problems returned. At that point, I discontinued the medication. It seems I am worse off then when I started as the hair caused by shedding never fully returned and the scalp is now more visible (however, my hair is no longer oily).

Have any of these problems been reported or am I experiencing a very unique situation?

Thanks for your help.

Although what you are describing is not common and is not usually one of the side effects of the medication, you may be having an adverse reaction to the medication. With the half life of Propecia (finasteride 1mg), one would expect your side effects to disappear sooner than one week after you stopped taking the medication. Have you tried taking half the dose you were taking to see if you have any side effects? I would also make sure you have a miniaturization study done by a specialist in order to properly diagnose your hair loss problem.

Dear sir,

i would like to try one product containing topical saw palmetto and topical finasteride !

i am only 20 years old,i would like to know if i will have the same orally finasteride side effects(reduced libido),thank you

There is no evidence that finasteride on the skin can predictably be absorbed. Interestingly, Merck (maker of Propecia) warns that women should not touch Propecia because of a threat of absorption, particularly in pregnant women, yet there is little information on this subject. I’ll try to get some clarification from Merck for a future blog post. I am also not familiar with topical saw palmetto having any value for hair loss treatment.

According to an article from the Journal of Drugs in Dermatology in 2004, 5 alpha-reductase and finasteride in pattern alopecia and acne: “Topical finasteride is well absorbed, but clinical results were minimal with this mode of drug delivery.”

The bold styling was not part of the original article — I added that to drive the point deeper. The question about topical finasteride has been asked of me many, many times, and I hope this explains why finasteride comes in an oral pill rather than a spray, gel, foam, cream, or even a suppository.

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Hello,

My question is in regard to Minoxidil. About ten years ago my mother tried the product and ended up having a very severe allergic reaction. Her face and throat swelled greatly and she was convinced she was going to die. Thankfully, she ended up ok after several months of treatments and recovery. Doctors told her that because she applied the product after scraping her head, it most likely entered her bloodstream and resulted in the reaction she experienced.

I am now 28 years old and have been losing my hair for about 5 or 6 years. I would very much like to try Rogaine, but I am afraid of having an experience like the one I just described. My question is whether an allergy to Monoxidil is hereditary, and if there is a way to be tested in advance to determine whether or not I am allergic.

Your response is greatly appreciated, and please accept my apology if this topic has been covered before.

Most medications reactions are not true allergies. A true allergic reaction to a medications cause, itching, rash, swelling, difficulty breathing. From your description it sounds like your mother had a true allergic reaction. A family history of reaction to a specific drug does not mean that one has an increased chance of reacting to the same drug. You can do a skin test where you apply minoxidil to the skin (a very small area on your arm, possibly the size of a pea) and then wait to see if you react to it.

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Hello Doctor – and many thanks for keeping this very informative website. My question is a point of clarification with respect a question that answered earlier (the original question was care of “a very stressed out medical student).

I had been taking propecia for several years and stopped approximately one year ago. My hair loss began fairly soon thereafter and has been fast and steady ever since, despite the fact that I started taking propecia again in November. Can you explain why this is the case?

Thank You.

You are likely experiencing “catch-up” hair loss, which occurs when one stops taking Propecia after being on it for a period of time. The hair loss noted when the drug is stopped will be the same as if you were never on it at all. By stopping it, you are bringing yourself back to the same degree of hair loss that you would have had anyway. Stay on the medication now that you have restarted it. It is possible that the hair loss you are currently seeing (despite being on the medication) is a result of the “catch-up” loss phenomena.

Your experience is one that our readers on Propecia/finasteride should take note of. This is a medication that you need to take for life, unless you come to a time when you are willing to lose your hair.

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I been reading that Propecia doesn’t help on receding hairlines. But what does that mean? Does it mean if you are a NW2 which is normal and you start to recede beyond that, Propecia won’t stop that or help you get back there?

My case: I’m 22 years old and am on a little more then a NW2 which is fine with me. But 3cm into my hairline the hair is less full (not obvious but I know) and the hair around the temples are becoming short. So Propecia won’t help me there? I noticed this problem like 4 months ago and just started Propecia. I have no family history of MPB except my father but he was in his 40s when it began.

Directly from the Propecia.com website: “There is not sufficient evidence that PROPECIA works for receding hairlines at the temples.”

It has been shown to treat hair loss primarily affecting the vertex (top of the head) and the anterior mid scalp area (where it sounds like you are having some of your problems). This does not mean that Propecia won’t help you. You need to be on it at least 8-9 months before you see any benefits of the drug. For you, there may be a beneficial effect on the frontal hairline, temples, etc and I have personally seen some wonderful results on the frontal area (including the hairline), although it is not common. Its best effect is on young men who have miniaturization in the frontal area that is not advanced. In these patients, the frontal hair loss may reverse. People can react differently to the same medication. You will also benefit from a miniaturization study to determine exactly which areas of your scalp that are mostly affected, thus determining if you indeed have male pattern baldness.

I been to a dermatologist and Dr. Bernstein and both advised me to use Rogaine in addition to Propecia at least once a day. They told me that Propecia will most likely halt the hairloss but Rogaine can help stimulate hair follices and help regrow. I been reading around online and that seems to be true. I know you been saying you should try Propecia first and later add Rogaine if you ain’t satisfied, but what are the chances Propecia can also give me regrowth?

I’m 21 and with early frontal hair loss something I noticed about 4 months ago.

In my experience, regrowth with Propecia is fairly common at your age. I have seen reversal in most young men, but not necessarily on the hairline if it is receded. The advice you have been given is also reasonable, but I generally like to go at it in a step wise manner, because if the Propecia works alone, then why use minoxidil and get hooked on it also?

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