Category: Drugs

I’m a male in my early 20s and I noticed my temples are now going beyond a NW2 and my frontal region seems less dense. I been to my dermatologist and Dr. Bernstein and both advised me to use Rogaine and Propecia. Should I really do that? I’m ok with Propecia but Rogaine is just too much work! Do you think Propecia is enough or should I listen to those doctors? I read on this blog you don’t recommend combo treatment for various reasons. But I been reading on the net that the combo treatment is a good way to go for frontal loss. I’m confused.

There is no correct answer to your inquiry. Opinions differ. I don’t usually recommend Rogaine (minoxidil) for those of your age unless the hair loss can not be controlled on Propecia (finasteride 1mg). For those who stop the loss and get regrowth from daily Propecia, there is no reason to double the medications. When you start minoxidil you become dependent upon it, so I separate the decision, first with Propecia for 8-12 months and then I re-evaluate the situation.

There is nothing wrong with using both medications at the get-go, but you’re going to have to use both for life, and won’t know which medication is providing visible benefits (so stopping one to cut costs, etc, is going to be a risk).

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how long does one need to use propecia to witness the benefits, and does it require continued usage-as in ad infinitum? how much does a yearly prescription cost on average?

Propecia runs between $700-900 / year, plus there are rebates offered by the drug company Merck. Cutting Proscar into 4 pieces will reduce the costs to about 1/3rd, but your doctor will need to be willing to prescribe that to you. Proscar is a prostate medication (finasteride 5mg), while Propecia is the same drug, but in a 1mg pill and FDA approved for the treatment of genetic male pattern hair loss.

There is a generic Proscar available, which also helps cut the cost. A generic Propecia is yet to be available legally in the U.S. due to patent laws.

Dr. Rassman,
I have been on propecia for roughly 6 years. I recently felt that it had lost a little bit of effectiveness, although I am also obsessive compulsive which probably played into that line of thinking. My question is if I begin to add rogaine to my regimen will I have some benefit. I guess I am confused whether or not any lost hair is salvageable after 6 years. Would the propecia keep some hairs salvageable for rogaine to take effect after this long?

Lost hair is likely not “salvageable” after many years. Remember that there is no cure for genetic hair loss. Drugs such as Propecia (finasteride 1mg) will slow the process. Propecia is not losing its effectiveness, your hair loss process is continuing so that your genetic predisposition is showing through. Or, as you said, your OCD may be causing you to over-examine your hair to try and find fault where there is none. I couldn’t say beyond speculation.

Hairs grown or maintained from Propecia will not be maintained using Rogaine, so if you stop taking Propecia, you will likely have “catch up” hair loss. In other words, your hair loss will progress to be as if you never took the drug in the first place. I believe Rogaine (minoxidil) can help, but it is the same story as Propecia on its limitations.

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I have read all over that Rogaine Foam causes vast more amounts of shedding than the liquid form. Is this true or do both cause the same amount of shedding (which of course varies by person)? I would like to know this because both are using the same growth agent in Minidoxil so I do not see how one could cause more shedding then the other. I have used the liquid form of Minidoxil for 2 months and have not experienced great amounts of shedding so I do not want to switch to Rogaine Foam if it will cause alot more.

I have not seen this in my patients, so I can not comment on the shedding comparison between the Rogaine foam and the liquid. If any readers want to share their experience with this, please leave a comment.

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Is dutasteride better for treating hair loss than Propecia?

In the Journal of the American Academy of Dermatology (Volume 55, Issue 6, December 2006), a 24 week randomized placebo-controlled study compared the two medications. DHT levels went down and testosterone levels went up on dutasteride. The results of this limited study suggested that in high doses, dutasteride had more hair growth than Propecia (finasteride). A total of 416 men were tested. There were more side effects on the higher doses of dutasteride.

This question has come up over and over again. We are waiting for the results of the Korean study to understand the meaning of the above publication. To get to the root of the question of effectiveness, we must know the results of dutasteride over a long time period and we must know the risks. There are reports of not only increased side effects such as more impotence or decreased libido, but there is also a significant impact on sperm count and possibly fertility in men. As there is a long half life of the dutasteride, the reversible nature of decreased sperm counts are not known. I would not suggest that every person rush to get this medication unless Propecia is a failure and there are reasons for trying the alternative. Please note that dutasteride is FDA approved to treat the prostate (marketed as Avodart), but it is not approved to treat hair loss, so it would be off label for the doctor to prescribe it and most doctors will not take the medical-legal risk for this off label use.

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Hello,

I was wondering if you are able to prescribe Propecia to people such as myself who are far away. Thanks for your time.

I need to see you and examine you before prescribing Propecia (finasteride 1mg). I believe that what you are asking of me is against the law, at least in California and thirteen other states. See FDA.gov – Buying Medicines and Medical Products Online FAQs for more.

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Hello,

Unless you are experiencing later stages of hair loss, it seems physicians in Canada are against prescribing Propecia. Can you please advise if you offer prescriptions for patients in Canada that are looking for use as a preventative measure?

Thank-you.

I don’t think doctors are against prescribing the medication until you’re losing a major amount of hair, as the drug will do more good in the early stage, but in your particular case perhaps the doctor does not feel you have balding or even early signs of balding. You should not be taking Propecia (finasteride 1mg) for a preventative measure if you are not even balding. You may want to see a hair transplant doctor for a detailed examination of your hair.

Dear Dr Rassman,

Can Propecia be taken along with Paxil (Paroxetine)? Do you have any patients on the combination?

Background: I am a 22 year old male. I have had social anxiety disorder and was prescribed Paxil CR 25 mg. I had weaned myself off it 15 months ago. Now my hair has started thinning and I was prescribed Propecia. But within 2 weeks of use I have had intense anxiety.

Please help me with your suggestions. thank you.

As far as I am aware, you can take Paxil and Propecia, but you need to ask your prescribing doctor before starting or stopping any medication as he/she may have more insight into what is going on with your problems. I am not your doctor and my suggestion to you is to speak to your doctor and ask him/her these questions.

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