Category: Drugs

Hey Dr. Rassman,

Since 19 yrs of age, I started taking Propecia daily as prescribed by a doctor. I’ve taken it for 6 years up until last July. I felt that Propecia’s effectiveness had started to wean off and I did not want to take a pill every morning for the rest of my life. Also, I felt that the prolonged usage of this medication might cause health issues when I’m much older and I had already started to dread taking the medication each morning.

Since I stopped taking the medication, I expected to shed massive amounts of hair in about 3-4 months after the medication completely leaves my blood stream and for my DHT levels to get back to normal. Surprisingly, the reverse actually occurred. My hair was getting better each month and I was even able to keep it long at a certain point.

I even noticed an improvement in my libido. On days when I would accidentally overdose on propecia (I used to buy Proscar and cut them up into quarters. Sometimes I’d take half a pill instead of a quarter), I’d have erectile difficulties.

I was wondering if I’m the first person you’ve heard of who’s actually done better off propecia than on it? Was I going bald in the first place? I do however use anti-dandruff shampoo and nizoral daily.

I hope my post helps individuals who’ve started propecia at a young age and are thinking of getting off the medication but are afraid to do so.

This is the first time I’ve heard of someone stopping Propecia after many years and their hair actually getting better. Normally, the story is just the opposite and catch-up hair loss occurs after stopping finasteride.

I have no way to know if you even had genetic hair loss in the first place. If you had early loss when your doctor first prescribed the Propecia, then what you’re describing doesn’t make sense to me, unless perhaps the Nizoral is providing you some benefits. I’m not convinced that Nizoral is a satisfactory treatment for genetic hair loss though, and I would’ve still expected some catch-up loss to occur. Out of curiosity, did you ever go back to your prescribing doctor to get his/her take on your situation?

In any case, I’m glad to hear of your hair growth success… but I would warn readers that as the opposite effect (hair loss) is fairly common after your stop the medication, following in your path may not be in their best long term interest.

Snippet from the press announcement:

The U.S. Food and Drug Administration, in partnership with international regulatory and law enforcement agencies, took action this week against more than 9,600 websites that illegally sell potentially dangerous, unapproved prescription medicines to consumers. These actions include the issuance of regulatory warnings, and seizure of offending websites and $41,104,386 worth of illegal medicines worldwide.

The action occurred as part of the 6th annual International Internet Week of Action (IIWA), a global cooperative effort to combat the online sale and distribution of potentially counterfeit and illegal medical products. As part of this year’s international effort – Operation Pangea VI – the FDA’s Office of Criminal Investigations, in coordination with the United States Attorney’s Office for the District of Colorado, seized and shut down 1,677 illegal pharmacy websites. The effort ran from June 18 to June 25, 2013.

Read the rest — FDA takes action to protect consumers from dangerous medicines sold by illegal online pharmacies

The press release points out that these sites were selling fake and potentially unsafe medications, while claiming to be Canadian pharmacies to trick US consumers into buying.

Hi Dr. Rassman,

I’ve been on Propecia and Rogaine for 3 years and have been delighted with the results……up until now. Propecia and Rogaine thickened the hair all over my scalp and slowed the regression of my hairline. Unfortunately, it’s becoming apparent that my crown is now thinning, an area that had been strong prior to treatment.

I’m 28 now, and, if possible, I’d like to keep my crown hair for another few years, what are my options?

1) Would upping propecia dosage ever be advisable for a 28 year old?
2) Should I consider Avodart off-limits until it is FDA approved for hair loss?
3) What would you do if you were in this situation?

I’ve a check up with the doctor (who I’m very happy with) that originally prescribed the treatment in a couple of weeks, and will pose the same questions to him. However, your opinion is really important to me, and will help inform any decisions I may have to make. All the best

Upping the dose of Propecia (finasteride) usually does not work in your situation. Rogaine (minoxidil) is fairly effective in the crown and worth trying. Avodart (dutasteride) is an option and some doctors will prescribe it, however, the long term risks of sterility are there (probably remote), and the side effects are more frequent than on Propecia.

Try the minoxidil and give it at least 6 months. Then reassess your situation.

Good afternoon Doctor. To make a long story short just want to say I am a 28 year old male with early hair loss, and my derma gave me an rx for the drug avodart to stop hair loss. He didn’t give finasteride as he said its weak, and avodart is better. he told me about all the side affects of both drugs such as erection problems, gyno, low sperm count with avodart, etc. and basically said its my decision to pick which one, propecia or avodart so I choose the more effective one. I honestly do not care about the side affects, I’m single and I could care less if I have erection problems from avodart. My hair is more important than sex lol.

But anyways my question is that does avodart from clinical experience and studies does it work on hair loss better, or its about the same as propecia? The reason I’m asking is because avodart is more expensive, so if it the same as propecia might as well take the cheaper one. My dermatologist said it blocks type 2 5AR way better than propecia, and that the type 1 blocking ability of it will do nothing for hair loss as type is negligible and not proven to cause hair loss. From your practice, are the patients that take this drug doing better than the ones on propecia?

My first choice for a drug treatment is always finasteride (Propecia) and in the generic form it costs about $3/month. So yes, while Propecia is probably the cheaper option, it is also the only oral drug approved at this time by the FDA for the treating genetic hair loss (the other is topical minoxidil).

There haven’t been a ton of studies comparing the two for treating hair loss, but the one study that stands out in my mind is from late 2006, where 416 men were studied over 24 weeks. The results showed dutasteride was more potent and resulted in a superior hair growth count based on photos. But that is just one study over six months time, published nearly seven years ago.

One does not have to give up their sex life, nor does one have to take crazy risks with this decision. The incidence of sexual side effects from finasteride is 1 to 2%. Avodart (dutasteride) might work better in some men, but the side effect risk is much higher. I would criticize your doctor’s view on these two drug choices, and will point out that you are welcome to get another doctor’s opinion. Some doctors who do not specialize in these areas may not have all the information.

Doctor, how are you. I have been on propecia for 2 years, with fairly good results. hair is about the same, but my question is why do I still shed alot of hairs. I just want your opinion on this from your experiences with propecia and hair restoration field. I mean I know your suppose to shed up to 150 hairs a day, but I feel like I shed more. The hair still looks the same, but why is the shedding so much?

The amount of hair I shed I should be slick bald now, but still have a full head of hair with a bit of thinning like it was 2 years ago when I started propecia. when I wake up theres like 20 hairs on pillow, when I shower I shed so much, when I comb I shed so much, and its been like this even before starting propecia, but still have hair.

are there people that shed more and its still normal? I shed thin weak hairs, to thick hairs, and hair still looks same. As I said with the amount I shed I should be slick bald

We still cycle hair and the thin, weak hairs will eventually be lost. Propecia delays the long term hair loss, but it does not stop it completely. If you have not had your hair bulk analyzed, you should have it done. A baseline of hair bulk will tell you over time what is really happening to you.

Wasn’t finasteride created based on the research DR. julianne imperato-mcginley did in the dominican republic where she followed pseudohermaphrodites that had the alpha 5 reductase type 2 deficiency. I have not read anything regarding an aboriginal tribe in the Amazon. the research that I have read on the internet is that merck created finasteride based on DR. julianne imperato-mcginley research. it doesn’t say anything regarding aboriginal tribes in the Amazon

From this article in the LA Times: “In the early 1970s, Dr. Julianne Imperato-McGinley, an endocrinologist at Cornell Medical College, traveled to a remote mountain village in the Dominican Republic to study a group of children with a unique condition.” DHT was identified as a cause of the problem of ambiguous genitalia. Of course, this led to the development of DHT blockers.

You’re right, though. I guess I misremembered that one. I’ve posted in the past that it was tribe in the Amazon instead of mountain village in the Dominican Republic (that post has since been updated).

I’m considering upping my dose of finasteride. When I began taking it 18 years ago I took the full 5mg daily. About 6 years ago I started taking 1mg Propecia, and I feel it has not maintained my hair as well.

Now, I’ve read the argument, and seen the graph explaining that finasteride suppresses DHT at a rate that platoes at about ~70% DHT for 1mg to 5mg. So the suppression rate of DHT is no better for 5mg of finasteride than for 1 mg. My question is this, if the amount of DHT suppressed by 1mg – 5mg finasterde is virtually the same, why BPH patients proscribed 5mg instead of 1 mg? If purpose of the medication is to reduce the amount of DHT wouldn’t 1 mg be as effective in the treatment of BPH, if dosages of 1mg – 5mg produce the same effect on DHT concentration?

For this reason I’m skeptical of doctors who say that increasing my dose of finasteride won’t produce better results (as I believe I’ve had before). Can you tell me where my reasoning is wrong?

Thanks a lot.

When drug doses are assessed, they are tested against large, statistically valid populations who have symptoms. The effectiveness of a drug is determined by balancing the safety of the drug.

In the case of finasteride, huge populations of balding men were given graded doses from as small as 0.25mg to as large as 5mg, and the researchers looked for what dose produced the best response with the least side effects.

For balding, although the drug worked well in ranges of 1-5mg, the 1mg dose produced essentially the same results as the 5mg dose with the least side effect. The same approach was done for those with benign prostatic hyperplasia (BPH) and the conclusions were that the 5mg dose was the most effective dose for that disease.

Snippet from the article:

Some men who take the drug finasteride (Propecia) to slow a receding hair line may also find it reduces their interest in drinking alcohol, new research reveals.

Almost two-thirds of the men in the study noticed they were drinking less alcohol than before taking Propecia, said study researcher Dr. Michael Irwig, an endocrinologist and assistant professor of medicine at George Washington University School of Medicine.

But the decrease in drinking seen in the study may not be found in all men who use the popular hair-loss treatment. (A higher dose of finasteride is also prescribed to men for an enlarged prostate, and is sold as Proscar.)

The study, which was aimed at better understanding the drug’s sexual side effects, looked at only younger men, ages 46 and under, who had quit taking the medication for male-pattern hair loss for at least three months, yet continued to experience effects such as a reduced sex drive and erectile dysfunction.

Read the rest — Baldness Drug Curbs Men’s Interest in Alcohol, Study Suggests

The study was of 83 men that claimed to have persistent sexual side effects after stopping finasteride, with 65% of them stating they drank less booze now, 32% stating no change in their drinking, and 3% stating they drank more.

I’m not sure if the study looked into the personal lives of these men to find out if there were other possible reasons for their drinking habits to change (lifestyle or psychological), but the findings were worth posting here. The study is fairly ambiguous about whether alcohol and finasteride are definitively linked, and the article points out that there was no control group. For what it’s worth, I don’t recall any patients ever mentioning a change in alcohol consumption to me.

Past studies by the same researcher, Dr Irwig, have been written about here before.

I’ve been on Propecia since April last year. However, my hair loss is continuing at a slow pace. I know that I might’ve been worse off without Propecia, but could it be possible that Propecia only really fully kicks in and loss stopping takes more than a year? Thanks.

My standard answer is to wait at least a year, but some people see benefits of hair loss reduction almost immediately and hair growth in 6 months. Everyone is different, though.