Category: Drugs

Couple questions:

1. I read in one of the questions/answers here that DHT is not as strong as testosterone, but the first paragraph for DHT Wikipedia (take it with a grain of salt) says that DHT is 3x more powerful than testosterone. How is this contradiction explained?
2. I’m having a hard time distinguishing between propecia and anabolic steroids. Both increase testosterone levels in men. Propedia does this by inhibiting DHT while anabolic steroids do this simply by adding more testosterone. Also for both, this increase in testosterone might mean an increase in estrogen levels/aromatizing and everything that comes with that i.e. fat in a female pattern, breasts, stunted growth, etc. With professional sporting organizations banning finasteride b/c it masks steroids, this further confuses the issue. I even saw propecia being touted on a bodybuilding website as something that seemed to mimic using an anabolic steroid. Is taking Propecia basically the same as taking an anabolic steroid?

I am not a pharmacologist and what I know about these drugs are practical things that I read about. DHT is more powerful that testosterone at some things like the development of male sex characteristics at puberty and the development of other male sex characteristics as boys grow into men. From a sex drive point of view, I do not believe it is as powerful as testosterone. The fundamental building blocks of the various adrenal and sex hormones have great chemical similarity, but small changes in the molecules make very different responses in the various organ systems of the body.

Taking Propecia is very different than taking anabolic steroids… like night and day. The observation that testosterone levels go up with Propecia is not to suggest that if you take it you will be having the same impact as taking anabolic steroids. If this answer is too cursory, then take the initiative and read about it, looking at the things that seem to interest you. I’d guess that these things are covered in extensive writings in text books and research papers. Unfortunately, I don’t have all the answers (though I wish I did sometimes), and I am not the source for this type of detailed information.

Hi Dr. Rassman,

I am a 27 year old male that has had some diffuse thinning for about 2 years now. There are presently no bald spots on my head, but the hair around my crown and around my hairline has been slowly thinning. I have been using minoxidil (combined with finasteride, progesterone and retin A) as a spray 2X/day since March of this year. It’s far too early to say if this has helped, but I have been thinking of starting propecia. However, I was hoping to stop the minoxidil to see if I would receive any benefit from the propecia alone. In your opinion, do you suspect I would lose hair from stopping the minoxidil, or do you think it’s still early enough that I have not become dependent on it yet? Your opinion is much appreciated.

regards

Two months of minoxidil use should not produce dependence, unless you saw an immediate benefit directly from it. You’ll get confused by playing around with these drugs, as you don’t know really what you are doing. If I were you, I would:

1. Get your hair mapped out for miniaturization to determine the degree of hair loss by area. This is a base like measurement so that you can see the impact of change over time.
2. Start off with one medication if you do have male patterned baldness. Propecia/finasteride is probably the best one to start with and wait 8 months on this one drug before doing anything else. This way you will have a better idea of which medication is working for you.

Good luck.

Paid advertisements (not an endorsement):

I have had a 0.5″ bald spot on the side of my head about 2″ above my right ear since I was born. Would Rogaine be a viable option to growing hair there?

If the bald spot was with you at birth, I doubt that anything short of a hair transplant into the bald spot will help. Rogaine (minoxidil) will not grow hair where none had been before.

Paid advertisements (not an endorsement):

I’ve been on Propecia for about 5 years and am concerned about research showing up online, especially about the drug crossing the blood-brain barrier.

According to what I’ve read, medical research shows DHT and 5AR Type-II are absolutely critical for male libido (sex drive), maintenance of proper genital tissue structures/size/function,
seminal fluid production, keeping Estrogen/Estradiol levels in check, mental clarity/function (via assisting the conversion of various neurotransmitters/neurosteroids in the brain), and
numerous other important and as-of-yet unknown functions in the male body.

Do you feel this is all hogwash, or is the hair loss community in for a big change of opinion about the wonder drug Propecia?

Propecia (finasteride 1mg) does not block 100% of DHT. The effectiveness ranges between 60-80% of DHT blocked, which means that DHT is still around and working in the various functions you outlined. I am sure that there are many things we do not know about DHT, but we are using Propecia for what we do know. I can not give you an all clear on side effects on anything that I don’t know. If you don’t trust the FDA’s clearance, that is your prerogative. I’ve had many patients on Propecia for over 10 years now without negative issues and I can only tell you what I’ve witnessed or experienced myself.

Paid advertisements (not an endorsement):

I used to take propecia,however i decided to change to dutasteride as propecia raised my testosterone, however dutasteride has raised my testosterone slightly higher than propecia. My question is, is there any point in taking these medications for my hairloss if they are only going to raise my testosterone inturn producing higher amounts of DHT. Do you think that dutasteride is capable of continuing to keep my testosterone higher than if i wasnt taking it. What i mean is, if i continue to take dutasteride could it keep my testosterone higher than normal for as long as i am taking the medication, if so would you think the best thing for me to do is stop taking it. Or is there a possibility that my testosterone will slowly decrease. I also have i higher sex drive than i ever did, which is due to the raised testosterone from dutasteride. What should i do. please help. Thanks

I don’t know the answer to your question. From my experience, the body often adjusts its testosterone levels downward after the initial rise with Propecia (finasteride), so I would expect the same with dutasteride, but I do not have direct experience with it.

Paid advertisements (not an endorsement):

I am 22 and my hair has always been really thin, from the time I was a baby. Lately I have noticed that the left side of my temple looks pretty normal, but the right side appears to be receding. Although the area that seems to be missing hair has thin blond hair covering it. If there is still thin hair there, would Propecia and/or Rogaine possibly help to grow it back?

I style my hair using a strong gel and blow drying it. Could this be an issue?

I found pictures of myself from 18 months ago, and the left side of my head does not seem to have any loss from that time. Unfortunately I cannot find any pictures of the right side. Typically how quickly would I notice hairloss if it was a major problem?

Thank you for your time.

At 22 years old, men can develop genetic hair loss which is often worse on one side until the other side catches up. Propecia (finasteride 1mg) can increase the size of the hair shaft (making it thicker) if it is miniaturized, particularly in someone of your age. Rogaine (minoxidil) seems to work by prolonging the hair cycle, but while it might also increase shaft thickness, I can’t find evidence for that and I just don’t know. Hair gel and styling are not causing your hair loss and there’s no timetable for how fast your hair falls out (it will differ in each person depending on genetics).

Here’s what I’d suggest you look into: get your hair mapped out for miniaturization, get a diagnosis and a metric for your hair thinning, and then your doctor will probably put you on Propecia, which directly addresses the balding problems in genetic hair loss.

Paid advertisements (not an endorsement):

I do laser treatment to get rid of some back hair. Now i take propecia for hair loss. Does propecia make the hair growth on my back worse?

Propecia will not make the hair on your back grow. If anything, there are reports that it can decrease body hair in some men.

Paid advertisements (not an endorsement):

Dear Doctor,

I have been on minoxidil 5% for about 6 years. It has been alright this while holding on to the hair i have without much regrowth. Recently, i feel that my scalp starts to get immune to minoxidil and i can see patches of baldness. Do you know if the effectiveness of minoxidil actually decreases over the years? How long can the effectiveness sustain?

So far, this is the only treatment i have received. Could you kindly advise me on what i can/should do?

For you advice and opinion please. thank you

People who have benefited from minoxidil will continue to sustain some benefit over time, but if your hair loss is progressive, the benefits vary with the status of your hair loss. I don’t know anything about you, so I can not advise you on what you should or should not take.

My hairline had receded slightly over the years and more so on the corners but was in pretty good shape as of my 45th birthday. But over the past 10 months I’ve noticed a lot of thinning on the hairline and in the area behind it, which I know now is called the mid-anterior scalp. I went to see a local dermatologist/hair transplant specialist who told me that propecia wouldn’t work in that area as it was only effective on the crown. However, he did offer to restore my hairline with 900 grafs for $5,000.

Luckily, I found your site and later read Merck’s report on propecia’s effectiveness for frontal hair loss. After crunching the numbers it seems to me that it works just as well in this region as it does in the back, although it may not be as apparent. Here’s how I got there. At the start of Merck’s vertex study, the average patient’s hair count in a 1 inch circle was 876. After one year of use the average propecia user gained 86 hairs. If we assume that the pre-baldness count per square inch was 1,400 than the average guy restored 16% (86/(1,400-876)) of his lost hair. In the frontal study the average starting hair count per inch was more dense at 1,096. One year later there was a mean gain of 49 hairs so the percentage restored was 16% (49/(1,400-1,096), the same as in the vertex study. Doctor, am I overlooking something? If not, why do so many dermatologists continue to believe that propecia won’t work for frontal hair loss?

If you are thinning in the front (and have some hair there), Propecia is worth a try, but it is not as simple as crunching numbers, as you will still have thinning in the corners. I think you are on the right path of doing research on the matter. Just remember that even a hair transplant procedure will not completely give you back what you lost.

I always tell patients that going to a hair transplant surgeon requires a buyer beware caution. I’m glad that you’re taking charge and believe that Propecia is worth a try for the area you are focusing on before looking for a hair transplant. As to why many doctors believe Propecia will not work at all in the hairline, I’ve addressed this before in Why Is It Difficult to Regrow the Hairline?.

Paid advertisements (not an endorsement):