Category: Drugs

Dr. Rassman,
Out of curiosity, is the actual biochemical mechanism of finesteride well understood? If the mechanism is enzyme inhibition and the drug is present in excess in the body, why would it not completely stop hair loss? Does the drug lose effectiveness because there is too much DHT in the system to inhibit or is there some secondary or tertiary contribution to hair loss beyond DHT?

(I guess I’m asking for your general thoughts because I’ve been reading the literature and haven’t found much)

A sincere thanks for your time and expertise.

The drug competes with DHT in a competitive process and it seems to win out about 70-80% of the time. That is why I believe it does not block the entire receptor site. That is a technical answer. With regard to other agents causing hair loss, I am sure you are right in your suspicions.

Hello Dr.Rassman i have been taking propecia for 8 months in the hope that it will help my DUPA hair loss, and i was wondering how i can tell if its working? i wear a light woolie hat on most of the time, would the hairs on the hat after each day be a good indication of if its working? because i don’t notice more that 15 or 20 a day.

well thank you for your time doctor

The right answer is a twofold approach:

1. Follow the photos of your hair from various perspectives with the hair cut to the same length — and do this yearly.
2. Rely on the science of metrics (measurements), which is best done with mapping out your scalp for miniaturization and then get a number each year on what is happening with the miniaturized hairs.

If your diffuse unpatterned alopecia (DUPA) is responding to treatment, the number of miniaturized hairs will be proportionally less.

Dear Dr. Rassman:

I am a fifty year-old female that has been experiencing hair loss radically over the last year. I have tried minoxidil several times, but can not continue on a regimen due to the
development of red, painful, fluid-filled bumps on my scalp. Are allergies common in the use of minoxidil, and are there any valid natural alternatives (plants/herbs, etc.)?

It does seem that you are allergic to minoxidil. However, you may also be allergic to the non-active (non-minoxidil) ingredient in the solution. You may want to try Rogaine Foam, which is formulated differently with different non-active ingredients, but place it only on one small area to make this an allergy test. Otherwise, there are no valid natural alternatives to treat hair loss that I would recommend.

Pretty basic question i think:
I have a prescription for finasteride 5mg which i usually divide into fours. This, of course means on a normal day i take about 1.25 mg. My question is, if due to time constraints or other circumstances i find myself not having time to split the pill and i take a 5mg pill, what side effects can i expect? are there any at all? Will it speed up the process that is already happening since i’m using the medication regularly? Thanx for the response.

Taking finasteride 5mg (Proscar) daily will not have any benefit over the finasteride 1mg (Propecia) in the treatment of androgenic alopecia (AGA). The increased dosage was studied when Propecia was released by the FDA. The higher dose will have an increased potential for side effects (there is a list of potential side effects for 5mg of finasteride here.)

My advice to you would be to just take the 30 seconds out of your day to split the 5mg pill into four pieces to get the proper dose. There are pill cutters available at your local pharmacy, and even a sharp knife would do the job just fine.

I have been taking propecia for 7 yrs now with great results…i have started to thin just a tad on my crown..still cant tell that i am balding..i was wondering if i can take saw pawmetto with propecia?? Will it block the propecia from working? or i am just fine taking my regular regimen of propecia, Omega 3 oil daily, zinc at night and Vit B and C in the morning?? Will saw pametto grow back any hair?? thanks

Call me a pessimist, but I doubt that saw palmetto will add much value to your hair growth. That being said, any DHT blocking that it might do may cause you sexual problems. I would therefore not recommend that you add it to your daily routine. Saw palmetto is thought to be a DHT blocker similar to Propecia.

I would be guessing about interference, as I do not know for sure… but my best guess is that saw palmetto will not block or interfere with Propecia.

I have read that DHT is crucial to muscle growth and building muscle. If I am an athlete who is just out of college and taking Propecia, will using the drug effect my ability to gain strength and mass? Thanks.

Dihydrotestosterone (DHT) is a male hormone, so I would expect that it might have some impact on muscle mass. Propecia blocks DHT and causes a rise in systemic testosterone by about 18%, so maybe there is an effect on muscle mass building stemming from an increased testosterone level, which is a much stronger male hormone than DHT. So indirectly, Propecia might be positive for muscle building if DHT levels go down (from the Propecia) and testosterone levels go up to compensate. Everyone is different, so I couldn’t say what is actually impacting muscle mass.

Lately, the big focus here has been that Propecia (finasteride 1mg) masks the blood measurements for other steroids when used in athletes, which is why finasteride is on the list of drugs banned for professional athletes.

Dr Rassman,

Thank you for the blog its very informative.

I was taking proscar (Finastride) and applying minoxidil for approx 6-8 months to good effect, noticing not only reduction of hair loss but good regrowth. However i was experiencing heart palpitations. I am in my mid 30s and do not have any history of any heart problems. Infact when i was experiencing the palpitations i had a thorough heart check up and was given a clean bill of health. I subsequently stopped both treatments and the palpitation went away. I have started taking Finastride in the last 3 months and do not notice any side effects however i notice no positive effect in either growth or the reduction of hear loss.

My questions are, how long does it take for Finastride to take effect if it is going to work since restarting it? Can i restart the minoxidil even with its side effect and would the side effect diminish over time?

Thank you for you assistance.

Minoxidil may cause a drop in your blood pressure even when it is applied topically, and this may precipitate heart palpitations. I would have recommended that you see a physician for this problem, but it seem you have already. I couldn’t tell you if the heart issues will cease with continued minoxidil use, but it isn’t likely as far as I am aware. I would discuss this further with your physician.

Propecia (finasteride 1mg) acts fairly fast once it is started, as we have seen a reduction in the hair that falls out within the first two months, but to see any possible regrowth of your hair will take a full year.