Category: Drugs

I don’t have a question. Rather, I have a narrative about how my hair loss issue has been progressing.

Here’s the scoop: Noticed hair falling out last August. Symptoms abated after 2 months before returning this Spring.

Additionally, my head was itchy and tingly and it felt like little pulses of electricity were running across my scalp. Saw my PCP, who couldn’t have cared less. Even so, he referred me to a Dermatologist. She also didn’t seem overly interested either. Even so, she prescribed Propecia. Dermatologist blamed my itching on dandruff and prescribed Nizoral 2%. I disagreed with her diagnosis, but I did notice a bit of dandruff. Still think that my dandruff was not causing the itching as I noticed that my hair seemed to fall out where I had the most tingling/itching. On a side note, my scalp was not red or in any way abnormal.

During the Spring, my hair was becoming noticably thinner. It would come out in the shower and when I ran my hands through my hair. The texture changed (dry, brittle) and my scalp felt “weird”. My head almost felt desensitized.

Read plenty online and especially at this blog about the horrors of Propecia and Rogaine. Still decided to give it a try as I don’t think I would qualify as one of those who’s “beautiful and bald”. I regretted that decision within 3 days of taking the first pill. I say that because I noticed a diminished libido, soreness in my chest and some real puffiness in my nipple/chest area. Stopped taking the pills after 1 week. Went to my PCP to ask questions about Gyno. He gave me a cursory exam and told me to scale back the dose in an effort to limit the symptoms.

Started back using 1/4 pill (1 mg pill, so .25 mg daily) for a week. My libido returned slowly. Also, my chest puffiness went down (also taking Ibuprofen and icing down) after a couple of weeks. Went up to 1/2 pill within 3 weeks and was at a full pill within 6 weeks. I currently alternate between 1/2 and whole pills daily. On average I probably take a whole pill 4-5 times per week and 1/2 pill the other days.

My libido has returned, the puffiness is mostly gone and my head no longer itches. Not sure if that last part is due to Nizoral or Propecia though. Tough to say. My dandruff is gone now though. As for my hormone/nutrient levels, I had those checked initially by my PCP as I tried to rule out non-Genetic issues. All of my bloodwork came back normal.

While I am on the subject of my history, there is absolutely no hair loss on my Father’s side, but my maternal Uncle and Grandfather both lost their hair by 25. I thought that because I had made it to 34 without any hair loss I was in the clear. My mistake.

It’s been 10 weeks now since I took the first pill and my hair loss has pretty much stopped. The shafts are still a bit thin, but there seems to be some (perhaps imagined) hair thickness returning. On a side note, I also bought 5% Rogaine foam for my widow’s peak, but that hasn’t really done anything yet. However, I have only been using that for about 6 weeks.

While the majority of my symptoms have abated, I will say that it seems harder to lose weight now. The same effort that it took last year to drop 10 lbs. now only results in a 5 lb. loss. I also just seem a bit puffier in general. Is that something to do with hormones? Anyway, I guess I’ll just have to work a bit harder to drop the weight.

Just wanted to post this for those that are not sure what to expect or get frustrated by all of the hair loss mumbo jumbo you see posted out there. This blog has been quite a bit of help when it comes to answering my questions and I truly appreciate the fact that Dr. Rassman has made this site available. Thanks!

Thank you for your post! I would welcome / encourage more stories from our readers…

Of note, finasteride (Propecia/ Proscar) will cause sexual dysfunction in about 1% of men.

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Since I’m Propecia (as I was told adding minoxidil (Rogaine) ) may help, but I’ve heard Doctors (as yourself) speak of minoxidil dependent hair. If you are already on Propecia, and minoxidil stimulates the anagen phase and acts as a vasodilator, how would a minoxidil hair become dependent or be different from a non-minoxidil dependent hair, once it starts growing and you are already on Propecia, how is it different, wouldn’t the DHT blocking effects of Propecia prevent the fall-out if stop minoxidil? How would a hair that has helped grow back from Propecia be different biologically from a hair grown from Rogaine (minoxidil), don’t all the hairs benefit from the vasodilation, presuming that is the mode of action of the minoxidil?

I wish it was that simple, but unfortunately nobody really knows the right answer (including me). You may have heard that what we do, as doctors, is called the “practice” of medicine and not the “science” of medicine. Sometimes medicine works in mysterious ways! Things that should work sometimes do not. Things that should not work sometimes do.

Minoxidil’s impact on hair growth is the result of the drug’s side effect. For example, if a woman takes minoxidil as a pill (used for high blood pressure years ago, but not today), they may grow facial and body hair as a side effect of the drug. This observation is what induced doctors to try this medication in liquid form and be used for hair loss.

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Hi Doc,

First off, I have to say I’m impressed that someone who makes a living doing transplants promotes the early use of Propecia which could reduce or delay people seeking transplants. At any rate, you have convinced me. I started Propecia 2 weeks ago, and already have noticed a definate change in shedding in the sink every morning. Impossibe right? I think stress has had a lot to do with my shedding the last year. Can Propecia counter the effects of hairloss from stress? And that fast?

Also I’ve already noticed some loss in libido. What do you normally suggest to patients? Stay the course? If so at what point should one make a decision to stop? I had read that going to a smaller dose and building up may reduce side effects.

Finally I have thinning in the crown with some scalp showing. How realistic is it to expect the crown to fill in?

Thanks

I appreciate that you noticed I recommend taking a pill as a first step, instead of getting you prepared for surgery. I want what is in the best interest of my patients and my readers, and for many men, Propecia is the logical first step. If a daily pill can help you to avoid a transplant procedure, that is what I will recommend — regardless of how it affects my bottom line.

Everything you said is ‘right on’. Stay the course. If the libido does not get better in a couple of months, then consider taking half of the dose. Although it starts working almost immediately, as hair grows at 1/2 inch per month, it takes time to see the results. Also, as most reports indicate that the results get better and better over the year, there is a cumulative effect as well. As for your crown thinning, Propecia tends to work best in that area, but as the drug works different for each person, there’s no way I can give any real assurance that it will regrow your hair. Your chances are better with Propecia than not taking Propecia at all, though.

Hi,

I was wondering that if you take Propecia does it also cause hair to grow on your body say chest an face an legs as well as your head?

Thanks for helps

No, but on a rare number of patients, I have seen it cause loss of body hair.

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Dear Dr. Rassman,

I have been on Propecia for almost a month now, I have been experiencing some discomfort in my male organ. It started by burning at the tip of my organ while urinating, it stayed for a couple of weeks and then it was gone, but now I have a constant feeling of itching my organ from the inside and at the tip.

Any suggestions about that would be great from you…
Thanks

Try stopping the Propecia and see if it goes away. Maybe you have urethritis. If simply stopping the medication does not work, see a doctor.

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Firstly I would like to thank you for making an excllent website which has enabled me to educate myself while challenging you to answer questions which you have done.

If Dutasteride was approved by the FDA in 0.5mg daily, would you prescribe it to your patients instead of Propecia or do you consider propecia a good fight against hairloss?

If I prescribe an ‘off label’ drug, I am open to liability from state licensing boards and possibly medical-legal liability if something goes wrong (like the Vioxx problem). If dutasteride was approved to treat hair loss and thus would not need to be prescribed ‘off label’, then yes, I would consider prescribing it, provided that the risk factors were fully understood by me and the patient. For example, is there a substantial risk for sexual dysfunction with dutasteride that is higher than finasteride? The patient must know that risk (as I must know it), but right now the studies are not available. Without FDA approval, we really do not know what the effective dose of the medication is. The reality today is that the doctors are all guessing at the dose (not a good scenario) and the guess work is not based upon science.

I’ve just had a hair transplant (7 days ago). Without going into debate about the use of ecstasy, would its use cause my grafts to fail?

“Without going into debate” about the use of illegal drugs, you should ask your doctor who did your surgery.

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There is some literature about the association between minoxidil and upregulation of keratinocyte growth factor and vascular endothelial growth factor in dermal tissues. Do you know if there are any groups looking at perhaps topical treatment with either of these growth factors? If not, what do you think about and therapeutic potential?

Also, there is some literature that suggests that topical cyclosporin induces hair growth. What about other topical immunomodulators like Protopic?

There are drugs that have been reported to grow hair as a side effect. In fact, that is how Propecia was discovered. The generic form of Propecia is known as finasteride. Finasteride was used for many years for the treatment of benign prostate enlargement. As a side effect, it grew hair on men. As such, the drugs and growth factors you cite may have had some press in growing hair, but there are trade-offs with risks and benefits and side effects associated with any drug use. Fortunately, Propecia was approved by the FDA and deemed safe with minimal side effects. The other drugs need rigorous testing and clinical trials before they can become clinically reliable. Besides dutasteride, I do not know of any drugs that are in development or undergoing FDA approval process for the treatment of hair loss.

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