Category: Drugs

i’ve heard people complain about “shedding” with Rogaine, Propecia, and Avodart (more with Avodart and Rogaine). I can see from what you have posted before how Rogaine may cause “shedding” (or loss of hair) as it speeds up the hair cycle, and may cause hairs to fall out to be replaced by new, by stimulating the hair cylce process. But how would Propecia or Avodart cause shedding? It seems like it would cause to stop, since only a hormonal inhibitor, not some hair regrowth stimulant. Are these people complaining of “shedding” really just experiencing hair loss from genetic hormonal factor (androgenic alopecia), and it just has not been long enough for their Propecia (6 months to 1 1/2 years) to really kick-in and cause regrowth?

Propecia (finasteride) and Avodart (dutasteride) may cause hair shedding in some, probably through the same mechanism. The exact mechanism for this hair shedding is not known, but the shedding induced by all different medications generally fall into the same pattern. As we’ve said before, this hair shedding is usually temporary and reversible within a few months and not as common as the readers of websites may think. In my practice, I rarely hear this complaint.

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Dear Dr. Rassman,

First of all, your website is very helpful and I commend you for offering your expertise.

My question is about a return to natural hair color while on Propecia. I am 28 years old with thinning hair, which has always been naturally thin but I am definitely balding recently. My hair is blonde but has darkened a bit over the years (a dirty blonde now). I have been on .5 mg propecia every day/every other day for 2 months now.

I noticed that much of the hair I lose is shorter, thinner, and a black color compared to the rest of my healthier hair strands. But recently since I started on propecia, the base of the hair falling out is a very light color, while dark towards the end. The lighter part at the root is about 2 cm or so and matches my more ‘natural’ hair color.

Is this an effect of Propecia? Does it mean that Propecia is having a positive effect returning my hair color/strength/thickness to it’s natural state? Why would thinner hairs be so dark in the first place?

Thanks for any answer you can give!

Miniaturized hair is lighter in color due to less melanin pigments present in each hair. Propecia can help thicken the miniaturized hair and by doing that make new hairs look darker. The light hair that you are losing may be the cycling miniaturized hair. Since you recently started taking Propecia, you may gain some of the original color back in the growing hair. Your miniaturized hair may continue to grow for a year or more and may eventually stop growing if Propecia can not keep it at bay. That is the reason most patients will see some return in color during the first year of taking the medication.

Dear Sir,
I am 32 years old male suffering from male pattern baldness. I ask you can I take antiandrogens for treatment of baldness? Looking forward to receive your answer.

Antiandrogen is a group of medications that block different forms of male hormones. What we generally recommend for treatment of male pattern baldness is finasteride, which is also classified as an anti-androgen in some sources. Finasteride blocks production of DHT (dihydroxytestosterone), which is one of the forms of testosterone that can affect hair growth in prone patients.

The typical antiandrogens can block testosterone. Although these medications are used for treatment of prostate cancer, they are not recommended for treatment of hair loss because of their numerous side effects. If you are a man using these antiandrogens for other medical conditions, they may positively affect your hair but may kill your sex life so you should not use them merely for treatment of male pattern baldness.

Dear Dr. Rassman,
hair loss started when i was 15, now that am 20 it got worse, and my forhead got bigger due to hair loss,what are the possible causes and treatments for that?

This is most likely genetic male pattern balding. You need to getyour hair mapped out for miniaturization to make the diagnosis and then possibly consider medications like Propecia.

I received 2 emails from 2 different readers about my recent post discussing using minoxidil and Propecia together —

EMAIL 1:

I was interested in your recent suggestion that minoxidil and propecia used together may be better than only one at a time. My question is concerning minoxidil. I tried it a while ago but got very bad itching of the scalp. Is there a form of minoxidil that won’t give me this side effect? (e.g. rogaine foam or some other variation). I would really love to use it in the hope that it will slow down the hair loss process. I know others have previously stated that they couldn’t use it due to the itching, so it would be great if there was something out there to fix that problem.

Thanks doc. I read your site almost every day and love it.

EMAIL 2:

In response to your new theory on the combination of Rogaine and Propecia. Would you then advise immediate combination of the two, or would you still prescribe a one year period of just Propecia? Could it depend on the results that one are looking for? i.e. regrowth vs. maintaining/slight regrowth. Thanks. Very helpful website.

I combined the answer of these two questions.

Although the combination of minoxidil and finasteride is reported to have a superior effect on hair growth over taking them separately, I generally do not start my patients on both of these medications at the same time. I may add minoxidil to the treatment regimen of a patient who has been on finasteride for a while and now feels that finasteride is not holding anymore. This usually happens after the first year of taking propecia when patients are done with the initial hair growth and stabilized in a new and better status. At this point patients’ rapid hair loss either stops or significantly slows down and the patient does not see hair grow as they initially saw within the first year, so they get disappointed and seek further help.

I like to leave at least 6 months to a year before starting a patient on the second medication and I also perform a miniaturization study before starting the second medication. This may give me some idea of the rate of growth with each of them. By starting one medication at a time, I know what medication is responsible for the good or bad changes. Also, if patient develops an allergy to one of these medications, it would be easier to find the culprit when you start them one at a time.

If you develop a contact allergy to minoxidil, it might be the result of the other chemicals in the solution and not the medication itself. You can switch between different versions of the same medication (i.e. minoxidil lotion vs. foam) to see whether you experience the same reaction or not with that particular product.

ive been lossing my hair since about the age of 17 and I gave up and shaved all my hair off and have continued to do so til today ( im 29) i still get very thin hairs that cover a good portion of my head, my question is will propecia and/or rogaine work at this point since ive been shaving it for so long. All the males in my family are bald.

Another question is I have a 17 years old brother and he has started to show some slight signs of hair lost is it safe to start him on propecia at such a young age.

First, shaving your head should not impact the way either drug works. One may make an argument that minoxidil is easier to apply with a shaved head and as the drug really works below the skin, the hair does not get in the way of the application of the medication when it is shaved. It certainly will not produce a negative effect.

What you did was ignore your balding over the past 12 years and the process has progressed. If there are many miniaturized hairs, Propecia may bring some of them back, so it might be worth a try, but go a full year on the medication. Rogaine Foam also seems somewhat effective and in combination, the two might help.

For your younger brother, do it the right way, get his hair mapped out for miniaturization to get a basic metric (measurement) and then put him on Propecia (ask your doctor). Maybe he will not go through what you did.

Hello,

I am 24 years old and started taking Finesteride about 10 months ago. Recently I started noticing a significant amount of hair falling out after I shower. I’m wondering if it may be due to the life cycle of hair. Could all the hair be falling out for new hair to be growing in?

Thanks

Propecia (finasteride) is taken to slow down the progression of hair loss, but you can still lose hair while on medication. If you are going through a hair loss cycle, it is possible that the Propecia may not fully stop it. It is difficult to say if what you are experiencing is normal without a miniaturization study and a good physical exam. If you are concerned, I recommend that you see the doctor who prescribed the medication and see what he/she recorded on your medical chart when you were first examined. If you had a miniaturization study done you can follow the progression of your hair loss/growth and see what the 10 month interval change has been. If the miniaturization is worse, then it is probable that a loss cycle is in process. I would want to know to what degree your miniaturization was, in what pattern you are now losing it, and if it corresponds to the miniaturized hairs and what was the predictive hair loss pattern that you might have inherited.