Category: Drugs

Doc:

While I’ve never read where you actually recommended someone take Avodart for hairloss, it seemed in the past you were more open minded about it when the subject came up. Nowdays I sense you feel it’s a very bad idea. Has your perspective changed?

I would recommend Avodart only under unusual circumstances. As a general rule, I believe it is best staying with medications that are known effective and safe for a particular problem. Avodart use in a young man who could potentially get their wife or girlfriend pregnant, does not have enough data for my comfort.

If anything, I am more open minded now than I was before on the off-label use of Avodart, but I have only rarely prescribed it so far. The issue of dosing of the drug is still up in the air as the long half life of the drug (5+ weeks) could means that less frequent dosing is appropriate, but as there is no scientific information on the value based upon dosing, it adds to my general discomfort level for use.

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Doctor Rassman, I appreciate your great blog. There is no more informative site on hair transplants. I am 51 yr old male with the following question on propecia:

Having gone through all of your archives, and other sites, I still am confused as to what exactly happens when one takes propecia that makes it necessary to weight six to eight months before we can tell if hair loss is being stopped. I know you use the terminology of anagen cycle but could you be more detailed and explain this a bit better. I have read web sites claiming hair loss stops in 4 months on propecia, but other doctors, like yourself and Dr. Bernstein suggest no benefits with regards to stopping hair loss until at least the 6th to 8th month. Could you clarify this, please. Knowledge is power.

Everyone responds differently to Propecia (finasteride). Some people get great results rapidly, while other go the ’slow route’. Usually, the better results (quicker) are seen in the younger man or the man who has had recent hair loss, more so in the crown than the front. The 8 month recommendation is a ‘catch-all’ recommendation, knowing that the good studies on the drug show effectiveness between 8-12 months. The visual benefits require hair length and as the hair grows at about 1/2 inch a month, it takes time for the hair that grows under the influence of the Propecia to work its way up the ‘visual’ shaft. Much of what we report here are statistics that we have learned work well. Be patient and wait it out if you have just started taking the medication.

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hey doc

I was interesting in starting propecia to stop my hair fall but it seems that i’m freaked out now. look at this link please
http://finasteride.jconserv.net/viewtopic.php?t=189

could that be true??

please comment on this

The site you sent does not contain balanced informational. Side effects are rare and are listed in the material supplied on Merck’s Propecia website.

You can follow those that run in panic mode, or are critical for unsubstantiated reasons, or are the exception to the rule. As the reference piece is extensive, please write to me again with any specific section that you want me to address, but first please review the link to the Propecia site above.

Good evening, Dr Rassman,

Firstly, may I compliment you on a most professional and helpful site.

Secondly, I would like to know what time of the day is best to take Propecia. Also, I have read that the first stage in the hair growth process lasts for about 1000 days. So why does it take only 6 months for Propecia to start working?

Thank you.

I realize I just posted something similar to this earlier today, but I generally recommend that you take Propecia in the morning, for that is when the testosterone level is highest and the drug levels are highest in the first few hours of taking it. The half life is 4 hours, so by evening, the circulating levels of the drug will have substantially dropped. There are also ’tissue’ levels of the drug that last beyond the half life of the drug in the blood.

As for hair growth, there is no 1000 day rule. I believe that the drug kicks in a few months and may last for many, many years. It varies between patients. Please see Propecia and Hair Count.

Hi Dr. Rassman, I have read in some of your earlier blog entries where you said that it is best to take Propecia in the morning because testosterone levels rise while you are asleep. But I was thinking that it would be better to take the medicine for you go to bed, because then while your testosterone levels rise during the night, propecia would be in your system to stop it from turning into DHT. What do you think?

Morning is better. If you take it by 7am when your testosterone is highest, only 25% of the drug will be left in your blood stream, as the half life is 4 hours.

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hey,

why is it that propecia and minoxidil aren’t (as) effective in the temple regions? i happen to be thinning in the temple largely, and have been on propecia for approximately 2 months. should i continue and hope that there is regrowth in the temples or continue for posterity’s sake?

At two months, you can not draw any conclusions about the effectiveness of Propecia. You need 8-12 months. I only report what the drug company submitted to the FDA as the basis of my knowledge on this drug and the areas of effectiveness. When you talk about ‘temples’, many people believe that the temples are what I might call the corners of the frontal hairline. You need to either send me a photo and show what area you are calling the temples, or see me in person to give you an appropriate opinion.

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Hello, I am a 23 year old male and have been taking propecia on and off for about 3 years, I recently began taking it every day and am hopping to see some new results. It has worked well until recently I have noticed some thinning on top, with little to no receding in front. Is it losing its effectiveness and will the new dose plan have any positive effect? Before i was taking it every couple of days.

I am considering adding avodart to my plan and am wondering if by taking a dose maybe once a week or so I would see any benefit and hopefully reduce some of the side effects, Will the long halflife of avodart make this possible?

In theory, you are correct. Nobody, however, really knows the real answer to the question on the dosing for Avodart (considering that it has a 5 week half life). The experience with Avodart is with older men (usually over 55) and the focus on sex is often less than in a 23 year old. There are significant sexual side effects on the 55 year old men taking Avodart and amongst the doctors who are recommending it in the ‘hair’ circle, there are reports of more sexual side effects with Avodart in the young man. As the drug is not FDA approved for hair loss use, there is really only anecdotal information and opinions on the subject available. You seem to want to be your own doctor. I always was told that a person who treats himself, may have a fool for a doctor. Your call.

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I take 1/2 Propecia once every other day and this seems to have completely halted hair loss and it will not cause the permanent side effects documented at www.propeciasideeffects.com and the forum at www.propeciahelp.com

Another strategy might be to take just 1/4 a table every day based on the pre-approval data submitted to the FDA which shows no statistical difference between .25 mg and 1 mg in the actual level of DHT at the scalp.

The bottom line is that although the Merck studies only cite a 2% occurance of side effects that were observed, this drug does cause change and damage to the penis itself if taken long enough.

So I think one should try to find a balance between the minimum amount of propecia needed to halt hair loss and then use other compounds to stimulate regrowth.

If you look at the placebo comparisons with finasteride, you will see that they are relatively close, but when people talk about drops in libido, the placebo data is rarely discussed. We offer finasteride (Propecia) at doses lower than 1mg per day to our patients (take a 1mg pill and cut it in half) if they have a drop in libido with the medication. In some patients, the side effects go away with lower doses of finasteride. In many patients who get the side effect of decreased libido, the side effect goes away in a month or two without changing doses. There is no research to support that lower doses of finasteride causes less side effects and this is only suggested on rare times by us based on logic. There is also no proof to show that lower doses of finasteride can provide the same results on prevention of hair loss in balding patients, in fact, the clinical tests show that the 1mg dose is the best dose for effectiveness against hair loss. There are some studies on effectiveness of lower doses of finasteride on animals, but before we see more results from human studies, we can not recommend a lower dose hair loss treatment.

DHT is crucial for growth and development of male genital organs before puberty, but there is no report of any changes in size and shape of male genitalia in adults who take finasteride for a long time. I have to emphasize that finasteride is contraindicated in children and pregnant women, and may adversely affect development of genitalia in male children or unborn babies.