Category: Drugs

Earlier this year I noticed my hair seemed thinner and a miniaturization exam revealed diffuse loss on the top of the scalp but not the sides or back. It was modest loss, only visible under harsh lights, but my hair definitely felt less dense.

Nearly three months later after consistent Propecia use, I could swear my hair feels thicker and I can’t see as much scalp in the mirror under harsh lights. Could this be a real effect or is it probably in my head? (No pun intended!)

This type of result seems like it might be too quick after just taking Propecia for 3 months, but I suppose it’s possible that you had a really great response, which we have seen in some men from time to time. It usually takes a few more months for most men to notice that much positive change, though. I’d keep taking the medication and keeping track of the gains.

Congratulations on the good fortune and better hair!

Dr. Rassman,

I appreciate your blog. I’m a 24-year-old male who started experiencing thinning and hair loss on my crown shortly before my 20th birthday. I started taking finasteride after my 22nd birthday and experienced fantastic results. However, I still have a somewhat large area on my crown that is much thinner than the surrounding areas.

I am considering using minoxidil on my crown, as minoxidil is supposed to be very effective in that area. I am wondering if, after being on finasteride for two years, there is any chance that minoxidil would be effective? I understand that the two drugs target different hairs (i.e. hair regrown using finasteride doesn’t preserve hair regrown using minoxidil, and vice-versa), but after four years of thinning, would minoxidil show any decent statistical chance of working for someone in my situation?

Finasteride plus minoxidil works better in the crown than finasteride alone in some people. My advice has always been to to start on the finasteride first (with a doctor’s prescription) and if after a reasonable time there is a poor response in the crown, then add minoxidil treatment to see if there’s an added boost to your hair growth plans.

For financial and time reasons, it makes sense to just start with one medication in case that accomplishes what you want it to, rather than committing to multiple lifetime medications from the start.

Dear Doctor Rassman,

Firstly I love your blog. I just read your article regarding the potential affect of Propecia on sperm counts. Myself and my wife are trying for a baby and I want to give myself the best chance possible of conceiving. How long after people who stopped using Propecia see there sperm counts raise, as I am considering stopping the drug during the crucial ovulation period

Thank

There was a study conducted at an infertility clinic (on men with severely low sperm counts to begin with) that I think you’re referencing — Study – Sperm Count and Finasteride.

As it seems that you’ve had a sperm count done, I would expect that an improvement in sperm count should occur within a month after stopping Propecia. I am curious as to how low your sperm count was or what your physician suggested. Most men on Propecia can conceive a baby, but some men have a reduction of total sperm volume even though the sperm count per unit volume remains normal.

Dr. Rassman and co,

Thank you so much for this blog, it is a great source of information and truth.

My question to you: I am a very good responder to finasteride, have been on it since 2010. I have recently been losing more and more hair especially from my temples and hairline. Would you think or recommend that i switch to dutasteride?

Also i added Rogaine foam since 2012 and have noticed only slight results and maybe even some accelerated losses from the hairline and temples.

Thank you

The decision to switch to dutasteride is one that should be made between you and your prescribing doctor. I rarely prescribe dutasteride, however, when I do prescribe it, I usually require the patient to have had a course of finasteride first. I would allow a switch to dutasteride only on a case-by-case basis, so I can’t recommend it for you (especially because you’re not my patient and I don’t have your medical or hair loss history).

First of all I would like to thank you doctors for allowing time out of your days to answer questions. I began shedding more hair than normal 3 years ago at age 22. I received the opinion of two dermatologists that I was not experiencing male pattern baldness. Even with these opinions I became paranoid based on the increased shed and my maternal grandfather and uncles baldness so I began using finasteride.

I showed no visible signs of hair loss then and do not now at the age of twenty-five. I am scared to stop using finasteride because if I am genetically predisposed I know I will lose what I have prevented the past three years. My question is, based on my age and beginning the treatment early do I have a good chance of keeping my hair well into older age and is it worth suspending the treatment just to see if I need to be taking the drug or not?

Paranoia is clearly not a good reason to take a prescription drug meant for treating something you might not even have.

At 25 years old, you still might see hair loss if you have the genes for it, but I have no way to know if finasteride is protecting your hair or if it is an unnecessary daily medication. I would see a doctor first and foremost, so that you can have an exam and any hair loss that is observed can be noted. Your doctor may decide to discontinue your medication and just have you keep your fingers crossed that there’s no loss that finasteride was delaying.

1 – Is it possible that taking finasteride for a certain period of time can alter the proper functioning of the endocrine system of a person?

2 – I’m kind of lost regarding side-effects and the possibility of them continuing after the stoppage of finasteride because from what I understand, the drug only stay in the bloodstream for a somewhat short period of time. How is it possible that the effects last if the drug is discontinued… It’s like saying that if you get drunk one night, you would be drunk for the rest of your life… it’s impossible.

Thanks

1.) There isn’t science that shows finateride permanently alters your endocrine system, as far as I’ve seen. There is anecdotal evidence and claims by lawyers, that may point to this but this is not scientifically based.

2.) The sexual side effect of Propecia occurs in about 2 % of the men who take it. Chances are, you’re probably the in the 98% who never gets a sexual side effect. If you do get the side effect, it will not last if you stop taking the drug, but in some people who stay on it, the sexual side effect lessens or disappaears. The medication is out of your bloodstream in less than 24 hours. That is why you take it every 24 hours (to keep it in the bloodstream). The drug binds to the tissues for up to a week and that is why it is effective after it leaves your bloodstream.

I realize there are Internet posts that report persistent side effects after stopping the drug, but I find this hard to understand/believe myself. In my years of practice, what I’ve seen in real life (face to face) patients is that they do have sexual side effects match the 2% statistics. In the actual patients that I see, the side effects are temporary and they go back to normal after discontinuing the medication.

I do recall meeting one patient who came in for a consultation asking me for advice, because he claimed he has the permanent sexual side effect, so I will keep my mind open, but I still find this hard to understand and this particular patient was not started on the medications by me.

According to the WiKi, the patent of Propecia in US has expired in Nov. 2013. Would you explain updates about generic products of finasteride? Is there any US company that has started manufacturing it?

Thanks

Generic Propecia (finasteride 1mg) has been available here for about a year and a half, though it was exclusively made by Dr Reddy’s until around mid-2013. There’s a list of Propecia manufacturers at Drugs.com that have FDA approval, and while some of them might be US-based, I’m not sure if the medication is manufactured in plants elsewhere in the world.

Almost all of our patients have started using the generic, but the prices have not come down to levels I expected. The lowest price is still had by dividing a 5mg generic Proscar pill into quarters, though your doctor will need to prescribe this higher dose with instruction to cut the pill.

As I’ve written in the past, I’m involved in an email group with some of the industry’s top surgeons. One of the topics that was recently brought up was a case where a patient was told, emphatically, not to take finasteride due to an increased cancer risk. Coincidentally, I received an email from a patient not too long ago with a similar concern… so I figured it was time to write about it again.

In a 2013 article published in the New England Journal of Medicine, the long term survival of participants in the prostate cancer prevention trial was discussed. It was reported that there was no increased in risk of death for those on finasteride compared to a placebo group. There was, however, a marked decrease in the overall incidence of prostate cancer in the treated group as compared with the placebo group. This was consistent with the original studies on the reduction of cancer incidence by as much as 25% for those who were treated with finasteride.

There’s a good breakdown of that NEJM article found at Cancer.org.