Category: Drugs

Hey Dr. Rassman…I’ve been reading your blog almost daily and have seen alot of questions about the long term effectiveness of Propecia (especially after the two year mark). I wanted to ask you a question that will help me feel better since I am just past that 2 yr mark. I am 26 yrs old and have been using propecia since 24. When I started using propecia I had hair loss that was not detectable to others..my only goal here was to maintain my hair.. When you talk about propecia losing effectiveness , are you talking about losing ground with the new hair propecia is responsible for growing.. or falling behind your starting point.

Of course, I’m just asking your opinion from your experience of seeing many patients over many years.. Do most people stay at or above their starting point after 5 yrs or more? thank you

Finasteride at the 1mg dose will not guarantee that you will stop your hair loss. Some people stop it and some people reverse it. Some people just see it slow down. I think that it works in all men, just maybe not as effective in some as in others. Over time the hair loss tends to progress, so if the drug worked for you initially and works less well now, that is the time to see a doctor to get a Master Plan in your hand for your hair loss and its future. It may be time to consider doing more about it if it bothers you much.

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A couple of days ago I had sent an email indicating that there is a belief that nutrasweet products interfere with the efficacy of propecia. The following site describes one such incidence.

http://205.238.137.71/hairloss-forums/viewthread.cfm?f=1&t=11649#33739

Please give me your opinion on this as I have been using propecia for 8 weeks with no effect.

I looked at the reference you cited. The piece proposes that nutrasweet may interfere with the action of Propecia, but it is conjunctural, not factual. Formaldahyde, if it were a significant metabolite of nutrisweet, would/could cause liver disease, which is not a reported side effect.

Hi Sir,
I take Proscar and break the pills in 1/4. Considering the fact that finasteride remains only a few hours in the body, would it be better if I’d break the pills in 1/8 and would take it twice a day?

thanks

What you say may be true. The problem is that the 5 hour half life is a reflection of blood levels for the drug (5 hours drops the concentration in the blood by half). The more important number may be tissue level of bound drug that binds to the receptor targets. I believe that this number is much longer than 5 hours (maybe a few days). Thinking this through is an intellectual exercise only:

1. The pill might be able to be taken less often, rather than more often.
2. A smaller dose might be just as effective. I was told in a personal communication some years ago with Dr. David Whiting (who was involved in the original Merck studies to determine the best dose to use) that half of a Propecia (0.5mg) is 80% as good as a whole pill.

It may be in nobody’s interest to really solve this problem for you so your guess is as good as anyone. I tend to stay with what is known and that happens to be Merck’s story on the commercial pill. Other than saving some money, I am not sure that for most men without any side effects of the drug that taking less of a dose has any advantage over the recommended dose.

I am a male of 39 yrs old with Norwood scale 3 vertex. Have been prescribed propecia and am taking propecia for 8 weeks now but I see no effect.

I have read on the internet that if one is taking propecia to stop hair loss and consuming nutraweet products (artificial sweetner)at the same time than the nutrasweet makes the propecia ineffective because the nutrasweet converts to something in the body which does not allow the propecia to work. Please let me know what you think as I trust your opinion on this much discussed topic.

I looked it up and could not find anything on it. Essentially, I don’t have a clue. Can you send me a point of reference?

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I am a 23 year old male and beginning to notice hair thinning and receding hairline. I have been on propecia for 8 months but my hair loss is not stopping at all. I want to switch to Avodart before it’s too late. They only sell it in 5mg. How do you prescribe it? Do you suggest one 5mg once a day? thank you.

I do not have the answer to your question, because effectiveness studies have not been done on an official scale. Also, the drug’s half life is about 5 weeks for blood levels (Propecia is 5 hours) so the drug hangs around for a long time. Those doctors who use it admit confusion over dosing, so it is a guessing game. Is 0.5mg too much? That would be my guess as the best dose, but should it be taken every day, or once a week, or once a month? Perhaps your guess is as good as mine. With Propecia, we know the answer!

Dr. Rassman,

You truly have a very informative site here! I don’t know where I would be without it. Anyways, in one of your responses to a question you stated that when you first start treating hairloss it is better to start off with propecia for 8-12 months, then if not satisfied move to Rogaine (minox). If a person wanted to keep/re-grow as much hair as possible wouldn’t this be a mistake as the Rogaine would cease to be as effective as it would’ve been if used in the very beginning?

From my experience, I have found that Propecia (finasteride) is more effective than Rogaine for men with genetic hair loss, particularly in the crown if it is early and/or they are younger (under 30). Technically, you may not need to use Rogaine at all while being on finasteride. I have noticed that most patients do equally well being on finasteride alone vs. finasteridewith Rogaine. The most important message which I wanted to get across is that you should always start out using finasteride as early as you can. You can always add Rogaine (minoxidil) if you are not satisfied with the results of the finasteride.

Hi Dr: I am a 36 year old male. I have experienced hair loss and I would like to try Propecia (Finasteride). However, I am a heart patient and I take Toprol, Altace, Zetia, Plavix, Lipitor. Will the propecia interact with any of these? I have read that it may interact with blood pressure meds.

Thank you

If you are taking finasteride at the 1mg dose (Propecia), I would not worry about cross-reactivity. The official site does not mention a problem with the medications you listed. Minoxidil on the other hand, is an anti-hypertensive agent so if you mix it with the anti-hypertensive medication you take, you could drop your blood pressure further. For general information on drugs and pharmacologic vs. Toxic Effects, see: http://www.hpisum.com/downloads/Downside.pdf