Category: Drugs

Hi. You have a lot knowledge but I couldn’t find this answer. I have been on Propecia for 4 months and my receding hairline seems to be getting worse the past 3 months. i am only 23 yrs old. Does this mean the Propecia is just not working? Shouldn’t it be slowing down? Should I increase the dose? thank you for your advice.

You may be going through a rapid hair loss phase and it is possible that if Propecia is working, it may not be working enough to stop the recession. We know that this drug traditionally works better in the crown, so I would not be surprised to see it less effective in the front (particularly for re-growing hair).

You need to know what is happening so mapping out the hair and scalp for miniaturization will give you some measurements to define what is happening. At this point right now, there is no way to tell. I would stay on Propecia for a full year or more. You need a good doctor to manage what is going on and a Master Plan to know what you will do next.

Is there any link to minoxodil and prostate cancer?

There are no prostate cancer and minoxidil linkages that I know which contribute to prostate cancer. You may be thinking of finasteride (Proscar). The issue at hand it that on the 5mg dose of finasteride, there is a reduction in cancer of the prostate in people taking the drug after 7 years.

Dear Dr. Rassman:
I’ve inherited my father’s genes-my hair began to thin across the top of my head since the beginning of high school. I saw a dermatologist at that time and have been on Propecia ever since. At 27, while the balding process has been slowed significantly, I’m beginning to question the safety of taking Propecia for another 10 or even 20 years. I’ve heard a great deal of positive press about the Hair Max Laser Comb, and because it isn’t a treatment that is taken internally, I decided to order one. What I’d like to know is how much of a gamble it would be to start phasing out my Propecia dosage if I begin using the laser comb? Thanks in advance

I would strongly suggest that you continue to use Propecia for the long term. If you stop it, there will almost certainly be fairly extensive hair loss based upon the fact that you had good slowing of the hair loss from using it. The protection that Propecia gives you will disappear once you stop it and what I call “catch up hair loss” will occur, which means big time hair loss happens in just a few months.

The HairMax comb has little down side, unless you fool yourself into believing that it will replace Propecia. Long term Propecia use has a good up-side — the prevention of prostate cancer. There are no long term reports of problems with the drug if taken for many years.

Dr. Rassman,

I’m 22 years old and my hair line has been receding since i was 20. I know that male pattern baldness can skip a generation, but no one on my mother or father’s side of the family has any hair loss.

I started taking propecia. My sexual drive was waning and my lips were swelling up. How long do these side effects stay around for? And if these side effects don’t go away, what should I do to fight the hair loss.

Thanks.

I would worry about an allergic response to Propecia. Swelling of the lips could point to such a problem. I would assume that some doctor has prescribed the medication for you, so see that doctor and ask for more information from him/her. At 20, you need your hair mapped out for miniaturization to determine what you are treating with the drug, if you have genetic hair loss, and what benefits you may or may not be having with the drug.

hi dr rassman, are there any studies to show the ratio of propecia users who have used for several yrs and then the drug loses its effectiveness, for instance 80% or 8 out of 10

There are no studies I am aware of that show such information. There are some general observations that I have made about finasteride which are strictly my opinion, however. Finasteride works better:

1. in younger men or when the hair loss is more recent (less than 2 -3 years)
2. in the crown for restoring hair
3. to prevent rather than restore hair in the front
4. to prevent shock hair loss after a transplant if it is started prior to the transplant
5. when the initial results are impressive, rather than at the end of the 5th year when the progressive nature of the hair loss continues with its slow progression

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Dr. Rassman,

I’m a 24 year old male and I’ve been losing my hair for the past 6 months at a fairly rapid pace – significant amount of hair loss in the shower, comes out when i run my hand through, definite loss of density, temporal recession, etc. This whole process really took me by surprise.

Yesterday, I began taking propecia and I’m hoping to keep a decent head of hair at least into my 30s. I’m concerned, however, about the potential for “propecia shedding.” I’ve read a great deal about it on your blog and I’m wondering if there are certain factors that make it more or less likely. For example, does it follow that because of my relatively rapid hair loss and noticable miniaturization (more hairs in telogen?) that I’m more likely to experience this shedding?

Also, does sudden, rapid loss indicate that propecia may not be effective for very long or be less likely to stop balding in spite of my age?

thank you so much for your time and this fantastic resource.

Everybody reacts differently to drugs. The shedding that you are talking about is very rare and a transient process when it does occur. You may be over-reacting to what you read. I cannot predict how you will respond, but if you have genetic balding, then Propecia should give you some relief within a few months and you will see its final impact in about a year. Only time will tell. It may be frustrating, but you need to take Propecia for 6 to 8 months to see its effects. You may want to visit a doctor who can examine your hair under a hair densitometer for miniaturization so he/she can quantitatively track your hair growth, hair growth/loss pattern.

ive been taking proscar for the past 3 years..it seems to of stopped any further hair loss but no new hair has grown..i should mention that i cut the pill in half and then take it every other day..so i was wondering if that is a good way to go about taking this medication and if its not would that explain why no new hair has grown in..

Cut the pill into quarters if you can, so that the dose is closer to the 1mg level (recommended to treat hair loss). If you are cutting the Proscar in half, then you are taking 2.5 mgs. There is no problem with the higher dose unless you experience decreased libido which is more common in the higher the dosages. Taking the pill every other day makes it less effective, because it is completely out of your system in less then 24 hours. So the days you do not take the drug, you hair follicles will not be protected and will be exposed to the full hormone DHT level in your body. If you take it every day, you may find a better result from the finasteride.

Thank you for setting up this blog.

Today, my dermatologist told me to use Loprox instead of Nizoral.

He said Nizoral was “not helpful” with hair loss and that he had several cases were Nizoral had made things worst.

Do you think Loprox is better to use than Nizoral?

I think he doesn’t know what he talking about.

Loprox Cream and Lotion contains a synthetic, broad-spectrum, antifungal agent and is the treatment for ringworm or fungal infections. Nizoral (Ketoconazole) is used to treat a variety of fungal infections as well, including blastomycosis, candida infections of the skin or mouth (thrush), histoplasmosis, coccidiomycosis, and others. Nizoral is also used to treat fungal infections that have not responded to griseofulvin, another antifungal medication.

As your doctor is prescribing these medications, express your concerns to that doctor. I do not treat fungal infections, but rather send them to a dermatologist, so I am not the best one to answer your question. If you doubt your doctor’s competence, get another opinion.

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hi Dr.Rassman , Ive been taking propecia now for 4 months and have noticed results , but i have also lost a lot of muscle mass and facial hair growth and was wondering if these could be side effects.

I have had one patient report loss of body hair with Propecia — did you lose body hair? There have been no reports in my practice of muscle mass changes. I would certainly get a doctor to analyze the testosterone and DHT levels, as well as other blood tests that he/she might feel are appropriate.