Drugs – Page 333 – Balding Blog

March 29, 2006

Hair Loss InformationPropecia’s Major Side Effects – Hair Loss Information – Balding Blog

Hi Dr., I am a 20 year old male who is goin bald and is considering a hair transplant. I was wondering what you recommened to maintain hair after a transplant, other than propecia because i have heard of major side effects. What is your opinion on rogaine and other topical treatments ?

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I often receive questions on finasteride (Propecia) from patients like you quoting “adverse” or “major” side effects. All drugs have side effects (even Tylenol), but when used correctly under the supervision of a qualified medical doctor it serves its purpose. I often find people are misinformed from the mass amounts of uncorroborated information available on the internet or just word of mouth. It is the source of folk legends and superstition. It is one of the reasons why these medications can only be prescribed by a medical doctor.

Propecia has been well studied for male pattern hair loss in men. The following is taken directly from the Healthcare Professional Information Label for Propecia (finasteride 1mg).

Drug related adverse experience for healthy men taking Propecia during a 12 month period:

	945 men on Propecia	934 men on placebo (sugar pill)
Decreased Libido	1.8	1.3
Erectile Dysfunction	1.3	0.7
Ejaculation Disorder	1.2	0.7

Rough translation: 1 in 100 (1%) patients had some form of sexual dysfunction. “Resolution occurred in men who discontinued therapy with Propecia due to these side effects and in most of those who continued therapy”.

There have been incidence of breast enlargement or tenderness (gynecomastia) reported. This occurred in 1 in 200 (0.5%) patients taking Proscar which contains 5mg finasteride (5 times the dose of Propecia) in a 12 month period. There is probably less than a 1 in 300 chance of gynecomastia from Propecia (which is 1mg rather than 5mg finasteride). This is also reversible.

Please note inb my practice experience there is a 1 in 10 chance of INCREASED libido (some may call this an “adverse” or “major” side effect for married men). I experienced this when I started taking it myself.

I believe the take home message for anyone who is serously concerned about their hair loss is to be make an appointment with a medical doctor (primary care doctor, dermatologist, or a hair transplant doctor) to discuss possible medical causes and its treatment options.

With regard to your second question, some doctors recommend the use of Rogaine (minoxidil) with a hair transplant on the belief that it accelerates the hair growth. I have used it on patients (half of the head with minoxidil and have without anything) and there was no difference with the use of minoxidil. The beauty of the hair transplant process, with the robust donor hair from the back and sides, is that no matter what you do or do not do with additional medications, the transplanted hair grows.

March 29, 2006

Gynecomastia and Rogaine? – Hair Loss Information – Balding Blog

I have a few questions for you.

– Does Paxil cause hair loss or thinning? I have been on two drugs for mental health reasons for about 8 or 9 yrs now; Paxil and Klonazapan (also called Klonopin). Have you heard of either of those causing loss or thinning if used long term?

– I think my hair would probably benefite from Propecia. However, I’m afraid of the risks around the chest / breast area. As a teen, I suffered from gynocomastia (sp.??) and had to be surgically corrected. I am too afraid of risking that happening again to try this drug. How likely is it to happen were I to try it? Would it be reversible if I stopped?

– Does Rogaine have the same risk ? Does it , or can it rather, cause gynocomastia, etc ?? Perhaps just rogaine or generic minoxidil over the counter is a better option for me, given my severe concern(s) about the possible Propecia side effect.

Thank you for your time.

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Many drugs cause hair loss. Paxil or Klonopin may cause hair loss, but it is very rare. You hair loss may be due to male pattern baldness and its relationship with the drugs (Paxil or Klonopin) may be coincidental. There is no real way to tell.

Before starting Propecia, you should be seen by your primary care doctor or a hair transplant doctor who can discuss its risks and benefits, plus have your scalp mapped for miniaturization so that there will be metrics to compare with any progress the drug might give you over time. With respect to Propecia’s side effects, there is approximately 1 in 300 chance of getting gyencomastia (breast pain or enlargement). I do not know your detailed medical history to say whether your risk is increased since you had it in your teen years. You also have a 1 in 10 chance of getting an increased sex drive and a 1 in a 100 of a decreased sex drive. In medicine (as in life) it boils down to risks and benefits and compromises.

Rogaine (minoxidil) has different risks from Propecia, and those risks do not include gynecomastia or reduced sex drive. The risks generally reflect skin irritation, fainting or light headedness, or drying of the skin.

March 29, 2006

Spironolactones and Hair Loss – Hair Loss Information by Dr. William Rassman

I posted a question some time ago but didn’t hear back from you so here goes. I am a 33 year old female with hair loss for the past year and 7 months. Started to notice the loss after going off the birth control pills. I went to see a hair loss expert at Duke University who said it was TE. Still hasn’t stopped thinning. I am back on the pill and spironlactone. I also have Hashitmoto’s disease. No family history of female hair loss although my dad has lost his hair. My testosterone levels recently came back at 86 which my doctor thinks is high and probably due to some PCOS. I have several questions. First, could the spiro be making my hair loss worse? What can be done to combat the high testosterone levels? I have a diffuse loss but also hair loss at the sides of my forehead (what I consider the temples) and my hair line has receded (which is what bothers me the most). Thanks for any insight.

The cause of your hair loss seem multifactorial. Birth control pills has been linked to hair loss even if you have stopped taking it. In other words, stopping or starting birth control pills may have ‘triggered’ your hair loss process. Hashimoto’s Thyroiditis is also a reason why you may have hair loss, because of its autoimmune process (your body may be attacking your hair). Polycystic Ovary Syndrome (PCOS) may also be related to hair loss by the virtue of hormone imbalances that this disease produces. Spironolactone, which is a common blood pressure lowering drug, can also be the cause of your hair loss as much as a help for it (now that sounds crazy, but it does say much about its value). Some doctors believe that Spironolactones may also grow hair, because spironolactone works by inhibiting a hormone called aldosterone, which is similar to testosterone (note: this is a very simplistic way of putting it). To my knowledge, there is no reliable scientific evidence of using spironolactone to grow hair. Most importantly spironolactone is not approved by the FDA to treat hair loss. Finally, your high testosterone levels should be addressed by your primary care doctor or a specialist who knows your complete medical history. PCOS can cause virulizing traits, and with high testosterone, that will just accelerate these traits. You may have already guessed, but spironolactone is commonly used to treat PCOS to decrease the androgenic hormone (testosterone) levels.

You seem to be doing the right thing by seeing the appropriate doctors. Unfortunately, sometimes there are no solutions.

March 28, 2006

Hair Loss InformationPropecia Side Effects vs Avodart Side Effects – Hair Loss Information – Balding Blog

1.If I use PROPECIA and report side effects, will the side effects occur with another 5AR inhibitor e.g. DUTASTERIDE?
2.Finasteride inhibits the enzyme 5AR.So we will have more testosterone in our blood. Why can sexual side effects occur?

Thank you for your time.

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If you have any side effects associated with finasteride (Propecia), you will likely have side effects with dutasteride (Avodart). Dutasteride has the same mechanism of action as finasteride, but it blocks 5 alpha reductase type 1 and type 2 isoenzyme. Finasteride only blocks the type 1 isoenzyme. Please note that blocking type 1 and type 2 isoenzyme does not necessarily mean it will work better. More importantly, dutasteride is not recommended (nor approved by the FDA) for use in Male Pattern Baldness (MPB).
Finasteride blocks 5 alpha reductase, which is an enzyme that converts Testosterone t0 Dihydrotestosterone (DHT). DHT is the hormone that has been linked with MPB. When taking finasteride there is a transient effect of more testosterone, but it is only temporary because your body has other ways of metabolizing the temporary increase in testosterone. Sometimes there may be sexual side effects (1 in 10 increase in sex drive or 1 in 100 decrease in sex drive), because testosterone is a hormone responsible for sexual drive (and many other normal body fuctions).

March 28, 2006

How Can I Be Assured That Treatment Will Work For Me? – Hair Loss Information – Balding Blog

I am 23 years of age and have a bald area in the front portion of my head. Many doctors who i have consulted told me that i have class 4 hair loss and can’t be treated by drugs. This may be true somehow because my hair started falling out from the age of 17 and i didn’t take a treatment then. Can you assure me that if i get treatment now, my problem will get resolved?

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“In this world nothing can be said to be certain, except death and taxes.” – Benjamin Franklin

I can stop here with the answer, but if you’re not satisfied please read on:

I can not assure you that a medication will work for your hair loss. In fact, no one can assure you that any drug treatment will work. You stated that you were seen by “many doctors”, which I assume included an examination, and were still told that your hair loss couldn’t be treated with medication, yet you wrote to ask for my opinion. I suspect what the doctors were saying in ‘doctor speak’ is that Propecia usually does not regrow frontal hair so a Class 4A balding pattern (where all of the hair in the front is gone), I suspect the hair will not regrow. In a 23 year old (without seeing pictures of your balding) I would assume that there is still some hair in the frontal distribution and that what hair is there is miniaturized. Miniaturized hair will often respond to Propecia to some degree in a young man, even if it is in the frontal area. Unless you try, you will not know.

I suppose I should be flattered to be thought of as a hair loss authority to give you assurance on a medication. If your scalp has been examined for miniaturization and you have a diagnosis of Male Pattern Baldness (MPB), medication such as finasteride (Propecia) may work, but there are no guarantees.

If you need another medical opinion, feel free to make an appointment with me.

March 27, 2006

Hair Loss InformationTrying 15% Minoxidil – Hair Loss Information – Balding Blog

I am a 46 year old balding man presently at class 5. I have tried minoxidil up to the 12.5% concentration (Xandrox) but has not worked for me. I also have had one transplant session of about 400 grafts (not NHI) but most of the grafts are gone and obviously am not happy with the result. I just wanted to know if you would recommend my continuing the 12.5% minoxidil or even try the 15% treatment just to slow down the balding process and keep me from going to class 6 or class 7.

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Your question is troubling me. Transplanted hairs are permanant and very successful so if yours failed, something is wrong. It is also troubling that you only had 400 hair grafts when you state you are a Norwood Class 5. That would hardly have an impact on your appearance. If your hair transplant was a failure, it is my opinion that you should follow-up with your original hair transplant doctor to discuss the failure with him/her. There are instances where patients believe their hair transplant was a failure because they also had ongoing hair loss. Could that be your situation?

Furthermore, if minoxidil 5% or 12.5% didn’t work for you, what makes you think 15% will work? Minoxidil, like all drugs, has its limitations and higher concentrations may have adverse side effects. Depending on your medical history and a good diagnosis of hair loss, I would also consider finasteride (Propecia) as another option.

March 27, 2006

Tribestan and Propecia – Balding Blog

Dear Doctor,
Recently I have been prescribed with Tribestan to boost my testerone level. But i have been taking Propecia for a year now and the effect from propecia is good and i am a more confident man now of course with more hair too.

My question is can Tribestan be taken together with Propecia? will it cause more hairloss? or any side effects?

Thank in advance. Desperately needing a answer… Best Regards

Tribestan is not a medication. It is a natural supplement that is available over the counter without a prescription. Since Tribestan is not a FDA approved product, there is no medical evidence for its efficacy or its precise mechanism of action. There are endless internet sites that promote Tribestan (as I have found), but there are no formal FDA approved or medical data on Tribestan, nor are there any studies that show safety and / or effectiveness. For those reasons there is no way for me to tell if there would be adverse effects when taken with Propecia. There is no medical evidence.

I do not know your medical history to know how or why your “testosterone level” is low. Perhaps you should be seen by your primary care doctor for a complete physical.

March 27, 2006

Massive Hair Loss After Stopping Propecia – Hair Loss Information by Dr. William Rassman

I wrote to you a few months ago and unfortunately my situation has worsened.
I have suffered a massive TE since discontinuing Propecia six months ago after six months of use.
I suffered intolerable sexual side-effects while using the drug.

Recently, the shedding has slowed a great deal but I have lost at least 50% of the density via diffuse thinning. And most troubling, ALL of my hair has become fine and wispy even the back and sides. It appears that all the follicles have miniaturized as a result of a hormonal backlash after abruptly stopping Propecia.

I am terrified that I am going to lose all of my hair. I am 46 and a diffusely thinned NW 2.

I really don’t know what to do.

Any suggestions would be most appreciated.

My quality of life is deteriorating, and my anxiety and stress are off the charts.

I often see men like yourself very upset when they come to my office after stopping Propecia. I always tell my patients that if they stop taking Propecia, they need to plan for ‘catch-up hair loss’, meaning that the time of taking the drug is wiped clean and the hair loss accelerates to where it would have been without the drug. There are other ways to deal with the negative sexual side effect than just stop taking Propecia (taking 1/2 pill per day works for many people). But the die is cast and you have lost your hair. You can try to take it at 1/2 pill per day and see if the side effect is still there.

One part of your information that troubles me is that you categorize yourself as a Norwood Class 2. There is an inconsistancy here between your statement “massive TE” which certainly does not make sense in a Norwood Class 2 patient. See a hair doctor in your area (use the physician search at ISHRS.org) and have your hair mapped for miniaturization so that it can be determined your true classification of hair loss, and so that hopefully a Master Plan can be made to help you along the way.

March 27, 2006

Propecia in 20 Year Old Male – Hair Loss Information by Dr. William Rassman

I am a 20 yr old male who noticed a large amount of hair coming out while in the shower and during the day; I have also noticed visible miniaturization in the strands that fall out. I am about NW2 now, and I notice slightly less density on the very front of my hair line. At my age, are there side effects to taking Propecia? Are there any other courses of action?

Also, I am in Europe; do you know of my options here? (Is Propecia available/branded under a different name/does it require a proscription?)
Thanks!

The drug Propecia can be taken at any age. There are possible side effects, but they are rare and vary per person. Please review the many, many posts on this blog that discuss Propecia and side effects.

Some countries have not yet allowed the drug in, while others allow it to be sold under a doctor’s guidance and control. I am sure that if you ask your doctor for finasteride, you will find it in the 5mg dose and then would have to cut it into 1/4 dosages to treat hair loss.

March 24, 2006

Finasteride for Female Hair Loss? – Hair Loss Information – Balding Blog

Ok doc, I just saw on the news (and the found it on the web) where it says Propecia is basically ok for women. Please comment on this new study.

Female hair loss treatment hope
Oral Drug for His Hair Loss May Also Help Her

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My concerns for this treatment are the following:

The study is very limited to only 37 women.
The “new pill” is finasteride 2.5 mg (which is 2.5 times the strength of Propecia for men) with an added birth control pill to prevent pregnancy because of the high risk of producing abnormal babies, a known side effect of finasteride in pregnant women.
Finasteride for women is not approved by the FDA for female hair loss. We know that in 1 out of 200 or so men who take the 1mg dose of finasteride, that there is some breast nodules (gynecomastia) as a side effect and this makes me wonder what the effect might be on women who carry genes for breast, ovarian or uterine cancer or who may have an early version of these cancers already growing in their body. If they take finasteride as used in this study, what will happen here? Safety is critical to FDA approval for a particular use, so I would worry that without adequate statistics, we will not know about this risk.
The study was not a double blind randomized control study. Which in short means there can be a bias in the study.
These stories are sensationalistic at its best, causing great interest for desperate women and providing misinformation to the non-medical population. Another example of media hype was this story from a few years ago: Lemon juice ‘is HIV-killing spermicide’.
These articles will, without a doubt, drive doctors and women to gather and exploit finasteride for the treatment of hair loss. We will know, the wrong way, about cancer and other such risks in these women when it appears in the courts.