Category: Drugs

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Hair Loss InformationPropecia for Women – Hair Loss Information – Balding Blog

a short while ago, you answered a question on the use of Propecia in women. It was your feeling that this drug is not indicated in women, yet some doctors are using it in women. Are there any indications for female Propecia use?

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There is no long term studies on safety in women for Propecia, but there are certain conditions that cause a woman to make a great deal of male hormones and as such, may actually develop a male patterned hair loss. In these diseases and only in a woman past child bearing years, a trial of Propecia may be indicated, but the patient must be made aware of the possible appearance of conditions that ‘theoretically’ may develop which could impact the breast, uterine and ovarian organs. For example, cancer risks have never been studied when a women is placed on Propecia and those women who are genetically prone to breast, uterine or ovarian cancer may find themselves at greater risk.

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Hair Loss InformationBest Solutions for Balding – Hair Loss Information – Balding Blog

What is the best product for thinning hair and small spot on the top of my hair. Thanks

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If there are many small spots of balding, then a visit with a doctor is critical because you may have a medical problem that requires expert insights. If you are a man, I am assuming that you are talking about male pattern ‘genetic’ balding. Both Propecia and Minoxidil may work. Minoxidil, applied to the balding area like a lotion, can be purchased over the counter in many stores. Propecia, a daily pill, requires a doctor’s prescription. Propecia, made only for use by men, can stop and even reverse the hair loss in some of the younger men.

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Hair Loss InformationAvodart Info – Hair Loss Information – Balding Blog

A BaldingBlog reader named Greg originally posted this as a comment to a blog entry, but I’ve formatted it to make it easier to read and have reposted it here.

The FDA has found Avodart to be safe (for BHP). The side effects were very simliar if not a tad less then Proscar 5mg, which also was cleared by the FDA many years ago. I think Avodart should be indicated as a off label prescription in some instances.

  1. non-responders to Propecia
  2. When the loss of efficacy of Propecia becomes bothersome to a indivdual

One other interesting point is that the age group the FDA studied on Propecia (18-42) was quite younger than what Proscar/Avodart (50+ median age 66 approx) so the chances of sexual side effects will inherently be larger in this age demographic as opposed to Propecia… meaning the side effects are probably even closer then one thinks/ Propecia versus Avodart. The one draw back with Avodart is that there is no “human model” with type 1 suppression so there is a question on “long term” safety as with many drugs. As long as you dont have any side effects with Avodart, the long half life can only be beneficial with Androgentic Alopecia and the phase 2 studies show this. People held onto the hair they gained (even grew more) 12 weeks “after” the the medication was discontinued (0.5 mg/ 2.5 mg only). Proscar users saw a sharp decline in this time frame. I hope these facts are helpful in some way.

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Thank you for your insight. I believe that what you said makes good sense. I would hope that I could adopt a similar view in an ethical/legal framework.

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Hair Loss InformationIs Propecia Mandatory After Hair Transplant? – Hair Loss Information – Balding Blog

Hi,
I have looked into hair transplants time and again but have been scared off by the horror stories of bad HTs. FUEs sound good to me. Where do I go to get evaluated? I am losing hair in my temple areas and am 36 years old. Also, do I have to be on Propecia? I was on it for a year, didn’t see any results in hair but did notice problems with sexual activity (i.e. hard to keep an erection) I like it a lot better without it. So, if I had a HT, would I have to be on propecia?

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You do not have to use Propecia after a hair transplant. However, by not using this drug you will not have any protection against the progressive nature of hair loss, assuming you are still losing hair and not totally bald. With regard to your sexual problems, almost 40% of men of your age have some difficulty maintaining an erection. One of the erectile dysfunction (ED) drugs can solve that. Taking Propecia for your hair and ED pills for your erection may give you both a better sex life and hair at the same time.

You indicated that you are based in Colorado. I would be happy to evaluate you for FUE, but my offices are in California. To find a FUE surgeon in your area, please visit ISHRS.org, but please note that there are not many of them out there that have the reputation and experience you may want.

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

I am 28 years old, and I have had the unfortunate expierence of losing my hair for the past 2 years.
I had a consult with a Bosley representative, and reccomended that I go on Propecia for about 9 months in order to retain my hair to be a good risk for hair transplantation. I would like to know, if this is a good reccomendation, and is the risk of side affects worth the effort? I have been on propecia now for almost 3 weeks, and I have had some side effects. In fact, I feel like I’m losing more hair due to propecia…Is that possible? With all this drama and money involved with going bald, I am about to resort to just shaving my head. It seems all the effort is in vain. It’s hard to beat genetics with a natuaral look.

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It is almost always a good idea to try Propecia if you have genetic hair loss, especially at your age, BEFORE you go through a surgical hair transplant. You may decide that after 9 to 12 months, you are happy with the results and do not need surgery.

I suspect that in the past three weeks, you have spent more time looking at your hair, watching for growth or hair loss, than you have in the past two years. It may take up to 12 months to see results from Propecia, and by watching your hair very closely and very often, you may miss some of the subtle growth that will hopefully be taking place. As far as side effects, erectile dysfunction, decreased libido and ejaculation disorders were reported about by .5% more men taking Propecia, than those taking the placebo- according to Merck. If the side effects are greatly impacting your life you will have to make the decision if you want to continue Propecia.

You sound like you are conflicted about your hair loss and solutions that are open to you. My suggestion is to take your time and research all of your options before you make the committment to surgery.

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Hair Loss InformationAvodart’s FDA Status? – Hair Loss Information – Balding Blog

You have mentioned that Avodart is not yet approved by FDA. Do you know what the status is on them approving it? Is it in its beginning trial stages or are the trials mostly complete and the FDA is just evaluating all of the research before making a decision. Or have they rejected it all together?

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Avodart was approved by the FDA for treatment of benign prostatic hyperplasia (BPH), in 2001. While I do not know which stage the trials are currently in, I am sure that the manufacturer of Avodart is doing all they can to speed up the FDA approval process for use in hair loss, if it is even at trials to begin with.

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Hair Loss InformationHerbal Treatments – Hair Loss Information – Balding Blog

Hi from Virginia Dr Rassman! I am 27 and am concerned about a receeding hairline I (and my friends) have noticed occuring right above my temples. The hair in this location has always been thin, but has become more pronounced in recent years. What can I do to retard and even reverse this thinning? I have read about Propecia, and they do not recommend it for receeding hairline. Currently I am taking Saw Palmetto (supposedly an herbal Propecia), a sustained-release B Vitamin and MSM (both which supposedly feed and thicken hair). What other treatments are available for receeding hairline, herbal, pharmaceutical, or other?

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If you have been losing hair in the temples and only the temples, then you may have a condition called Triangular Alopecia. IF this is the case, then you need a diagnosis. As I have repeated many times, the hair throughout your head must be observed with high magnification. If the hair loss is only in the triangular temple area, then this diagnosis is probable.

Make an appointment with a good hair doctor and show them this answer. They will know what to do. Don’t rush to herbal or other over the counter remedies without knowing what is going on. Once you get a good diagnosis then you should address the cause or use a treatment that works with scientific proof or at least a reasonable certainty.

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Switching From Propecia to Proscar – Hair Loss Information by Dr. William Rassman

I have taken Propecia for 4 plus years with some success. I’d like to take proscar but don’t know how to go about it. Could you help? thanks

Proscar is the same drug as Propecia, just in a higher dosage per tablet. Propecia contains 1 mg of finasteride per tablet, and Proscar contains 5 mg of finasteride per tablet. When Merck did their studies on hair loss, it was determined that 1mg of finasteride was just as effective as 5 mg or even 10 mg of finasteride, but that taking only 1/2 mg of finasteride was 20% less effective.

So the only ‘benefit’ to taking more than the recommended 1 mg of finasteride in each Propecia pill, is a higher chance of side effects. If you want to take Proscar because it is more cost effective, you can split the pill into fourths. Splitting into fifths is more difficult and you tend to lose some of the pill in the cutting process. The doctor who prescribed Propecia for you, can prescribe Proscar for you.

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Hair Loss InformationJournal Articles on Propecia (Finasteride) – Hair Loss Information – Balding Blog

Two articles are summarized below which address the drug Finasteride (Proscar 5mg and Propecia 1mg).

These article are very technical and may not be good reading, but I have put them here as part of my effort to educate the readership. Both of these articles discuss what we have learned on preventing prostate cancer with finasteride (very important as most men who live long enough will develop prostate cancer) and the cost/benefits of taking finasteride over time. In medical circles, these are controversial articles in many ways. I have included the comments of one doctor in the hair restoration field. Dr. Bill Reed, states: “An oversight on the author’s part that would probably negate the need to reduce the price of finasteride is the enhanced quality of having more hair! With regard to the authors’ basic approach, it’s an awkward premise to attempt to attribute a monetary value to quality. For example, is the real quality and value of treating BPH (enlarged prostate) with finasteride [to produce a] better sleep and absence of urgency or the money saved from a TURP? I’ve always loved how a healthier prostate and more hair probably go together with this drug [How does one quantify this value?]”

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European Journal of Cancer. 2005 Jul 29; The article addresses the finasteride prostate cancer prevention trial (PCPT) and asks: What have we learned?

Author: Mellon JK., Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.

In 2003, the first of two large NCI-sponsored prostate cancer chemoprevention trials was reported. The prostate cancer prevention trial (PCPT) demonstrated a 24.8% reduction in the prevalence of prostate cancer in men taking finasteride 5mg/d for 7years. However, despite the overall reduced risk of prostate cancer, men in the finasteride-treated arm of the study were more likely to develop high-grade disease. This article examines some of the controversies aroused by the PCPT and evaluates some of the arguments that have been advanced in an attempt to explain some of the unexpected outcomes of the study. In addition, some of the recent studies assessing the potential impact of an effective chemopreventive strategy on population mortality are reviewed. To conclude, there is some discussion of factors, which need to be openly discussed with male patients who might be considered for finasteride therapy.

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The American Journal of Medicine. 2005 Aug;118(8):850-7. The article addresses the lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer.

Author: Zeliadt SB, Etzioni RD, Penson DF, Thompson IM, Ramsey SD., Fred Hutchinson Cancer Research Center, Seattle, Wash.; Health Services Department, University of Washington School of Public Health and Community Medicine, Seattle, Wash.

PURPOSE: We estimate the lifetime implications of daily treatment with finasteride following the results of the Prostate Cancer Prevention Trial (PCPT). In this trial, prostate cancer prevalence was reduced by 25%; however, an increase in the number of high-grade tumors among the treatment group necessitates the long-term projection of the likely benefits and costs. METHODS: We use a Markov decision analysis model with data from the trial, the SEER program, and published literature. The model measures the cost per life-year and cost per quality-adjusted life-year (QALY) gained for a cohort of men age 55 years who initiate preventive treatment with finasteride. RESULTS: Finasteride is associated with a gain of 6 life-years per 1000 men treated at an incremental cost of $1,660,000 per life-year gained. The quality-adjusted analysis results in 46 QALYs gained per 1000 men treated at an incremental cost of $200,000 per QALY gained, due primarily to the favorable effects of finasteride on benign prostatic hyperplasia. Under the assumption that the increase in high-grade tumors observed among finasteride treated men is a pathologic artifact, the incremental costs are $290,000 per life-year gained and $130,000 per QALY gained. CONCLUSIONS: The cost burden associated with finasteride is substantial, while its survival benefit is small and only realized many years after initiating treatment. To achieve an incremental cost below $100,000 per QALY gained, the price of finasteride must be reduced by 50% from its current average wholesale price and finasteride must be shown to prevent high-grade as well as low-grade disease.