Category: Drugs

Dr. Rassman,

I would like to request your insight into my situation. I am a 20 year old male and have been on finasteride 1.25mg and minoxidil 2% for one year now. I went to my doctor at the age of 19 requesting finasteride for minor hair thinning. I had not yet lost any hair, or even had any major thinning, but my scalp was visible in the front to middle area of my head under moderate lighting. I have also been expecting to lose my hair for a few years now because of a horrible family history; father, both grandfathers, and all biological uncles but one have progressed to NW5+. My doctor agreed based on sight that there was initial thinning and she prescribed. But I have not ever taken any actual photos or measurements of my hair.

Now, one year later, I am unable to tell by the naked eye whether there has been any improvement or not. Essentially, I seem to have basically the same full hair that I had last year, with maybe some minor thinning visible under the right lighting. I have had no side effects on the medications and I continue to use them.

What would you recommend I do at this point? I know that you do not give medical advice online, but this is more of a procedural question. Is it worth continuing both medications if I am uncertain that they have even been needed at all? Should I try to take some measurements now to gauge my hair loss progress for the future? I am not aware of any doctors in my community, in Hamilton Ontario, who perform bulk measurements or miniaturization tests.

Thanks a lot. All the best.

Did you ever receive a diagnosis of androgenic alopecia? I mean, do you even have actual balding or did you get prescribed a medication base on your insecurity? Almost everyone has their scalp visible under moderate lighting, but that doesn’t mean you’re necessary losing hair. Taking a life-long medication like finasteride without a good diagnosis just because you have a fear of balding is not good common sense.

At this point, I would voice your concerns with your doctor. If that does not help, I would find another doctor for a second opinion.

I have two questions if I may:

I take Proscar and split it in to 5 pieces for my intake of finasteride to combat hair loss. When I do take it is only 1 piece per day which equates to 1mg I believe is what propecia pills are made to. However, I sometimes take a piece every 2 days or every 3 days – so it is quite a big gap between than what most people are told to take daily. I have been doing this for 5 years now and have a very good coverage.

Prior to taking proscar I was extremely paranoid as I had very noticeable thinning on my scalp, and would obsess about it every day to the point where it got me very depressed. Out of my family on both sides, only my dad and his brother were the very first to experience balding in the family chain, so I was convinced I would continue this after seeing my thinning. I saw are Tricologist and was recommended finasteride. After taking the drug and seeing great improvements after a month I no longer worried about it and my hair started to grow back. My hair on the scalp does feel thinner than the front but is no way noticeable to anyone else but me.

Do you think my stress levels were the cause of my original hair loss? I’m too worried to stop though in case it resumes.

My second question is what medical checks should one have and at what regularity for taking this drug? I’ve read that using proscar may increase the risk in developing prostate cancer?

Thank you for your informative website

If you saw significant improvement from taking finasteride, then I would assume that you had/have genetic hair loss and the drug was appropriately prescribed. At 1 month, the only benefit a person would see would be a reduction on hair shedding. In a person without genetic hair loss taking this drug, nothing will be seen and the normal hair cycling (100 hairs lost per day) should not change. Stress can accelerate the balding/thinning process, but I don’t know if your loss was purely stress related, or a combination of genetics and stress. That is something your doctor should’ve considered before prescribing the medication.

With regard to your prostate, if you are under the age of 40, you should not have prostate problems such as trouble urinating. A good doctor can provide a rectal exam, where the doctor can feel your prostate (not necessary without symptoms) or colon/rectal cancer (very rare in men under 30). There’s no specific evidence that I’ve seen which shows taking the low dose finasteride for treating hair loss poses a prostate cancer risk. I’ve written more about that here.

Snippet from the study abstract published in the International Journal of Clinical Practice:

Objective: We evaluated 5-year safety, efficacy and prostate volume data from BPH patients treated with finasteride or dutasteride. Methods: A retrospective analysis of 378 consecutive men treated with 5α-reductase inhibitor monotherapy between January 2004 and September 2009 (197 on finasteride and 211 on dutasteride) in a single clinic was performed.

Conclusions: In this retrospective analysis of data from consecutive patients treated at a single clinic, both finasteride and dutasteride were effective therapies for the management of lower urinary tract symptoms. However, dutasteride resulted in significantly more sexual side effects and breast complications than finasteride.

Read the full abstract — A 5-year retrospective analysis of 5α-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride.

This study contained 378 men with the mean age of 58.7 years old, and the conclusion of the study (see above) is one of the reasons why we do not prescribe dutasteride off-label. Yes, this is a study of men with prostate issues and the dose is most likely different for treating hair loss… but the side effect risks and dosage for using dutasteride as a hair loss treatment are still unclear.

I am a 19 yr old male taking Propecia for about a year with great results. I have had minimal, if any side effects, though I have read some aritcles about people complaining that the drug can cause sterility. I am hoping to have a family someday and was wondering if you believe any of these claims about the drug. Thanks

I do not believe Propecia causes sterility. If you are having side effects (whatever it may be), please tell your doctor. If you are concerned, you can ask your doctor for a test to measure your sperm count to set your mind at ease — or at least have a baseline measurement.

Hello Doctor, I was on 1mg Fin for 4 months, was very happy with my hair results, however I have developed anxiety and slight depression.

I asked my doctor whether I could lower the dosage and she said I could do 1.0mg pill every other day. She did not explain why.

Are there any studies that show that 1mg every other day is better than 0.5 mg every day? thank you!

I don’t know of a study that compares 1mg every other day to 0.5mg daily.

Logically speaking, Propecia’s half life is about 4 to 6 hours. So by the next day the medication is almost all gone from your blood stream. Thus, the medication is intended for daily use. Taking 0.5mg daily would seem more of a steady state than taking 1mg every other day. Practically speaking, I would think 0.5mg daily is easier to remember as a routine in your compliance than taking it every other day.

Your doctor may have her own reasons behind the recommendation, and after all this is a “practice” of medicine. I would speak to your prescribing doctor on this issue and make sure both of you are on the same page before making any changes to your medication. She might not have explained why she suggested the every other day dosing, but it doesn’t hurt to ask her.

I am a girl. I want to grow a beard. Could I do this with rogaine foam for men? This is serious.

It is known that minoxidil could cause hair growth, and if you were to use this on your face, a beard might become a side effect.

Of course, I would ask why you want to do this and have you consulted your family and/or doctor about it? It’s not every day that we get emails from women wanting to grow facial hair.