Category: Drugs

Hi, Dr. Rassman. I had a procedure done a few years ago in Texas with Dr. McClellan and I’m very happy with the results. My hair loss has been very slow, thankfully, in some part perhaps due to the fact that Dr. Bob put me on Propecia after my initial consultation. I took it up until about a year ago, and now my crown is thinning pretty badly (I know – it was stupid to stop). My question is this: I’ve read on other hairloss sites of guys buying Proscar and cutting them into fourths or fifths so that they are down to, or near, the 1 mg found in Propecia. Will this give you the same results? It is, after all, a cheaper route. Most of these guys get the Proscar from Canada or overseas, which makes me wonder about the authenticity of the drugs, but I guess that is another question altogether. Thanks, and this is a very helpful site.

I am glad that you are pleased with the results. Dr. Bob does excellent work! As to your question, Finasteride is marketed in two strengths: Proscar (5 mg for prostate problems) and Propecia (1 mg for hair loss). While you can get the same result if you were to exactly cut the Proscar tablet into fifths, it is sometimes difficult to cut the pill in equivalent doses. As a NHI patient, this is something you may want to discuss with us when you need a new prescription. Give us a call at 800-NEW-HAIR (800-639-4247) to set up a phone re-check. I do recommend that you only order prescription drugs from reputable suppliers.

Hi.DR.RASSMAN, I would like to know if type 1 DHT causes hairloss?? or is it just type 2..?? Please let me know when you get a chance… and do you think they will becoming out with anything better then propecia in the near future???

Propecia is a type 2 competitive inhibitor of DHT and Avodart is a competitive inhibitor of both Type 1 and Type 2 receptors. I think that is what you are asking. There is no clear evidence that blocking both Type 1 and type 2 receptors is better. What we do know is the Avodart does drop the DHT level in the blood stream more effectively than Finasteride (90% vs 75%). What this means is suggestive that it might work better in some people. But I must state clearly that safety and effectiveness is the mainstay of the FDA and until we have a handle on these two issues, I believe it is better to stick to Finasteride.

I have been taking Propecia for sime time and I recently ran across a site that talks about a combination of 2% Minoxidil and Retin-A. Should I switch?

Propecia works at the cause of hair loss, by blocking the action of DHT on the genes that impact hair loss. Minoxidil is a drug that has a side effect: growing hair. The side effect of a noticeable growth of new hair occurs in between 3-15% of the Minoxidil taking population. Minoxidil does not block DHT, so its action is very different than Propecia. Retin-A is an acid which produces a burn to the skin. I generally look at burns negatively; why burn the skin? The burn causes increased vascularization and therefore allows a higher absorption of the Minoxidil. Retin-A also has it’s own side effects and warnings. Retin-A possibly may make the Minoxidil more effective, but at what cost to you and your skin? That is the question!

Lots of Propecia questions this week…

I am 21 and notice that my hairline is going. Should I start taking Propecia?

There are many important elements to your question and like all good questions, the answer may be more complex than you were expecting. There are many reasons for the hair line to move, the most common reason is the transition from having a youthful hairline to acquiring a mature hairline. This frontal change in the hairline occurs in 95% of young men and it is not reflective of the balding process. I can not tell you if Propecia will stop or slow this process down, but I suspect that it might considering that this is probably a DHT induced manifestation.

With regard to early genetic balding, I would get a good doctor to examine your hair looking for miniaturization of the hair shafts. The finding of miniaturization is an absolute sign of genetic hair loss, If you have it, Propecia is recommended to be started at the earliest appearance of genetic hair loss in the post pubescent male. Since genetic hair loss is a progressive process, the earlier you get a good diagnosis, and begin Propecia, the better your chance is to keep your hair for a longer period of time.

Can doctors legally give someone a prescription for proscar when they just need propecia?

Yes, doctors can prescribe whatever is in the best interest of their patients. With regard to Proscar versus Propecia, they are both exactly the same medication, but Proscar is a 5mg dose of finasteride while Propecia is a 1mg dose. The two are exactly equivalent if you can cut the Proscar 5 mg pill into fifths. That is a problem for some patients, because the cutting process is not easy.

In your opinion is there ever any reason to up the dosage of propecia? Do you know of any side effects from doing this? If you were to raise up your dosage would a smaller dosage then become ineffectual as your body gets used to the larger amount?

The dose of Propecia has been tested from as high as 20mgs to as low as .25mg. The researchers did a good job testing the value of higher doses. They determined that higher doses were no more effective than the recommended 1mg dose, much to their surprise. If you were to take a higher dose, you might start to see sexual side effects which start to show up as the dose increases.

I am 30 and I have had a good results from Propecia on my crown, but not good enough. Can I have my crown transplanted? What will the results be like?

You have had an excellent result from Propecia. The readers of this should first put themselves into your place and ask themselves if they would be satisfied with this result. If not, yes you can have transplants, but transplanting the crown without knowing what will happen to the front has risks. You need to know what is your worst case balding scenario. Whatever grafts you use in the crown now, will not be available for the front later if you start frontal balding. However, if your donor supply is very high, or if you don’t have a family history of extensive balding, or if you have no significant amount of miniaturization in the donor area, then saving grafts for future balding may not be a concern.

You and your doctor must lay out the long term goals and the plan that you will follow. Only you will be in a position to make the final decision.

The photo on the left was taken about 18 months ago (before taking Propecia) and is scanned from a Polariod, so please excuse the quality. The photo on the right was taken this month and shows the results of this patient’s crown after taking Propecia.

I am 43 years of age and have been classified as Norwood 4. I started slowly losing hair in my mid thirties or so. Both my grandparents had a full head of hair, but my uncles on my Mothers side are Norwood 6’s. So, is it a high probability that I will progess to class 5 or 6 + in my later years?

Norwood Class 4

Norwood Class 6

With treatment using the drug Propecia, I suspect that you can arrest your hair loss so that you do not become the Class 6 pattern of your mother’s side. If that is all you want, then no transplants are needed. If you want to reverse the hair loss, then hair transplants are the only real option.