Category: Drugs

Just wondering if it is known why Propecia is often not effective around the front/sides ? Is there any hope for a new drug in the works that may address the front/sides?

When Propecia works, it works where the hair loss is relatively newer. The frontal area is often the first place the hair loss starts but often it is not noticed until the hairs are fully miniaturized or lost and at that point Propecia is not effective. Propecia can work well in preventing rapid hair loss in the frontal areas when the drug is started early enough. There is clearly a difference between frontal balding and crown balding, which tends to start later, in the way the genetics are expressed.

Hello Dr. Rassman,
Well I am 23 year old student and I have been experiencing hair loss since I was about 22. My question is regarding dutas or the generic avodart that is made in India. Do you believe that this is a legitimate form of .5 mg dutasteride? Furthermore, I just order procerin and was going to take it in conjuction with the .5 mg dutas as a supplement as well as revivogen and tricomin. Do you recommend this and if not what do you recommend that I take to supplement the dutas. Thank you for your time.

I can not advise you on medications made off shore (India). The other supplements you discussed are not scientifically proven to my satisfaction. That does not mean that they do not work, just that I can not advise you that they do work. I generally stick to what I know works and that is limited to two approved medications Rogaine (or the generic form of it) and Propecia. The rest is up to you, the buyer.

I just heard back from the manufacturer of Propecia, Merck, concerning the question raised on April 29th (see: Propecia and Liver Disease). The question related to a person with a liver disease called Primary Scholerosing Cholangitis (PSC) and the safety issues with using Propecia.

A detailed three page answer was forwarded to me (with quotes from many scientific publications), so I will summarize it as simply as I can. The drug experience comes from Merck’s experience with Proscar (5mgs of Finasteride) and Propecia (1mg of Finasteride). A liver adverse effect has not been listed in the clinical trials of the drug for hair loss treatment. The drug itself is broken down by the liver, so decreased liver function will directly impact the rate at which the drug is metabolized by the liver and will keep serum levels higher in people known to have decreased liver function. In other words, the ability of the liver to clear this drug from the body may cause the serum levels to be higher than on someone without liver disease. There has been no study performed on the effects of hepatic insufficiency for Finasteride pharmacokinetics. Also, a search of the medical literature did show a rise in liver enzymes in one of 14 subjects studied in healthy volunteers (Shimazaki and Nose). One case of hepatitis induced by Finasteride was reported in a patient with many organ problems including a high alcohol intake. The inability to find another cause for the hepatitis on this patient led the doctors to believe that this drug may have been the cause for the liver disease on this one patient. When the drug Finasteride has been used with Flutamide, there was some impact possibly inducing liver disease.

In conclusion, I would strongly suggest that if you have known liver disease, that you use this drug with caution. Follow the use of the drug as prescribed in the literature and have a doctor follow your liver function tests periodically with the use of this medication. Liver disease in healthy people has not been reported (based upon the Merck communication with me). I would not consider liver disease as a significant risk in the typical patient’s routine use. But as a caution, every medication that anyone takes has potential risks associated with it. Even vitamins and Aspirin have their problems, yet we seem to continue to use them as well. The challenge is to balance reasonable risks against the alternative hair loss that might be slowed, stopped or reversed on this medication.

I have been taking propecia for about 6 years. I also have Primary Scholerosing Cholangitis (PSC), a liver disease. Do you know of any studies or have any other knowledge about the impact of propecia on the liver? Thank you.

There are warnings on the use of Propecia for those people with liver disease, however, it is not clear if the drug can negatively impact the liver directly in those with active liver disease. What I suspect is that the metabolism of the drug may be affected by active liver dysfunction. I will ask Merck, the makers of Propecia, about it and get clarification from them, getting back to you in the very near future. They are usually responsive to my questions.

UPDATE (May 3, 2005): Please see the response from Merck here.

Hi,
I am 6 weeks post op. I received 1500 fu’s and earlier punch graft work repaired. Other than some minor shock loss in the donor area, I seem to be healing fine for 6 weeks. My question is this; I have never used Propecia or Minoxidil before. I am curious if 5% Minoxidil would speed up and/or enhance grafts. It states that Minoxidil only works in the vertex area. Would that not apply to recipient area on the top of my head? After all, the grafts were taken from below the vertex. Also, I’m using Mederma for scarring from old plug extraction on crown. Is it wise or safe to use Mederma and Minoxidil at the same time? I have purchased the Minoxidil, but have not used it yet. Any information would be appreciated. Thank you.

The donor hair will not be affected by Minoxidil so I do not recommend its use after a hair transplant. I generally put people on Propecia if they are young and in the balding process at almost any stage, as hair transplants can accelerate any hair loss process that is active. Mederma is an over-the-counter herbal medication that is recommended for (1) old scars, and (2) new scars. Its claims include that it softens the scars. It has no defined scientific benefit that I know of. I suspect that it is safe, but I do not have first hand knowledge about it.

Dan wrote…

a website called consumer-review.net/hair-loss.html rates a product called procerin higher than propecia, procerin’s website, procerin.com elaborates on their product. I was getting ready to order some procerin, when my wife heard your ad on the radio and I checked out your website, and read about dutasteride. Are you familiar with procerin ? Also could a dermatoligist prescribe dutasteride to patients before it has fda approval ? please advise

The product you described, like many other similar products, adhere to a very loose standard for the health food additives which are naturally found in the environment. There are many natural herbs that are poisonous as well. There is no requirement for any of these products to prove effectiveness or safety, unlike those that go through the rigorous FDA process. This is the reason that I maintain what I believe is a healthy skepticism for these ‘natural’ products. The same is true for my attitude for prescribing dutasteride for hair loss, which has not been shown to be both safe and effective for hair loss. I am familiar with hearsay reports that the libido impact is greater for dutasteride than with Propecia and the drug has a very long half life, which means that it takes months to get out of your system. If you should take dutasteride and develop a libido problem (for example), it may take 6-12 months for it to rectify, while with Propecia is would disappear in days. I personally would not be against prescribing dutasteride, but I have not done so yet. My motto, like any good doctor’s philosophy must be “Above all, do no harm”.

Also, it should be noted that the link on that consumer-review.net site you mentioned is an affiliate link to the Procerin site, meaning that Procerin pays that site if people use their link to buy the product. In that regard, it would seem that it’s in that site’s best interest to highly recommend Procerin.