Category: Drugs

Doctor Rassman/Pak thank you guys for the blog, you guys are truly amazing.

My question is, is Dutasteride really better than propecia? I know its no fda approved for hairloss, but in your opinion do you guys think it is better and more effective? Doctor Rassman/Pak I know you guys rarely prescribe dutasteride, but do you guys have any patients that are on it and have had better results than they did with propecia first? also do you have patients that did not respond to propecia at all, then went on dutasteride and had good response? or at the end of the day avodart and propecia are both the same, and the more dht reduction from avodart does not make any impact more than propecia in terms of hair?

thanks guys

You are correct in stating that we at NHI rarely, if ever, prescribe dutasteride. Some doctors in our community prescribe dutasteride and believe that they gets better results with it versus finasteride. There may be differences in their efficacy, but the higher risk of side effects and long term effects are unclear, especially the risks of sterility that have been reported.

I have occasionally seen patients who have taken dutasteride after taking finasteride, but in my opinion their results are equivocal.

hello dr

i want to ask you about this fat burner as it has grapefruit extract. does this product accelerate hair loss or affect propecia effects?

Grapefruit is problematic with many medications due to the way it metabolizes, and I’d expect grapefruit extract would be similar. In simple terms grapefruit can compete with the metabolism of many drugs including Propecia so you may end up with higher levels of Propecia in your blood stream. This is not necessarily good. If possible I would NOT take grapefruit and Propecia at the same time.

Can cutting back on Fin have better results for some that don’t respond well?

I have recently decided to lower my dose of Fin. Since cutting back I have seen a large decrease in the daily hair shedding. I have been on 1.25 mg Fin for about 2 years now since I have been taking and my hair has continued to slowly get worse. It never really increased in density at all. I simply believe that I may be a non-responder.Now that I have been on .625mg, I believe that my daily loss has decreased as while after I dry my hair in the shower I do not see bunches of hair just falling out like I normally do.

My question is that, if someone is one of theses so called non-responders, could cutting back or even getting off of Fin actually help with the hair loss or will I soon see an large increase in the shedding due to my lowering the dose?

Thank you in advance

I do not know if lowering your normal finasteride dose will DECREASE shedding. It does not seem to correlate. You must also consider that your hair loss rate may not be consistent or at a constant rate, and the change in dose may be coincidental. Your perception of shedding may be just that — a perception and not a definitive fact. Without microscopic examination or bulk analysis (objective measurements), it is difficult to tell.

I do not know how lowering your dose will affect hair loss over time. I guess only time will tell. You should talk to your doctor about changing the dose.

Hi Doctor William Rassman. I was on a forum called hairloss talk, asking a question regarding my situation, and most of the users there told me to email and ask Doctor Rassman, as you are very prominent and reputable in hair restoration.

I recently visited my dermatologist regarding my hairloss, and after checking my hair he said I am showing signs of AGA, and said if I don’t treat it it will progress. From my research on the net, I figured he will put me on propecia. In fact he put me on avodart. When I told him its not fda approved for hairloss, and propecia is he said avodart is better and brings DHT down more, and propecia is nothing next to avodart. He told me to take it everyday for 2 weeks, then every other day from then on as it has a long half life. From researching on the net, many hair restoration doctors, rarely prescribe avodart for hairloss due to some dangers. whats your opinion on this?

I would love to come see you, but I live in Canada. do you think I should go see another doctor and get propecia? do you prescribe avodart to your patients? or propecia? in fact is avodart that much better than propecia?

Thanks doc, I would really appreciate a reply on your opinion. I know medical advice is not given over the net, but I just want your master opinion.

Propecia (finasteride) is still the right drug of choice in this situation mainly due to the FDA approval, and the lower side effect frequency than Avodart (dutasteride). I have prescribed Avodart in select cases before, but usually only to poor responders to Propecia.

I don’t know where the dosage info your doctor came up with comes from (14 days of daily use, then every other day), as the dosage for hair loss treatment hasn’t been clearly defined. Avodart does have a long half life, so if you do experience side effects they will take much longer than Propecia would to leave your system. If you’re concerned about the prescription your doctor gave you, you can talk to another doctor for a second opinion.

Hello Doctor,

I have been using Minoxidil 5% for one and a half years and have seen some effect in terms of reduced hair shedding and some hair growth on the frontline. It’s not thick but I can notice it. My hair is sparser on the right temple and I think it has also progressed a bit on the top. My question is can I use Minoxidil 10% in the area where the hair is sparse and continue with the 5% on the other areas?

Thank you for such a great site and providing information that makes real sense.

You should be managed by a good doctor and you should get some scientific measurements on the results of this treatment modality that you are proposing.

I have heard about some doctors mixing minoxidil to 15% concentrations and it is possibly more effective at the higher dose, but beware of complications that are more likely to occur. The higher the dose, the worse and more common the side effects of minoxidil. Also, I wouldn’t expect great results from minoxidil at the frontal hairline / temples regardless of dose.

If I’m experiencing mild side effects from propecia, weaker erections, decreased semen, etc. is there a chance the side effects could subside with further use as my body adjusts to the med and lower DHT levels?

These are questions you should ask of the doctor who prescribed the drug to you. Yes, the side effects could subside with time… or there may be adjustments to the dose that would help you.

You could set up a private consultation over the phone with us if you are not in Los Angeles, sending pictures of your scalp ahead of the call, and I will be happy to discuss your problem with you. Keep in mind though, you should be able to communicate with the doctor that prescribed you this medication, particularly if you have follow-up concerns or questions.

Hi Dr, thanks for maintaining such an informative and unbiased blog.

I have had good results with propecia for a couple of years. Having recently started minoxidil (4 months) i am starting to see some good results.

However, do you know if hair regrown by the minoxidil would be maintained with propecia if i where to stop using minoxidil?

Thanks!

Unfortunately, hair grown from minoxidil won’t be maintained by Propecia (finasteride)… and vice versa. Their methods of action are different, so one won’t keep the results from the other one.

Hi Doc

I am 32 and have been using propecia for 6 years. I have recently noticed a lot of shedding and my hair feels thinner. Is this normal after 6 years? Should I now introduce minoxidil to my hair prevention? Does minoxidil affect non balding hair (back and side) and make them dependent on the drug as well. I am slightly concerned about making non balding hair weaker by making them dependent on a chemical. is there any reason to worry about that?

Also what ever happened to the potential of a natural apple based solution that helped prevent baldness? I saw a few years ago that a japanese company was running trials and said they had good results. Did this ever go anywhere or are they still running trials?

If your doctor measured your hair bulk throughout your scalp before you started the medication (something that probably wasn’t available then) or performed miniaturization analysis (which was available), you would now know when/if the drug stops working optimally.

Some men have said they’ve seen their hair loss resume after years of taking Propecia, but each case is unique. I’ve had patients on the medication for well over a decade with continued great results. I don’t know that it is “normal” but you’re likely not alone in what you’re experiencing. You should get a doctor involved so that you can start getting measurements now, which will be beneficial if you do decide to add minoxidil.

Topical minoxidil is an off the shelf medication that you do not need a doctor’s prescription to use in most countries. Many men start using it, then get lazy and stop after about a month or two when they don’t see immediate or significant results. It takes about 6 to 12 months of twice daily use to see some effect. Before starting or stopping any mediation it is always good to speak with your doctor. As to your question about dependency, see here.

With respect to natural apple based solutions, I have not heard or read much about it.

Snippet from the article:

The name of the Food and Drug Adminsitration’s new public awareness campaign, “BeSafeRx,” has the same ring to it as the websites you aren’t supposed to be trusting: “expressrx4les,” “healthydrugsonline,” “ineedmypill.com” and 10,000 others that the National Association of Boards of Pharmacy identified and recommends against.

It also comes off, at first glance, as a bit of a no-brainer. Don’t buy pills from the people spamming your inbox — it’s like not accepting unwrapped Halloween candy from your creepy neighbor, except riskier. But the FDA’s survey of over 6,000 people revealed that only 13 percent of those who had purchased drugs online checked to see if the site was licensed. Almost one in five admitted to purchasing medications from websites that weren’t affiliated with their local pharmacy or health insurance plan, and 47 percent of those same people relied on comments and reviews to verify the drugs’ safety.

Read the rest — How Legit Are Pillz-4-Cheap Websites?

On one hand, I get why people might be tempted to buy prescription drugs online — price and embarrassment being key issues. On the other hand, there are reasons why prescription drugs require a prescription, and you’re taking a huge risk when buying from these unlicensed and illegal websites.

How can you be sure you’re actually getting the right medication? How can you be sure you’re not actually doing yourself more harm than good? How do you know if you even NEED the medication that you’re buying? If it seems to good to be true, it probably is.