Category: Drugs

Hey I wrote to you before about low/watery sperm volume when it comes to propecia. I just wanted to ask: could a side effect like this occur earlier if I’m only suffering from a receding hairline. Could 1mg of propecia be too much for a patient with only a receding hairline & thickness of hair everywhere else on the head? Should I think about lowering my dosage and try it out?

If you just have a receding hairline, it’s unlikely that Propecia will regrow the hair there, though it could keep further loss at bay. Watery ejaculate isn’t specific to those with just hairline recession, nor do I believe that the speed at which it might occur is related to the degree of loss.

You’ll need to talk to your prescribing doctor about dosage changes. I don’t know anything about you and you’re not my patient, so I can’t tell you how much or if you should be taking a prescription medication.

Snippet from the article:

Pharmaceutical industry heavyweights are teaming up to address a challenge that’s long vexed drugmakers: how to improve the way experimental drugs are tested so they can get approved, and reach patients, faster.

Ten top U.S. and European drugmakers, including Pfizer Inc., said Wednesday that they have started a nonprofit organization, called TransCelerate BioPharma, to collaborate on the problem.

Read the rest — Drugmakers cooperate to streamline test process

The article points out that “5,000 to 10,000 potential drugs fail for every one approved“, and only about 5 of those even make it to the expensive human testing phases. So drug companies are looking for a way to streamline the processes and to ultimately cut costs. Hopefully this will lead to new treatments for a variety of health issues being available cheaper and quicker.

The high costs do not make drug development an attractive investment unless there is a significant return. From a financial standpoint, I would not want to be in the Propecia business today. Would you want to be, with the patent expiring shortly and competitors wanting to take away what market Merck may have built?

I had been on Propecia for years but unfortunately suffered with notable side effects, particularly sexually. I had little libido, suffered with incomplete erections, testicular pain, and limited ejaculate volume. I realized that it was negatively impacted relationships with women since I had little interest in them sexually.

I decided in January to come off Propecia as a trial. I noticed a bump in libido after a few weeks off and improved mood and motivation. My erections did not return however until about four months off Propecia, firm by five months. I am now in a dilemma because the hair loss has been terrific. I went from excellent hair to thinning lifeless hair (made worse by using Rogaine) and noticeable loss of temporal region hairline. My appearance has definitely suffered and I am not in a relationship.

I am contemplating going back on Propecia and wanted to know if you would recommend 0.25 mg starting dose or 0.5 mg? Can I expect some regrowth on top at these doses? What is your experience with these lower doses. Some have recommended 1 mg every two to three days due to the long action of the medication (in an attempt to limit side effects). Any assistance would be greatly appreciated!

My assistance and recommendation for you is to discuss your issues with your doctor who prescribes you the medication. This is a general source of information. I do not and cannot advise you on personal medical issues.

If you have side effects from medications then it is something you inform your doctor. Some patients continue to take the medications after the risks and benefits have been considered. Some patients take a lower dose in hopes that the side effect would be less and the benefits would continue.

There are reports that at even half the dose (0.5mg finasteride daily) can be about 70 to 80 percent effective on the treatment of androgenic alopecia. I’ve prescribed a lower dose to some patients and they’ve had continued benefits from the medication, but that is something you’ll need to discuss with your prescribing doctor.

Hey Doc, I just wanted to share my opinion on Propecia. I was noticing some recession of my hairline & got it checked by mt Derm. He told me it’s just my maturing/adult hairline forming. But I panicked & asked for a 1 month Propecia Prescription. I’ve taken it for only 2 days & have noticed a low volume in sperm when I masturbate; almost liquid/watery. Much less thickness then before. What I’m going to do is get my Hormone Levels check in a week since that might be enough for Propecia to exit my body. Could it be that I might not need Propecia if my DHT levels come back normal. And the low volume could have been a sign saying there’s no need to decrease your DHT levels since you have normal DHT levels. Again I’ll wait and see what happens.

The last thing I would like to state is that I think at least a good 70-80% might notice low volume when it comes to the sperm. Now this could just be a common side effect of your body getting used to Propecia, and will return to normal within a few weeks- hence the only 2% notice sexual side effects of a period of years when it comes to the trials. So basically I think the low volume when it comes to the Semen could be just like Shedding or mild headache from something like Rogaine which a lot of people experience while using Rogaine & then it goes away. So maybe the Low volume in Semen could be the same- first few weeks it could be low & then return to normal after the body gets used to it.

The thing is if this is true and Merk knows it, then they should state it clearly: That most men taking Propecia will notice a low count in the volume of semen in the first few weeks but then it will subside and return to normal. I think this very much is true, but Merk might be scared to state this clearly as it will scare of customers from hearing about low volume in semen in the first few weeks. Again I would love your insight on this, as I believe it is true. I’m not saying Propecia has a long time effect on Semen Volume, but it could have a short time? maybe a few weeks as the body is getting adjusted to the levels. Again Merk should state this as it could also put rest to all the stories of side effects ruining peoples life.

Thank You & I hope you take your time reading this

One of the side effects of Propecia involves the volume and/or viscosity of the semen, but I would be surprised if it would occur in just 2 days. This has nothing to do with the sperm count per unit volume of semen or one’s erection or libido.

The mature hairline evolution may not be impacted by finasteride, but I really am not sure on this statement.

Hi There Doctor!

Im a 22 year old guy with a pretty good head of thick hair currently. No one currently would ever know I am thinning. Recently I went to get my haircut and my stylist told me i may have some “thinning issues” as she noticed short hairs near the front of my hairline. Crown is very thick at the moment.

I made an appointment with a dermatologist and she said that right now is a great time to catch it and potentially preserve everything I have and started me on Finasteride 5mg cut in half once per day. (2.5mg daily) and she said “see ya in a year!” I have been on it for two and a half weeks with no side effects yet.

My question is if it takes a year for Finasteride to show any results, isnt a year a VERY LONG time to lose hair? Couldn’t I lose A LOT of Hair in that period of time? I hate this feeling that I’m on the best medication for hair loss, but at the same time I’m gonna be losing hair at the same rate for a year before it even starts working?! Am I understanding how Finasteride works correctly Or does it immediately start to “help” but will just take a year to see any major preservation or potential regrowth?

Thanks!

It may take up to a year before you notice the effects of finasteride on treating androgenic alopecia. Maybe some will see signs in 6 months, but I generally inform my patients that they should be prepared for a 6 to 12 month time span before they can see results. That being said, Propecia (finasteride 1mg) is for the treatment of androgenic alopecia on the crown and top of your scalp. Some patients and doctors use it for frontal hairline thinning, but it is generally not effective.

As for the dosage you were given, the recommended dose is 1mg taken daily. Many patients and doctors, in the interest of cost saving, choose the generic 5mg which they break into quarters (1/4) to make 1.25mg of finasteride. There is no generic finasteride in 1mg dose legally available in the US yet due to patent laws. While breaking up a small 5mg tablet in to four small semi-equal pieces may be annoying, it saves hundreds of dollars a year. For example, a one year supply of finasteride 5mg taken 1/4 pill a day will cost you under $30 per YEAR. The brand name will cost you close to $800 a year depending on where you buy it. There is no difference in efficacy in taking the generic drug. Taking 1.25mg a day as opposed to 1mg should not have any significant difference. Ideally you should be cutting the pill in to five equal pieces, but this is not practical.

Taking 2.5 mg daily is more than doubling the dose and it would not have any beneficial impact in treating your hair loss. Taking more does not mean it will work better. Rather, it will give you more side effects. But some doctors have their own opinions and they’re in their right to practice medicine and prescribe medications as they see fit. If you do not agree with your doctor and have concerns, you should seek a second opinion. After all it is called a “practice” of medicine. Just to be clear, I am not your doctor and this is not a second opinion.

There is a rising body of evidence that less finasteride may work. So for those of you who may be experiencing any side effects, a half dose may be just as effective as a full dose. This is presently an unofficial comment as this is not yet what the majority of doctors believe is the recommended dose for finasteride.

Finally, what troubles me most from your question is that you state that you never considered yourself as someone who is losing hair. You set off on this medical endeavor because your hair stylist mentioned something that got you worried. And now you are second guessing your dermatologist’s recommendations and treatment plan. From what I am reading, you need to speak with your dermatologist regarding your concern and if you are still not satisfied you need to seek a second opinion.

What I do with everyone who sees me is to perform bulk measurements on the hair in different parts of the scalp. This is a very accurate way to make the diagnosis if hair loss is occurring before you can see it with your naked eye and it brings scientific measurements to the diagnostic process.

Dear doctor how are you doing. I love the website and you have helped me with a lot of my hair loss problems that my regular doctor hasn’t been able to answer. I am 30 yrs old and have been taking finasteride for a decade.

At first, when I started taking the drug, I was shedding a lot and almost thought I would go bald within a month. Thankfully I didn’t. However, now I am not shedding as much so does that mean the drug is losing its effectiveness?

2nd question is, I took 5 mg of proscar the other day just to try it out. If i take 5 mg which is meant for prostate, wouldn’t that make me want to go to the washroom more often? It didn’t, so does that mean the drug is losing its effectiveness.

Thank you very much.

So you just decided one day for the hell of it to take 5mg of finasteride instead of 1mg? I’m not sure I understand why you’d do that, but it won’t cause excess urination, nor would excess urination mean anything about finasteride’s effectiveness on hair loss. And if you’re not shedding while you’re on finasteride, it sounds like it’s being quite effective. Am I missing something here?

Talk to the doctor who prescribed the medication to you. It sounds like you need advice from someone who can examine you and form opinions on your hair situation, since you’re clearly concerned about effectiveness and willing to experiment on yourself.

Hi Doctor,

I’ve seen you comment on the topic of propecia-related gynecomastia before but, what I’m wondering is, how often you see it in your practice. Would you say it’s as common as the sexual side effects? Moreso? Less so?

I’m a bit worried at the fact that you say you now work with a doctor in your practice who treats this. I don’t supposed you’d have need for it if it weren’t pretty prevalent.

I’m starting to experience MPB. I am 26 and my father lost his hair at a very young age. Unfortunately, my visit to the dermatologist was not ideal. I was very nervous and she did nothing to calm me down. Honestly, she spoke to me as if my being there was a waste of her time. “You’re 26, it’s not unusual at this age.”

I understand that but a little understanding wouldn’t have hurt. She only suggested Rogaine for me. She mentioned Propecia but did not prescribe it for me due to being “disturbed by recent studies.” Being an FDA approved medication I really think it should be the patient’s decision as long as the risks are clearly explained. My general practitioner does not seem to want to prescribe it for me, either.

Any information you can provide on these topics is appreciated. I’d like to try the medication but, if I keep hair but grow breasts…I’m not sure what I’ve gained.

I think you read into things a little bit when I mentioned I now work with a doctor that surgically treats gynecomastia. I acquired a dermatology practice where one of the doctors has built up a massive experience treating this problem over the years. Most gynecomastia is not related to Propecia use, as this is very rare in my experience. Gynecomastia occurs in many men at many ages.

If you don’t like how your dermatologist treated you, you should find another doctor. I’ve written much about the “recent studies” which are actually just biased interviews with 50+ men.