Category: Drugs

I have been taking Propecia since I was 28, in varying doses from .25mg to 1mg. I have seen a huge benefit from it, but I have also seen some increase in breast tissue along with some pain in the breast area. My doctor has asked me to stop taking it to see if the pain subsides, and I have stopped for about a month but it has made little difference in terms of pain. What has changed is that my hair has thinned dramatically, mostly in the crown area.

My doctor would like me to continue off of Propecia for another month or so to rule it out as a culprit, but I’m concerned that I may lose a lot of hair permanently. Can you give me any idea of how permanent the hair loss is that I am experiencing now? If I’m off Propecia for two months, am I likely not to get back to near the same levels of hair that I had while I was on it?

If you were my patient, I would probably tell you to stay on the Propecia (unless you are willing to lose your hair and then not get it back). Hair lost after stopping Propecia might regrow for some, but I would expect that once the hair is gone, it won’t return.

Breast enlargement resulting from Propecia does not go away simply by stopping the drug. The breast tissue should be treated by a person knowledgeable in this field, first examined carefully to make sure that there is no breast cancer. Then consider treating it as a typical gynecomastia case with surgery and possibly liposuction done by someone experienced.

I am now working with such an experienced doctor at my office who treats this condition, which can occur with or without Propecia use.

Hello Doc,

Please go through this ridiculous article in Yahoo.

Link: For Some Men, Propecia’s Sexual Side Effects May Be Long-lasting

Please tell me what you think.

Thanks

There are a great deal of claims that may accurately reflect the patient example, however, the documentation and balance of the presentation is poor and heavily biased. Read it accordingly.

It’s worth pointing out that this recent hysteria is just based on interviews with 54 men, where the participants reported their own issues after stopping the medication. Even more important is to note that these men were recruited from PropeciaHelp.com, an anonymous web forum where men post about problems (real or otherwise) they have from the medication.

The surprising 96% figure gives the media a good, scary headline to get people interested in watching or reading their report. For example, I just saw a quick 20 second segment on my local morning news that said “96% of men have persistent side effects”, but provided nothing else beyond that. It’s very alarmist and misleading.

Snippet from the article published online June 20, 2012:

Finasteride use marginally increased the incidence of prostate and overall cancer at a level of statistical significance. Dutasteride use significantly increased kidney cancer risk. Dosage analysis showed that lower doses of finasteride were associated with higher overall and prostate cancer risks.
…
The major limitation is the lack of important data in the NHIRD, such as prostate cancer histologic grades, smoking habits, alcohol consumption, body mass index, socioeconomic status, and family history of cancer.

Read the rest at The Oncologist — A Population-Based Nested Case-Control Study in Taiwan: Use of 5α-Reductase Inhibitors Did Not Decrease Prostate Cancer Risk in Patients with Benign Prostate Hyperplasia

This study seems to go against the grain of some of the original studies which showed some protective effect of finasteride in the overall population, however, the original study used the 5mg dose. This article suggests that the results of lower doses might be a problem.

I know I’m going to get a bunch of questions about this one, but I can not comment beyond what is in the article. I’m just presenting it so you’re informed.

what is the purpose of propylene glycol in minoxidil? why not just alcohol and minox only? thanks.

Propylene glycol reportedly increases the skin penetration of the minoxidil. Perhaps a chemist might be able to shed more light.

Dr. Rassman,

I started taking finasteride (1 mg) back in early March of this year. Each evening I would take my daily 1 mg at about 6 pm to about 7 pm. Reading your blog, I have realized that testosterone levels are at their highest in the morning after one wakes up from sleeping. For the past few days I have been taking my 1 mg at around 9 am. I am doing this because – in theory, at least – this should improve the effectiveness of the medication I’m taking. I am not suggesting that Propecia hasn’t done anything for me because it certainly has – my hairline is actually proceeding! I just want it to work even better – if it can.

My question is: Will this sudden change affect me negatively in any way? I don’t imagine that it would, given that the information that comes with my medication says nothing about what I’m bringing to your attention.

I just want to be extra sure.

Thanks a lot!

It really doesn’t matter when you take Propecia, so long as you remember to take it every day. Dosage consistency is more important than what part of the day the medication is consumed. I’ve written before that taking it in the morning is best, but there’s no proof that says morning dosing works better. It was just my opinion.

Propecia does work on the hairline. In some cases it may help slow down further loss and on a few occasions I have seen it reverse frontal loss (very rare out of thousands of cases I have treated over the years). I tell my patients not to expect the medication to regrow a receding hairline, but if it does do it, that’s an added bonus. Propecia works best on the top and crown areas of your scalp.

So to answer your question — if you switch from taking Propecia in the evening to taking it in the morning, I wouldn’t expect any problem. But just be consistent.

Hello,
I’ve been reading your blog for a long time and really appreciate the time you take to help inform people about hair loss. I’m 22 years old and have some extensive MPB-caused hair loss (started balding around age 18). I have seen numerous dermatologists and have been prescribed Propecia for the hair loss. However, I always have negative side effects when I take Propecia (pain in testicles and frequent urination), and have been unable to take the medication for more than a week before having to stop. I have even tried lower does (.5mg and .25mg) and still had the side effects, so I know that I cannot use Propecia

However, my question is related to Dutasteride – especially because of the new report you recently put on the blog. While I understand that the proper/safe dosage for taking Dutasteride is unclear at this point, I was wondering if you think that someone (like myself) who has had negative side effects from Propecia, would be likely to have negative side effects from Dutasteride?

Does having negative side effects from Propecia make it likely to have similar negative side effects from Dutasteride, or do the medications work differently and create different responses in patients? I would like to try a small dosage of dutasteride, and that is why I am writing to you with this question.

Thanks so much for your help!

Dutasteride is similar to Propecia (finasteride) in its mechanism of action, so if you have side effects from one you would likely have the same side effects from the other.

Of note, dutasteride has a HIGHER percentage of side effects than Propecia. How that translates between one person taking the two medications and its side effect profile is not clear. It would be an assumption that you would have more side effects if you switch from Propecia to dutasteride.