Category: Drugs

I took finasteride for two months and then stopped because of decreased libido. However, I am not sure they were because of the drug. I had low libido even before I started to take it. It just got worse, but it might have been just in my head anyway.

Now, my libido is back to normal so I am considering starting propecia again. My question is, if I already have taken propecia without permanent side effects (because everything is fine now, those side effects were clearly temporary) does that mean that I will surely not have adverse side effects if I get back on it again? That even if I do have the side effects they will be temporary?

I think the key is that you had low libido even before starting Propecia (finasteride 1mg). You should speak about this with your doctor and consider further testing of your hormone levels. If you took Propecia and you believe it caused side effects, you can try a lower dose (such as 0.5mg). A lower dose may give you no or lower side effect profile, and is about 70 to 80 percent as effective for treating your hiar loss. In all my years in practice I have never seen irreversible side effects or even heard of them from short term use (2 months or so).

Hi, I had a hair transplant a year ago January 2010. I had a thinning crown and little hair on top. I had 3000 follicle transplant and use Minoxodile and 1.25 tab of finisteride daily. Wow. 6 months later I was so happy with the results.

Then in November due to published side effects of propecia I quit everything and now am experience a massive hair loss. I hate even washing my hair seeing all the hair on the shower floor. I can lose 50 hairs just by brushing in the morning. My hair is finer than it used to be and when I walk outside without a hat I feel the cold on the sides of my head like never before. I’ve started everything(finesteride and Minoxidle) back up about two weeks ago in hopes of reversing this. What should I do and can I expect some or most to regrow? Thank you

You have experienced what I’ve called “catch-up hair loss” which means that the full benefits of finasteride and/or minoxidil may be lost within a few months of stopping the drug routine. Your hair loss then catches up to the point you would’ve been at had you never used any medications.

I can not tell you what you can do, but just wish you luck. It’s possible you’ll see some benefits restarted in a few months, but I have no way to know if you’ll regrow what was lost. The wild internet postings about side effects from finasteride that persuaded you to abandon your successful treatments may have unfortunately lead to more hair loss, even though you didn’t mention seeing any side effects yourself. The reality, of course, is that if you were to have developed sexual side effects from finasteride (about 2% of men), you would have seen them within the first month of so of starting the medication.

Dear Dr. Rassman,
Congratulations on the new NHI site. Very nice and user-friendly. I noticed however in the frequently asked questions section on Propecia you recommend against doctors prescribing 1/4 Proscar, as it is not certain that the active ingredient is distributed evenly. In past posts you have referred to the use of 1/4 Proscar without mentioning such risks. Would it be possible to clarify this? Thanks for your insight

For treating hair loss, the daily finasteride dosage should be close to 1mg when you cut the Proscar (5mg finasteride) tablet into quarters. Finasteride fixes (attaches) to the tissues, so blood levels which are relatively short (under a day) will not be impacted by varying the dose from (let’s say) 0.75mg to 1.5mg/day.

You are safe with the 5mg dose divided into four pieces. The information you found on the NHI site about not cutting up the generic finasteride is outdated and we will update the old reference. There’s more recent info about this here.

doctor rassman
whatever happened to the fda trials with avodart? we all know avodart is more effective but when will it be cleared by the fda for hair loss? are their trials still going?

We know that dutasteride (Avodart) works when used to treating genetic hair loss. Some reports suggest that it may work even better, but the safety issues in young men, the sexual side effects and other side effects, and the long term issues related to sterility are not known.

The last I remember, there was a Korean study being done… so I looked up the ClinicalTrials.gov site and found this post about recruiting 900 Korean men for a dutasteride post-marketing study by GlaxoSmithKline (makers of Avodart). It was updated just a couple of weeks ago, though I’m not sure which part was updated, and appears to be concluding in July 2013 — AVODART Alopecia Post-marketing Surveillance (PMS).

The FDA will weigh out the safety issues before any application for use in hair loss is approved. So at this point, we’re still in wait-and-see mode.

Dear Dr. Rassman,

Thank you for your very informative blog. I have been on Propecia for nearly three years with good results. For cost reasons I am thinking of getting Finpecia when I am next in India. Do you believe switching from Propecia to Finpecia would have any effects for a good responder like me? I will only do it if the transition can be seamless.

Many Thanks

Assuming Finpecia is 1mg finasteride, I do not expect there to be an issue. Propecia is just the brand name for 1mg finasteride, and the generic form is sold by a variety of different names outside of the US (where it is not legally available until late 2013 due to patent laws).

There might be some differences in the manufacturing process, but chemically Finpecia (made by Cipla) is the same as Propecia (made by Merck).

Snippet from the article:

Warning labels for Merck & Co’s drugs for baldness and enlarged prostate will add notices of sexual side effects that continued after use of the medicines was stopped, U.S. health regulators said.

Labels will be revised for Proscar, which treats symptoms of enlarged prostate, and hair-loss treatment Propecia, the Food and Drug Administration said. The active ingredient in both drugs is finasteride.

The Propecia label will now include notification of problems with libido, ejaculation and orgasms that continued after use of the drug was ended. Proscar’s label will include notification of decreased libido.

Read the rest — Sexual side effect warnings added to Merck drugs

I am 25 years old, and weeks ago i had my first appointment with Dr Pak at your office.

He was very helpful and professional and gave me very good news, we took a look for miniaturization and bulk loss and everything was fine and there was no point for my to worry about.

Dr Pak told me that it wasn’t even necessary for me to take propecia (which i been taken for two years and 6 months), i havent stopped propecia so far, because even though Dr Pak didn’t classify me on the norwood scale, what worries me is the hairline, now i believe i am between norwood 2.5 and 3.

My question is, is it safe to stop propecia when the norwood scale is more advanced that 2?

Perhaps my pictures taken by dr Pak two weeks ago are available in the data, and perhaps you could classify my in the norwood scale.( i’m not ok with having them posted)

Anyway i want to thank you and Dr Pak, I plan to have an apointment once a year if everything stays the same without changes, and i also plan the possibility to have a hair transplant with nhi on the hairline when i hit 30.

Thank you Dr Rassman

I did review your file and it seems your hair loss issue started when you had a long hospitalization stay from your illness (considered stress-related hair loss). You noted hair loss after being discharged from the hospital and since then it has grown back.

There is little harm taking Propecia if there are no side effects; however, if after bulk analysis, miniaturization mapping, and observing your frontal hairline, it still indicates that you are not balding, then taking the drug is unnecessary.

Many men worry that they have frontal balding and often classify themselves as having a Norwood class 2 or 3 balding pattern, but they are really just seeing the appearance of a mature hairline. We often do not agree with their classification, but the final decision about taking Propecia is obviously yours and I can justify the drug in your particular case.

I’m a 24 year old male. I’ve been using Propecia for about 40 days and just started getting testicular pain. Everything functions as normal, but I have pains and my libido seems down about 30%, although it could just be from the pain. I can deal with some libido loss as I really want to keep my hair. It’s unlikely to be caused by anything else. Will symptoms likely fade and how long should I wait before discontinuing treatment? Also, I take the generic, Finpecia 1mg.

Testicular pain can be a serious medical emergency. Before dismissing it on a side effect of a medication please contact your doctor or get yourself to the nearest emergency department. This is not a place to get a diagnosis for your testicular pain issue or self treat a potentially serious medical issue.

In the last 10+ years I remember only two of my patients who had testicular discomfort (not pain) reported as a possible side effect from Propecia, and both of them found that their symptom was gone (best of my memory) in less than a month.

Hi, I’m 22-years-old (111 lbs) and started to diffused thin when I was 17. At the time, I was under severe prolonged stress and eating turkey with wheat bread for every meal for 7 months due to digestion problems, and using Nizoral to treat dandruff.

Since then, for the past 5 years, I have kept most of my hairline, excluding the receding area around my right-temple.

Most of the thinning is near the crown and on top of the scalp. The left-temple still has its shape but the hair quality is noticeably thinner than the rest of the hair on the sides.

I have been on-and-off Minox 5% for the past 3 years; Finasteride 1 mg for 16 months; miconazole nitrate cream for 6 months; and Folligen since the last month.

Overall, I have been trying to convert my vellus hairs into terminal ones, but so far I have not been successful. Should I drop Finasteride and go for either Dutasteride (? mg) or RU58841?

Thanks and looking forward to your response.

Sorry, I am not your prescribing doctor and can’t tell you what medication you should take. Dutasteride’s proper dosage is still undetermined, it isn’t FDA approved for treating hair loss, and as it is a much stronger medication, the side effect risk is likely greater (and longer lasting). As for RU58841, the last I remember it was some experimental lotion that was tested on macaques years ago.

You sound desperate to try anything, but with severe stress and malnutrition, your hair loss should be one of the last concerns you have.