Category: Drugs

I have been taking propecia for 8 months now and feel my hair loss is ten times worse than when I started.my hair has gone from thick shafts to almost baby type thinness.I have seen a hair specialist who has told me to sit it out another 3 months but I am in a terrible state of mind,please help.

ps will this affect my chances of a hair transplant if I choose.

First and foremost, there is no drug that will completely stop genetic hair loss. Propecia (finasteride) can help, but in the long run your genetic fate will take its course. We have wrote about this concept over and again on this site.

Many people who take Propecia do notice benefits in their first year as they see hair loss slow down. Unfortunately for a few like you, they lose the battle, so to speak. This does not mean the the medication made it worse, but it most likely means you were rapidly losing hair as you were pre-programmed to lose (with or without Propecia). Although it works for a majority of men, it doesn’t work for every man.

I know these aren’t exactly words of encouragement, but it is an unfortunate fact. The good news is that a hair transplant may be an option still as a last resort. I’d have to see you to make that determination, though.

Dr. Rassman-
This question can be answered by you or any other M.D. working on the site, I do not mind. I am a 25 year old 4th year medical student who has been on propecia for 4 years and have had great results with no side effects. Stopped my hair loss completely at a Norwood 2 and have maintained since starting.

My problem is that the Dr. that prescribes to me, a prominent hair guy in New Jersey, has recently been unavailable for reasons that I can not figure out. I recently had to get an family doc that I did not know from my school to write me a temporary 90 day script, but with my future move to residency and the time constraints on a surgical resident (which I will be), makes me worry I will be left in the lurch if this keeps happening.

My question is basically this: can I write myself scripts for propecia every 90 days when I get my prescription pad this July? Is their anything ethically/legally wrong that will prevent me from doing this?

All the best

I understand that dealing with doctors can be difficult, but in your generation of medical students I am sure you are ingrained in the medical ethics of medicine.

In addition, the American Medical Association suggests, “Physicians should generally not treat themselves or members of their immediate family“.

So as harmless it may seem, you should not be prescribing medications to yourself. If you are so motivated, I suppose you can ask a colleague or another physician if they would mind (or feel comfortable) prescribing you the medication.

Hi Dr. Rassman I appreciate your website and blog very much I visit here everyday. I have been considering propecia for a month now. After searching the internet of course I have been scared like everyone of side effects of ed,low libidio,and I know your answer to this. Now I recently have been seeing everywhere on the internet about propecia affecting fertility! I mean I wanna have kids and start a family one day which out weighs having hair.

I am a 27 year old male and have some thinning and receding up top. So my question is if I take propecia is there any chance of it affecting my ability to have children in the future? Can you please set me at ease I realize you have answered this before

The information available shows that there is little risk to fertility from Propecia. If there is an incidence of drug induced infertility, it is very, very rare. What has been reported seems to reverse on drug withdrawal. Permanent infertility to finasteride does not appear to be a problem. If you are still concerned after reading this, when you take the drug for your hair loss, consider taking a sperm count somewhere after 3 months while you are on the drug.

Just wondering what is the difference between type 1 and type 2 alpha reductase? If proprecia only inhibits type 2 alpha reductase what is it targeting besides scalp tissue? Can reducing it damage some other tissues in the body?

Dihydrotestosterone (DHT) is part of the metabolic pathway in the breakdown of testosterone. Wikipedia has a very good overview which will cover much of what you asked.

I am often asked why I do not recommend dutasteride for treating hair loss (aside from the fact that it isn’t FDA approved for that), and that is because it is both a 5-alpha reductase type 1 and a type 2 blocker, and its impact may produce more side effects than finasteride, which is strictly a type 2 blocker. I’ve read that dutasteride is 3 times more potent at blocking type 1 and it may be 100 times more potent at blocking type 2 than finasteride. There are many target organs that will be impacted when you take a DHT blocker, so it is always best when using a drug to get it down to its simplest and lowest possible dose to minimize the side effects that might be experienced. Fortunately, the 1mg dose of finasteride works for most people with significant side effects in less than 2% of the male population taking it.

Hello dr.Rassman

Is this true? TwinsHairLoss.com

Can dutasteride be so effective on maintaining hair? Or is it photoshop?

I hadn’t seen this site before. After reviewing the photos, my first thought was that they were fraternal (not identical) twins, but they claim they are identical twins and post pictures of their childhood years. I have no way to 100% verify that the photos were not doctored, but you can use your best judgment there.

Taking everything at face value, the difference in hair growth/loss seems remarkable between the twins and shows that dutasteride works for androgenic alopecia (male pattern baldness). But the misleading point (which I do not think was intentional) is that the casual readers may infer that dutasteride is “THE” drug to take. Propecia (finasteride) works in the similar manner as dutasteride in targeting DHT.

At this time, only Propecia is approved by the FDA for treating androgenic alopecia. Dutasteride is a drug prescribed for men with certain prostate issues and the long term side effects on young men are not clearly established. Proper dosage of dutateride for treating hair loss is also not clear. For those interested in taking dutasteride, you’ll need to find a doctor willing to prescribe it to you for off-label use. It should be noted that Propecia has its own fiercely debated side effect discussion on this site and the Internet, and dutasteride side effects are likely to occur in those that experience side effects from Propecia.

Paid advertisements (not an endorsement):

Hello doctor,

I want to start by commenting on this awesome blog to educate people on hair loss topics.

I’m 23 and I have had (noticeable) hair loss for about one year now. I saw a doctor that prescribed me 1mg of Propecia and I’ve taken it everyday since. In my family, my father and my uncle (mom’s side) both experience hair loss. But on both sides of my family, my grandparents have/had full heads of hair.

It’s been about one year since I started taking Propecia and I’m still thinning and losing hair. What are my options from here?

I look forward to your response. Thank you

See a doctor who will measure your hair bulk and map this out on your scalp. This will give you a metric on hair loss and if you compare this measurement over time, you will know if you are losing the battle or not.

If you are indeed losing hair continuously (and at the same pace), it’s possible Propecia isn’t working for you… and in that case, your options are even more limited. Minoxidil might be worth a try. Have you taken the HairDX Test for Finasteride Response?

I’ve been using Rogaine for the past 6 months and I’ve notice that since I’ve been using the product I get erections, especially at night. Is this normal?

Maybe you feel better taking Rogaine and that is your now, normal state. Rogaine (minoxidil) does not produce erections.

I am getting good results from Propecia. My question is: would using a testosterone gel for low testosterone overwhelm the therapeutic benefits of Propecia and speed hair loss, or would the DHT inhibitor deal with this increased but now clinically normal amount of testosterone?

Probably not a problem if it returns your testosterone to normal levels.

–

(On an unrelated note, this is the 10,000th post on BaldingBlog!)