Drugs – Page 70 – Balding Blog

August 11, 2011

Hair Loss InformationCanada Will Now Have Breast Cancer Warning on Finasteride Labels – Hair Loss Information – Balding Blog

Hello Doctor,

Thought you would be interested in this new advisory from Health Canada regarding finasteride and breast cancer:

Link: Finasteride (Propecia, Proscar): Potential rare risk of breast cancer in men

I know this topic has been discussed before, but it looks like Canadian patients using finasteride (including me for 8 years) will see the new advisory in the leaflet…

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The average age for male breast cancer is 71 years old. The number of cases I can find in the medical literature are very few. As the press release points out, of the small number of cases, “Most of the reports have been in association with the 5mg formulation”.

With the average age for our patients under 40, the lack of finding breast cancer is not surprising. I recall reading that up to 50 men taking 5mg finasteride (Proscar) and just 3 men taking 1mg finasteride (Propecia) had been reported to have breast cancer, though the link between the medication and the breast cancer wasn’t proven — nor could it be ruled out. If there’s updated information, I still suspect the total number is very low considering the number of men using the medication at any dose. Nevertheless, even with this rare risk, I will add include it in my discussions with patients.

As an aside, I wonder if these 3 men had the gene for breast cancer, which (in theory) could be provoked by finasteride. The best way for a typical young patient to evaluate this should be in his own family history. Those men with a family history of breast cancer in mothers, sisters, grandmothers, aunts… should be more aware of this risk, although still very remote.

August 11, 2011

UK Newspaper Reviews Hair Loss “Cures” – Hair Loss Information – Balding Blog

Dear Dr Rassman,

I thought your readers may be interested in this article. The Daily Mail, here in the UK, reviewed some common hair loss “cures” including your favorite product the laser comb :). Not surprisingly, they were all found to have little or no effect apart from regaine.

Here is the link: From a laser comb to rubbing coffee on your head, the His and Hers guide to hair loss cures

Best regards

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Aside from the fact that there is no real hair loss cure, this is a decent round-up of some of the over-the-counter hair loss treatments. It doesn’t surprise me that that highest marks for the products they reviewed went to Rogaine (Regaine as it is known in the UK), and treatments like fish extracts and saw palmetto lotions got low scores.

August 10, 2011

Can Rogaine Ruin Healthy Hair? – Balding Blog

Dr. Rassman,

Thank you for this great blog. As you’ve pointed out several times in the past, you can’t believe everything you read on the internet about hair loss treatments like Propecia and Rogaine. My question today is about Rogaine. In your many years of treating patients, have you ever witnessed were Rogaine actually made the healthy hair fall out or become damaged? I’ve read where some individuals are claiming that Rogaine destroyed their hairline and damaged what healthy hair they had. Any experience with this in your own practice?

I’ve answered a similar question before.

I do not believe that Rogaine is bad for your healthy hair. If you have a full head of hair and you use Rogaine, there should be no impact on it… but then, why would someone do that? Apply the medication to the areas that have hair loss. And if you’re losing the hairline, applying minoxidil there most likely won’t show a lot of impact anyway.

August 9, 2011

At What Point Should You Stop Using Propecia? – Balding Blog

During the course of hair loss, at what point should you stop using propecia. How do you know when you have lost 80%-90% of the hair you will lose during your lifetime?

Is this the time to consider a FUE procedure?

Maybe your doctor didn’t explain this to you, but in general it is recommended that you take Propecia indefinitely. I suppose if you eventually end up as Norwood 6 or 7 it wouldn’t make sense to continue the medication, but that’s something you should talk to your prescribing doctor about. If you had any significant side effects, then stopping the medication or reducing the dose might help with those.

As to when to consider a follicular unit extraction (FUE) procedure or any surgery at all, it is best discussed with your surgeon. You need realistic expectations as well as an understanding of the limitations of any surgery, along with the risks (more hair loss) versus the benefits. In other words, there is no simple answer.

August 9, 2011

Low Testosterone and Finasteride Results? – Balding Blog

Do men who have low testosterone typically have better results with finasteride?

Male pattern baldness is really is not about testosterone levels, but rather, about your genetic predisposition. I don’t believe you can predict response to finasteride based on a hormone (testosterone) levels alone, but I really don’t know. It may be a good research topic.

August 8, 2011

My Son Saw Total Regrowth After a Few Months on Propecia, So Was it the Drug? – Balding Blog

Dear Dr. Rassman,
My eighteen year old son has been on propecia since march 2011 and has been using rogaine 5% since April 2011. He has had just about total regrowth starting with the month of June, his hairline is restored. The dermatologist was pretty sure it was MPB but left a stress issue on the table. My son had been through alot the past year. The Dr. never did any mapping etc. My question maybe he does not need the propecia, I don”t want to put him at any risk.

What do you recommend and is it unusual to have this success so quickly with these meds. Thank-you You are a voice of reason in all this confusion

I just answered a very similar question last week.

I have seen total regrowth (particularly in the hairline) on rare occasions, and when it occurs it usually happens in men under 22 years old or so. It’s been 5 months since he started on the medication, and although that does seem pretty quick to see so much success, it’s not improbable. Results can be seen anywhere from 3-12 months after starting Propecia. As this is a prescription drug, I’ll defer to the prescribing doctor as to whether or not your son needs the medication. He can always get a second opinion, of course.

Ideally, he will want to have a doctor who can check for miniaturization and hair bulk in a number of areas of the scalp to determine if he is balding. Hair transplant doctors know hair, so that would be a good place to start — not for surgery, but for the consultation. You can look for local doctors by using the physician search at ISHRS.org or if you’re planning to be in the Los Angeles area, he can see us.

August 5, 2011

My Doctor Suggested I Take Generic Propecia – Balding Blog

Hi Dr, many thanks for the excellent blog. I just had a question regarding generic propecia. My doctor in the UK approved me as a good candidate for propecia and advised me I could now buy generic 1mg propecia online to save money. I’m currently on merck’s product and haven’t experienced any serious side effects.

The generic manufacturers on the site he suggested are Sunrise and Cipla. I can’t find much info on these companies and was wondering if you were familiar with them and if they are reputable, or furthermore if you think buying generic 1mg is a good idea in the first place, even if I have been examined by a Dr?

Any advise would be much appreciated. best

The generic should be the same as the name brand. The 1mg generic finasteride isn’t legally available due to patent restrictions in the US, but the 5mg generic is off patent and available. Things could be different in the UK. I suppose that if you get the generic from a reputable source it would be fine, but many online pharmacies are suspect since they don’t require a prescription in the first place. I’m not a fan of that.

As for the companies you asked about, I think Sunrise is US based, but I’m not too familiar with them. All I could really find was their website and an FDA warning letter from last year about the use of excessive active ingredients in some medications they made. I am more familiar with Cipla since I’ve been asked about them a few times before. Cipla is a very large pharmaceutical maker out of India and their biggest claim to fame is that they’re the world’s largest producer of HIV/AIDS fighting medications.

For more info on Cipla:

For more info on Sunrise:

August 4, 2011

My Diffuse Loss Has Regrown After 5 Months, But Do I Need to Continue Propecia? – Hair Loss Information – Balding Blog

I began to experience Propecia side effects about one month ago, and about two weeks ago stopped taking the drug. After two weeks without the drug the side effects had disappeared. My dermatologist told me to take Propecia every other day from now on to limit possible side effects. In addition to Propecia I am taking Procerin, applying Rogaine, and shampooing with Nizoral three times a week. I wrote in in February about diffuse hair loss through out my head; today you can hardly tell I lost any hair. I have been taking propecia since March 4.

My main question is if this drug could have provided such benefit in such a short time, and if not how can i be sure that I do not need it? As learned in my other question, I had been through very stressful times before the loss occured. I am 18 years old with no immediate family history of hair loss. On a side note, my temple points had seemed to be gone back in the winter, though now they are back in full.

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It sounds like you are getting the response you need and want from Propecia (finasteride 1mg). You’ve been taking it since March, and so it’s entirely possible that you saw regrowth in that time from the medication.

I doubt that the other things you are using are helping as much, but that’s one of the risks in using a few products at once. You have no way of knowing which one is the most beneficial. Stopping the finasteride could result in losing the gains you’ve made… or things could maintain if the finasteride didn’t actually help you (for example: if your loss was temporary and related to stress). I have no way to know that for sure via the Internet, though.

You’re under the care of a doctor already, so you should be asking these questions to him/her. Regardless of how you regrew your hair, I’m pleased that you’re seeing success with your regrowth goal.

August 1, 2011

I Have OCD, Social Anxiety, and Early Hair Loss — I Want a Transplant Now! – Balding Blog

Dear Dr. Rassman,

If one is in the early stages of MPB, is it possible to have a hair transplant straight away, and then keep having “top up” hair transplants as the hair behind the transplanted hair begins to recede? I wanted to take Propecia to begin with, but I am petrified after reading about the possibility of irreversible sexual side effects. I know that some people, including yourself, believe that these may all be in the mind, but the problem is, I am very fragile mentally (I suffer from depression, OCD, and social anxiety), and so I believe that I could be more likely to suffer from them because of this.

Many thanks.

If you are “petrified” about using Propecia, maybe the drug is not right for you. You are already biased against the drug and if you do have an obsessive-compulsive disorder and anxiety issues, it will be a difficult hurdle. I do find that most people who are very apprehensive about the side effects of Propecia almost always end up with the side effects. This has been corroborated by other hair transplant doctors in the past. In that sense I think there is something to be said about the negative placebo effect. I do not mean to shed a negative light onto your issue with medication, but in the end I believe you should speak to a doctor about your options.

With respect to hair transplants in men in their early 20’s with early stages on MPB, I generally do not recommend transplanting at that age, because you may do more harm than good. The process of hair transplantation may accelerate the MPB and you could end up looking even worse after surgery. This is a generalization and you also need to address this one-on-one with a qualified physician.

In the end, there is no easy answer and I do not have all the solutions.

Paid advertisements (not an endorsement):

July 29, 2011

Hair Loss InformationWhy Do You Prefer to Prescribe Propecia Rather Than Transplanting? – Hair Loss Information – Balding Blog

You have not made it clear why you would prefer to prescribe drugs for hairloss rather than a surgery. It is safer in every way to administer a hair transplant. Perhaps you realize that patients will opt out of treatment altogether since many men would never consider the very significant and costly method of pursuing a transplant?

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I would use a non-surgical recommendation for a wide range of problems (e.g. many forms of heart disease, Parkinson’s disease, epilepsy, herniated lumbar disc). In some situations, I would recommend hair transplants as I get to know the patient if I am convinced that it is in his best interest. That puts the burden on the patient to convince me about his agenda.

I am not a plumber who is fixing a leaky pipe. I am a caring, responsible doctor who always does the best thing for his patient. Think about how strongly I must feel about this. I would rather offer a free consultation and then prescribe Propecia for a total fee to me of $85. My average surgical fee exceeds $5000… so I must really believe in the welfare of my patients to turn that down.