Category: Drugs

Hello Doctor Rassman,
Does spironolactone cause more hair loss? I seen a lot of people on the internet that claims propecia make their hair worse and others says that this is reflex hyperandrogeincity and their argument was “when DHT lessened testosterone increased alot and cause more hair loss!” but what about Sprio? I heard it decreased testosterone itself and also block androgen receptor, so how it could cause more hair loss?

I’ve always said the Internet is a great source for information, but not everything you read on the web is factual and true. If you want to treat your hair loss with a medication, you need to speak with a doctor. Anecdotal statements or claims found online will mostly mislead or confuse people.

Spironolactone does have theoretical anti-androgen factors, but clinically I have not seen or found credible evidence that it helps with androgenic alopecia. But I do understand that there are patients and doctors who use it as a treatment option. I do not.

Propecia (finasteride) does treat androgenic alopecia. It is not meant to cause hair loss. It is meant to grow hair. I understand there may be controversy on the Internet of Propecia’s side effects and some patients have strong feelings regarding those side effects. My opinion is that each and every individual talk with their doctor and discuss the side effects and understand the risks and benefits. In my practice, many patients use Propecia… and have been using it for over 10 years with no issues.

We can all sit on our ivory tower and debate the biochemical relevance of drugs and mechanisms, but in the end the results (hair growth) is what matters.

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.

I’ve been taking Propecia for 4 years and have been satisfied with the results. My new MD recently prescribed me to take generic Proscar and split the pills in 4ths as it would be cheaper with approx the same amount of finasteride. After a couple months i noticed more thinning and my hairline receding more. Can this be that generic proscar is less effective? Please offer your professional opinion on this matter, money is not an issue for me I’m willing to do whatever will produce the best results. Thank you

If the Proscar (or generic) is legitimate, it should be the same drug as Propecia even when it is quartered. Many people want the generic simply for cost-savings. You can always go back to name-brand Propecia if you are concerned. There are many counterfeit drugs on the market and some are even sold in legitimate pharmacies (though the risk is likely low), so you could also try a different pharmacy or different generic maker.

And for those readers that might be unfamiliar, Proscar is 5mg finasteride for treating the prostate; Propecia is 1mg finasteride for treating hair loss.

I need to know what dosage of dutasteride you would recommend to a 27 year old patient who has been on propecia for 5 years and is still experiencing hair loss even on the propecia (1mg/daily). I fear that the propecia is just not strong enough. I want to zero the DHT some days so the follicles in my frontal area can have a shot at regrowing. I am not able to accept hair loss and am willing to do whatever it takes to stop the DHT which is hurting my DHT-sensitive follicles. Please help!!

I can tell you’re desperate to maintain your hair, but I do not recommend dutasteride at this point, as the dosage is still unknown for treating hair loss. I hope you are under the care of a doctor, as these are prescription medications… and in that case, your prescribing doctor should have the answer for you.

Hello,

We have generic here for Propecia, and on the instructions they say that on propecia we should use a condom during intercourse. It seems that it is pretty new, and there is nothing on the intructions of Propecia. My first kid is a boy and was born while I was using propecia. It seems normal.

Is there really a risk ? What is the position of Merck on it ? It seems that we have different opinion and it is quite difficult to have an opinion. Why this warning has appeared ?

Is there a proof somewhere that a newborn has trouble while the father was on propecia ? Thank you for your answer.

There must be thousands of boys born whose father’s took Propecia (finasteride) during conception.

We know that in the womb during the first 3 months, if a woman is exposed to sizable doses of finasteride it can alter the sexual development of the fetus. If the man was taking it, however, there is no evidence that the drug will cross to the woman and into the fetus. I know that the formal concerns are published and they are unfortunately more a statement of what the lawyers want the drug companies to say rather than a scientific observable risk.

I haven’t seen the Propecia packaging that mentions using a condom during sex, but I will also refer you to this letter we received from Merck about this very issue a few years back. In part, it states that “no significant mechanism-based or non-mechanism-based teratologic effects have been observed in infants born to women exposed to finasteride via semen during pregnancy.”

Hey doc, been using Propecia for 2 1/2 years its slowed things down a lot, just added Rogaine Foam last week. Just wondering if I can get a straight answer on the effectiveness of Rogaine Foam. The commercial says 85% of men see regrowth, ive heard other people say it only works for 50% of men and then I saw a post from you in your archive where you say it only works well for 15% of men. Well which one is it?

We are prisoners of our words, so I will stick to what I said.

If you are in the 15% of good responders, then it moves you into the 100% category (playing with numbers, or course). Some people feel that the Rogaine Foam works better than standard liquid Rogaine drops, because it is easier to use and thus better for those who find the drops difficult to titrate. If there are 85% of men that see some growth, I’d estimate that maybe 15% of men see it work very well.

I am male, 25 years of age, 5’11 and 152 pounds. I have hair on both sides of my head but barely any in the middle. If I use Rogaine foam on the middle spot, will it help regrow hair on just that spot you put it on or your whole head regardless?

If you’re going to use Rogaine Foam, you need to apply it to the areas of the scalp that are thinning. The same goes for the non-foam version of Rogaine. Just putting it on a small spot won’t be effective on the entire area of hair loss.

Be sure to read the instructions that are included in the packaging for information on dosage and application. You can also check the Rogaine site for simple application instructions.

I’ve received a few emails directing me to the a publication in the New England Journal of Medicine from last month regarding finasteride, dutasteride, and prostate cancer reduction. We’ve written about this issue here and specifically, albeit briefly, about this NEJM piece here. So I’ll take the opportunity to highlight it again, since people are still finding their way to the article.

The authors’ take on the relationship between the use of these drugs (finasteride and dutasteride) and the risk/benefit relationship on prostate cancer concluded that the original reports of a cancer reduction in the studied men (about 10,000 men who received finasteride 5mg dose) showed that the lower risk was found only in men with low grade cancers. If men had a high grade cancer, they felt that there would be no benefit to taking these drugs and suggested a possible harmful risk that is clearly ill-defined at this time. On the basis of this conclusion, the use of finasteride or dutasteride as a preventative medication for prostate cancer is claimed not to be justified.

The FDA came out echoing this sentiment. It appears that “the labels of approved 5α-reductase inhibitors, which are currently indicated for the treatment of symptomatic benign prostatic hyperplasia and male-pattern hair loss, have been modified to include the observation of high-grade prostate cancers” found in the relevant trials.

I am sure that one result of this formal, official FDA change in position is that some men will consider abandoning the use of these drugs. I will be attending the annual ISHRS physician meeting in September, where this subject will be discussed amongst many doctors who are concerned about this announcement. I’ll be curious to learn about patient reactions to the FDA’s position.