Category: Drugs

Hello Dr., I took Propecia a few years ago for a period of 8 months and had good results, but also had significant thinning of body hair (legs, arms, chest, & back). I quit taking it because of financial reasons, but 6 months ago I got back on generic finasteride (1.25mg) and now have no perceptible body hair loss, maybe slight thinning on my back. How could I have such a different response this time? Should I assume that the generic finasteride is not working? (I got it from my local CVS pharmacy.) Thanks

I have heard on rare occasions that for some men that take Propecia (finasteride 1mg) their body hair thins out. This isn’t a usual side effect, though. I am not denying that you have noticed a relationship between Propecia and body hair loss, but that does not mean the drug is or isn’t working. If you are splitting the finasteride 5mg into quarter sections to make it 1.25mg, that is nearly equivalent to Propecia (finasteride 1mg), and there shouldn’t be a significant difference.

I have no way to explain the side effects (or lack thereof) that you’re seeing. The presence or absence of side effects do not indicate if the drug is effective.

I had gone to dermatologist for the hairloss problem. He prescribed Finasteride along with Beclomethasone Dipropionate lotion. I want to know how does this Beclomethasone lotion function. Any side effects of it and for how long it has to be taken ?

Finasteride 1mg is for traeting androgenic alopecia (genetic hair loss in men). Beclometasone dipropionate is a corticosteroid that is used to treat skin disorders, like eczema or psoriasis… and is not usually used for treating androgenic alopecia. Do you have a skin disease?

Perhaps you should ask your doctor, since he/she is the one that prescribed it to you. I can’t give you advice on how much or how long to use a prescription medication, as I didn’t prescribe it and I don’t know what you’re treating.

Note: BaldingBlog often receives incredibly insightful emails from our readers. The following comments echo many of my thoughts on the subject of Xandrox and Dr. Lee. The writer wishes to remain anonymous, but he’s contributed posts in the past about the FDA and I want to thank him for taking the time to elucidate the issues so clearly.

This is a follow-up (for those that missed it), about the FDA stopping Xandrox sales.

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The post about Xandrox requires clarifications and additional information about physician prescribing and the FDA. It is correct that Dr Lee makes unsupported claims about his products (whether it is his unregulated herbs or regulated medicines sold online). However, a more likely reason why the FDA intervened to remove sales of Xandrox (containing 15% minoxidil and finasteride) is that a potential for increased risk (i.e., a safety concern) existed. Even with substances that do not normally fall under FDA jurisdiction (e.g., herbs that do not require regulatory approval for sale), the FDA can intervene if a health concern exists. A good example is when concerns regarding the safety of ephedra supplements (and potential cardiac deaths) led the FDA to ban the sale of ephedra-containing supplements in the United States in 2004.

 
The poster asks whether prescribing Xandrox in this manner is acceptable because it is off-label. “Off-label” use presumes use based on a specific scientific rationale and sound medical evidence (data on effectiveness and safety of Xandrox is absent). While most off-label use is the same dose and formulation for a different indication (thus allowing for an understanding of the likely safety profile), the FDA legally allows and classifies off-label use as below, which can include different doses:

“Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product’s use and effects.”

With Xandrox, there is zero data available on the safety and efficacy of the formulation and one wonders – especially with high-dose topical minoxidil – what cardiac issues could result. But, who knows. Data (and thus informed decision-making) for the user is not available. This is the antithesis of “evidence-based” medicine: “Here, buy this because I said it does A, B, and C – don’t worry about any evidence.” Or better yet, “I’m getting great results…I haven’t had a problem (yet)”.

As a result, those who the poster refers to as benefiting may be the same individuals who may be getting good results and have no side effects, but may be at increased risk to have a complication (again, who knows, the proper studies have not been conducted). In other words, besides the unsupported claims, the idea of selling drugs in different concentrations than have been studied is not very good informed consent. Medicine also has a long history of drugs that are dangerous but do not produce their problems in most who take them (several effective diet drugs initially considered safe were removed from the market worldwide because of serious heart conditions that were so infrequent to only be discovered after millions of individuals took the drug after regulatory approval).

 
And, no, drug companies don’t have the power to affect regulators such as the FDA (it is usually the other way around). But of course the pharmaceutical companies billions of dollars are not going to be affected by Dr Lee’s online sales. This has nothing to do, as the reader suggests, with the “FDA cracking down on drugs sold online.” This is the FDA cracking down on unapproved drugs sold online within their jurisdiction.

Finally a serious editorial comment. Dr Lee’s site notes that “Therefore, patients no longer have access to the drugs that they have used for over twenty-five years.” First, these drugs in the formulations he has concocted – have not been available for over 25 years and that’s the point. I can’t just go online and – in the absence of regulatory approval based on data – begin selling “super-aspirin” at 40 times the approved dose and be upset when I am asked to stop (fortunately before an expected lawsuit from the many who will probably end up with peptic ulcers from this approach).

The poster concludes that “knock on wood – MD’s doing the same thing as he did and they haven’t been touched…yet” as if such advertising of claims that are unsupported is somehow a virtue. No one benefits when physicians (and most often non-physicians) sell drugs online that may benefit some but present undefined (unstudied) risks.

Hello,
I live in the midwest and it’s very cold and snowy. A few days ago I accidentally left my Propecia in my car overnight. When I went out the next morning, my water bottle and everything in the car was frozen so it had gotten quite cold the night before. This is the first and only time this has happened. Do you think the rest of the prescription is okay?

I spoke with a rep at Merck about this and was told that freezing may alter the value of Propecia. The safest thing to do is to replace what you are using with fresh medications. Or you can chance it, but that’s entirely up to you.

Snippet from the article:

A Connecticut law firm has filed a lawsuit against pharmaceutical manufacturer Merck & Co. on behalf of men who have taken Propecia, a prescription drug that combats hair loss but, its critics say, can also cause severe side effects such as sexual dysfunction and mental impairment.

Attorney Edward Jazlowiecki of Bristol has joined two other firms, in New Jersey and New York, in filing the suit, which alleges that Merck has failed to fully disclose the serious side effects of Propecia and failed to adjust its warnings in the American market even after European regulators forced the company to carry a stronger warning label.

Read the rest — Lawsuit Blames Hair Loss Drug For Sexual Dysfunction And Mental Problems

As one might expect, Merck says that, “The company intends to vigorously defend against the lawsuit.”

As I’ve mentioned before, I’m a part of an email group of hair transplant doctors that share information amongst each other. The other day I received an email from a well respected doctor (let’s call him Doctor A) reporting that he’s now had two patients in the past 12 months who had persistent erectile dysfunction (ED) even after they stopped finasteride (traditional 1mg dose). These are two patients out of thousands that this physician has prescribed to, and I have no knowledge of other potential health factors or even full details on the cases.

Other doctors in the group chimed in:

1. Doctor B in the email group responded that he had been prescribing finasteride from even before it was approved to treat hair loss and he has never seen one case in this situation.
2. Doctor C wrote about two patients who had the problem in some 1500-2000 patients.
3. Doctor D said that he’d also seen two patients in his 18 years of practice that talked about ED permanence.
4. Doctor E who has also been practicing about 18 years has seen no cases of ED permanence.
5. And then there’s me (I’ll be Doctor R). I echo that from the thousands of patients I have prescribed finasteride to, I have never seen nor heard of such a complaint after the patient has stopped the drug.

So while I don’t have specific case info or medical history of those claiming permanent side effects, it seems that there are 6 cases out of maybe between 6,000-10,000 prescriptions (estimated). Unless you’re one of the 6, the risk is extremely limited (if it is shown that the medication is the cause). I’ve always maintained (my opinion) that these side effects are reversible upon stopping the medication, as this has been reported in peer-reviewed studies and in thousands of my own patients. However, I make it my job here to educate our readers as I become more informed. I’m not writing this post with the intent to scare anyone, but do whatever you’d like with the information. We still don’t know for sure that the “permanent” ED cases are even related to finasteride. Remember, I do not sell finasteride to make Merck profitable. If that were the case, I wouldn’t tell patients (or readers of this site) how to cut into Merck’s Propecia profits by buying the generic 5mg and splitting the pills when discussing alternative suppliers.

The incidence of low testosterone in men is high. There are reports that 44% of men have low testosterone levels. We know that 20% of men have ED, 30% of men have ED, 40% of men have ED and so on. That is the market that Viagra sells to. Can we be confusing the ED observations from Propecia and the ED resulting from low testosterone levels? There are many causes of ED, so we should be careful not to state that the ED we are seeing was from the Propecia/finasteride that these men were taking.

I still believe in this medication fully for treating genetic male pattern baldness, and I must point out that these reports are still extremely rare. The alternative for the balding male is to continue to go bald. For some, that small risk of sexual side effects may not be worth abandoning their hair. Sill, the consumer (you) must make his own decisions on what to do with such reports. I fully expect my inbox to be flooded with “See, I told you so” emails from forum trolls, but if anything, this should show you that I’m not disregarding the claims outright. As I’ve always said, I’ve never seen any case and the medical literature supports that. I do, however, appreciate respectful discussion.

Also, keep in mind the study we mentioned yesterday about common everyday pain relievers like aspirin and ibuprofen being linked to erectile dysfunction. Who knows what else is in the systems of those claiming permanent ED.

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