Category: Drugs

Snippet from the non-hair-loss-related article:

Of those who took painkillers regularly, 64 percent said they could never get an erection, compared with 36 percent who did not routinely take NSAIDs.

After accounting for factors like age, weight, high blood pressure and cardiovascular disease, the researchers still found a 38-percent higher risk of ED among men taking painkillers.

Read the rest — NSAIDs Linked To Higher Risk Of Erectile Dysfunction

The study, published in Journal of Urology, looked at nearly 81,000 men aged 45-69 and found that of those that took aspirin, acetaminophen, ibuprofen, and similar NSAIDs, there was significant risk of developing erectile dysfunction.

USA Today also has the story.

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I took Propecia for 7 months before developing erectile dysfunction over night and a low libido that onset more slowly. I immediately discontinued my use of the drug. Unexpectedly, one year later I still have erectile dysfunction and low libido, and my hairloss has not resumed!

I had my hormone levels tested by a neuroendicronologist and it was found that my DHT levels were far below the normal range for adult males. I had an appointment with a sexual psychologist and she determined it was a physiological issue. Is there anything I can do to restore my body to where it was before I took Propecia?

I have difficulty believing that you just developed erectile dysfunction (ED) overnight after taking the medication for more than half a year. You need to see an expert in sexual dysfunction. I have seen a few patients who had your symptoms, though none of them with rapid onset and all of them who stopped the drug saw a complete reversal in less than a week.

ED will likely lead to your confidence going down, which in turn causes the gradual of libido… but I do not believe that the ED can be blamed on Propecia if you have been off of it for some time.

Dear Dr. Rassman –

Just thought it might be worth flagging up with your readers that the new rogaine foam is scent free. That is, it no longer smells like grandma’s hair spray. I know the awful smell kept me from using it in the past, so maybe other readers out there would benefit from knowing the change.

While we’re on the topic, can I ask a Rogaine question?

I’ve stopped taking propecia because I was one of the few with side effects and was curious whether you thought Rogaine was worth it in isolation. So, what I mean is would you take it on it’s own or is the impact of taking it in isolation limited. I ask because I don’t really want to go through a shed and the hassle of taking it regularly if it doesn’t seem worth.

Certainly curious about your other readers’ experience with the product.

Thanks for the tip about the foam now being available in unscented. I found this press release about it for those interested. But really, Rogaine Foam is now scent free. That’s all the press release really says.

As for your question — I have seen patients in the past who use Rogaine with good results, but most men are not creatures of habit and the compliance of applying it twice a day makes it a challenge over the months/years.

I (male aged 34 years) am taking Cipla’s Finpecia (Finasteride 1mg) for the past 1.5 years. One of the side-effects i seem to be experiencing for quite sometime now (not sure if it is due to finasteride but seems to be very much linked) is hesitation during start of urination (need to exert some pressure during start of urination to start the urine stream).

Please let us know if this is a known side-effect or i need to undergo any further medical diagnosis like medical tests etc. of this symptom. Thanks.

I think that you should see a urologist and have your prostate checked. The symptom you are referring to may be the result of some prostate problem.

I would doubt that this symptom is a result of finasteride, which is used to reduce urination problems in men with BPH (benign prostatic hyperplasia).

Snippet from the study abstract:

PURPOSE: This post hoc analysis of the Medical Therapy of Prostatic Symptoms trial examined the effect of finasteride alone compared to placebo on the clinical progression of benign prostatic hyperplasia in men with a baseline prostate volume less than 30 ml, or 30 ml or greater.

MATERIALS AND METHODS: Men were randomized to placebo (737), 4 to 8 mg doxazosin alone (756), 5 mg finasteride alone (768) or doxazosin plus finasteride (786) (average followup was 4.5 years). Approximately 50% of patients had a baseline prostate volume of 30 ml or greater. The present analysis was based on the finasteride alone and placebo arms only, and included patients for whom baseline and end of study data were available. We examined the effect of treatment on the cumulative percentage of men who did not experience clinical progression of benign prostatic hyperplasia by study end.

Read the rest — Long-Term Treatment With Finasteride Improves Clinical Progression of Benign Prostatic Hyperplasia in Men With an Enlarged Versus a Smaller Prostate: Data From the MTOPS Trial.

This was new data mining of a previous study that included over 2200 men with an average followup of 4.5 years. The new study concludes:

“Long-term treatment with finasteride led to a significant beneficial effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with an enlarged prostate (baseline prostate volume 30 ml or greater). Finasteride had no significant effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with a smaller prostate (baseline prostate volume less than 30 ml).”

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Thank you very much for your useful blog. I have been taking propecia for a year and a half with great success. I have tried to get a prescription for finasteride 5mg from two different doctor but they both refused to prescribe it to me. So my question is do you know anyone that can do this in the London?

Some doctors aren’t open to prescribing the 5mg, but I couldn’t say for sure which ones would. You made sure to tell those doctors that you know you’re supposed to cut each pill when treating hair loss and you just want it to save money, right?

Dr Bessam Farjo is an occasional contributor to BaldingBlog, and he has an office in London. I can’t say for sure if he’d prescribe the 5mg dose, but it’s worth a try. Good luck!

Hi Doc,

I’ve been reading your blog on a fairly regular basis and have found it very informative. I’m almost 19 and my hairline has been creeping back since around my seventeenth birthday. At the moment I’m probably an nw2. My brother who is 21 would be considered nw4 if it wasn’t for a very fine scruff of hair in front.

Concerned that I was following suit with him, I decided to fill a prescription of propecia. The possible side effect were pretty unnerving but I figured it was my only real chance at keeping my hair.

I’ve read on your blog that the 1 mg dose does not affect the prostate but it definitely did in my case. The day I took the first pill, my prostate had sudden pains throughout the day. My semen also became water-like. I know this isn’t supposed to be a big issue, but it concerns me that it started happening right away and seems to me like another sign that it was affecting my prostate.

My question is where do I go from here? Have any of your patients had a similar experience? I recently started using a minox product but am unsure what to do as far as meds. Should I try a lower dosage of propecia? Would saw palmetto be worth trying?

Also, have any of your patients experienced results in the hairline from minoxidil alone?

Thanks for your work

First, how do you know what prostate pain feels like? I don’t imagine most men would be able to pinpoint which internal organ is hurting so quickly… particularly the prostate. Prostate pain generally ranges anywhere from lower back problems to urinary issues. Is that what you felt? Second, you had sudden pains after one dose? That strikes me as extremely odd. It’s worth noting that there are some rare reports of testicle issues after taking finasteride, but I haven’t heard of any case where this occurred on the same day that you took your first dose ever. I’d think it’s more likely that you psyched yourself up for side effects, as you said you were pretty unnerved about the medication before you even took it. You were expecting some negative reaction and you got it — this would also be known as the power of suggestion.

You need to get a good, solid diagnosis with the tests I have suggested (miniaturization mapping, hair bulk measurement) before you make the decision on taking finasteride for life. I hope your prescribing doctor gave your scalp a thorough examination before suggesting you take this medication. Now that you’re noting problems though, you should talk to your doctor about this. I’d get off the medication to see if the pain goes away. Remember, a good Master Plan is needed for every young man facing an uncertain future for hair loss.

As for minoxidil, that is an over the counter treatment and so long as you don’t become worried over potential side effects from that drug, it might be worth a try. It would be rare to see regrowth in the hairline from minoxidil or finasteride.

Hello Doc,

I have been a frequent reader and an occasional poster on your blog for a while now. I have been on finasteride (1 mg) for the past year and a half with mixed results. The drug has definitely slowed down my hair loss to an extent and could have also initiated some regrowth in the crown area. Of late (for about a month now) , I have been experiencing some sexual side effects that I had never experienced during the past year and 5 months. Although I do not want to discontinue the medication (since it seems to be working) I am apprehensive about the long term ramification of these new developments. Under the circumstances, would you recommend reducing the dosage from 1 mg a day to 0.5? I might have come across a post on this blog, where you had mentioned about virtually no difference in the potency of the medication at dosages of 0.5 and 1 mg (I might be wrong). It would be great if you could respond to this query.

Thanks for your time and keep up the good work.

I am not your doctor and Propecia is a prescription medication that a doctor needs to prescribe to you. You need to ask this question to the doctor you get your prescription from. You should ask your doctor about changing doses in your medication. As for the reduced dosage, I’ve read a study that cites about 80% effectiveness with 0.5mg.

There may be other issues (not only the possible side effect from Propecia). Some men (even in their 20’s) experience impotence, decreased libido, etc, WITHOUT any medications. These issues are not discussed openly in public, because of their sensitive nature… but it does happen. Find out if your issue is due to Propecia or other medical or psychological issues.