Category: Drugs

Dear Dr. Rassman, Thank you for this wonderful blog. Me and my friends in Dubai are eager to know any reliable international online pharmacy (such as drugstore.com) that can send us Rogaine FOAM to the UAE. We only have generic minoxidil here which causes severe irritation. My heart broke when I came to know Amazon.com and Rogaine.com do not take orders from UAE. These were the two sites I could trust. I’m not sure about minoxidilshop.com. Kindly help us. Thank you very much in advance.

I searched for online pharmacies that ship to Dubai and couldn’t find any that I’d put trust in. I suggest that you might check with doctors who come from the United States and practice hair transplantation in Dubai, as they may be willing to bring in the medication with them. Check out the physician search at ISHRS.org for physicians in the United Arab Emirates.

Or if there are readers in Dubai that know where Rogaine Foam can be purchased, please let us know! Thanks.

Hello doctor William

why don’t doctors ever mention that testosterone by its self can cause hairloss as well. I know its metabolite DHT is more potent at causing hairloss but we all know testosterone on its own can cause hairloss as well.

I mentioned this before, propecia increases testosterone by about roughly 15%. A persons front region/temple/hairline is more sensitive to testosterone and has more testosterone receptors.

Doctors always fail to mention that propecia has a possibility to accelerate hairline thinning. Yes it help the crown but at the expense of the hairline. For example if a person has mild hairloss, then by simply taking propecia it will jump start his hairline thinning.

I enjoy a good conspiracy as much as the next guy, but come on…

Doctors do not mention testosterone causing hair loss, because testosterone does not cause hair loss… except by its conversion to DHT. If the body has testosterone, it automatically has DHT. Genetics cause androgenic alopecia that is precipitated by DHT, and that is why finasteride works. It is not a hormone issue, it is a genetic issue. If you do not have the gene for hair loss, you can have all the testosterone or DHT or whatever hormone you want to blame and you will still have a full head of hair.

Also Propecia does not cause hair loss. It slows down hair loss. I can see why you think this, but your logic is flawed.

First of all, I just wanted to let you know that I have found your blog very useful.

I am a 24 male and for the last couple of years I have noticed my hairline receding and then my hair getting much thinner. I look back at pictures from 3 or 4 years ago and I am in awe at how much my hair looks different. Anyway, I have tried rogaine for about 4 months and have not seen much of a difference, plus it is kind of a pain to use. In fact my hair seems to just continue getting thinner.

I would like to try Propecia, however, I am in medical school and I really cannot justify using that much loan money for propecia, if you know what I mean. I have noticed that you and others suggest using 5mg generic Finasteride normally used for BPH as an economic alternative. I would like to ask my doctor about this option. My question is whether this is considered ethical/legal and how physicians usually respond to this.

Thank you for your time

There are no ethical or legal issues associated with prescribing finasteride for androgenic alopecia. There is however a financial issue, as finasteride 5mg is about $30-$60 for 90 pills and finasteride 1mg is about $150 to $200 for 90 pills. If you cut the 5mg finasteride in four parts, the 90 pills should last you 360 days! This drastic difference is based on U.S. Patent laws that give protection to Merck, as they have the rights to manufacture the 1mg dose of finasteride up until mid-2013. The 5mg finasteride is available as a generic because the 5mg patent expired already, so the prices are way, way lower.

As far as doctors are concerned in prescribing medications, as a medical student, I hope you will soon find that there are hundreds of medications with generic versions that are exactly the same and just as effective as their branded counterpart. Consider this when you prescribe branded medications to patients after the drug companies wine and dine you.

On a final note, there is an ethical issue to the patient if they decide to cheat the system by getting the generic finasteride 5mg using their insurance card. The insurance companies may approve finasteride 5mg thinking you are treating a prostate problem. Finasteride used for androgenic alopecia is not covered by insurance.

Dear doctor,

I am a male of 22 years old. I am experiencing very slight recession of my hairline at this moment almost invisible for the human eye. I also have some shedding which freaks me out a lot(not an understatement) because I always have got extremely thick hair and never noticed any shedding. My dermatologist prescribed me minoxidil and the second appointment because I was still worried gave me a prescription for Finasteride 2.5 mg. She said I could take it ‘preventive.’ Is this true? My pharmacist forgot to write the dose on the box so I have been taking 5 mg for one month. Is this dangerous; should I start taking the right dose now(i.e. 2.5 mg or just keep on with the 5 mg.

Thanks a lot in advance

What you are doing (taking 5mg finasteride daily) is not dangerous, but it is not the right dose. For the treatment of androgenic alopecia, the correct dose of finasteride is 1mg a day.

In your case, there is nothing you are telling me that you were even diagnosed with androgenic alopecia! You should not be taking any drug for preventive measures. Perhaps you need to find another doctor and a pharmacist.

I understand that a 1mg dose of Propecia is recommended. What I want to know, however, is how much more hair grew at a 2mg dose vis-a-vis the 1mg dose — 10% more? 15% more? I know these data exist. So, what incremental improvement might there be with a 2mg dose?

While it’s quite possible that the data for 2mg finasteride hair loss treatment benefits exists, I don’t have it, I don’t recall seeing it, and I’m not sure if it was ever made available to the public.

I do know that there were studies that looked at high dose and low dose finasteride (prior to Propecia becoming available) for treating hair loss. More is not better and I am not aware of a 2mg study showing any additional benefit. The stories that I do hear are anecdotal.

Snippet from the article:

A class action was filed today in the Supreme Court of British Columbia by Vancouver resident, Michael Miller, against Merck Frosst Canada and its affiliated companies. The lawsuit has been brought on behalf of Canadian men who used Propecia or Proscar and suffered continuing sexual dysfunction.

Propecia and Proscar are prescribed as a cosmetic treatment for male pattern hair loss also known as androgenic alopecia. The product monograph discloses that some men may experience sexual dysfunction but states that the symptoms disappear after cessation of the drug.

Mr. Miller, who is in his early 20s, was concerned when his hair started to thin in some areas. He was prescribed Proscar which he hoped would stop his hair from thinning.

Read the full story — Class action filed against manufacturer of Propecia & Proscar

If this young man was in his early 20s and prescribed Proscar without being told to cut the pill into a smaller daily dose to treat hair loss, his chances for side effects would’ve increased. Proscar is 5mg finasteride used to treat prostate issues. Propecia is 1mg finasteride used to treat hair loss. So if you’re taking 5x the recommended dose, what would you expect?

We’ll see how this class action suit plays out…

Just a quick note about Propecia. I have been on it for 15 years. Never had a single side effect. Well not that I’ve really noticed anyway.

Any time you take a medication you have to realize that there are side effects. One of the side effects to Proscar for instance is that it can STOP YOUR HAIR FROM FALLING OUT!!! Get the idea? Birth control pills also has a ton of side effects but almost every girl I know is on the pill… hmmm…

I’m not saying to run out and buy Proscar but if you do, it’s your choice. There’s nothing wrong with educating yourself before taking something but understand that “side effects” are the reason you’re taking it. This is your hair on drugs… Any questions?

Good advice. I think if one actually read all the side effect possibilities in common medications that they think are 100% safe, they’d be surprised.