Category: Drugs

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Do Propecia Benefits Outweigh the Risk? – Hair Loss Information – Balding Blog

My doctor recently prescribed propecia to me, a 20 yr old male. After reading all this stuff through the web, and i know you even stated that the side effects seem a bit exaggerated, i am kinda skeptical about taking it. I really don’t want to have a decrease in arousal and definitely do not want to develop breasts. Do the benefits outweigh the chances of the side effects?

Also, whats the effect of lowing DHT on your muscles? It seems that the only answers i could find say that lowing DHT would lead to weight gain and muscle loss. This seems quite the opposite of what i have researched since DHT is not the main source used by skeletal muscle and the reduction of DHT would lead to higher levels of testosterone, the ultimate muscle booster. Thanks

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Official studies have shown the side effects occur in 1-2% of men. The medication has shown benefits over 5 years in 77% of men (statistics here). So yes, the benefits outweigh the risk… but it depends on your priorities.

The real answer lies in what you think of yourself balding progressively over the years and what you will feel about yourself if you become bald. Balding is the natural way to go, but I am in business because other men do not want their genetic cards showing. If you’re truly concerned, don’t take Propecia. Remember, it’s an elective medication. If you think you could be one of the 2% that has problems, perhaps it isn’t worth it to you. Then again, you could fall within the 98% that has no side effects…

With regard to muscle mass, I have never seen any impact at all.

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Hair Loss InformationPermanent Finasteride Side Effects Article in Journal of Sexual Medicine – Hair Loss Information – Balding Blog

Dr. Rassman, et. al, the Journal of Sexual Medicine has recently published an article describing the permanent sexual side effects of using finasteride. I quit taking propecia approximately 2 weeks ago and am terrified that I have permanently damaged myself. What are your thoughts on the article?

Adverse Side Effects of 5?-Reductase Inhibitors Therapy

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Many of my patients have been taking Propecia for over a decade without side effects. I have yet to meet a person in my practice who complains of permanent side effects associated with Propecia after they stopped the drug. The few that do have side effects at all elect to stop taking the medication and the side effects have subsided as their hair tumbles to the ground. But that is just my humble experience.

The article itself doesn’t provide anything new, just reviewing previously published reports from a subset of men that raises the possibility of a casual relationship. They did report a single case of a man with total sexual function loss, but that sounds peculiar and I’m not convinced. I would wait for confirmation by other investigators on claims of permanent damage from finasteride. The Journal article was digested by the Boston Globe here and even mentions what we’ve been saying for years about the percentage of those that saw side effects:

“In one trial, about 1.9 percent Propecia takers who took the drug for up to two years experienced a loss of libido compared to 1.3 percent of placebo takers; 1.4 percent of Propecia users had erectile dysfunction and 1 percent had an ejaculatory disorder compared to 0.9 and 0.4 percent of the placebo takers.”

For most of the frightened men, I wonder what they’re so terrified about. Did they actually have side effects? Are these men willing to risk balding over a 1-2% chance of side effects? As I’ve often said, the medication is completely elective. You don’t have to take it and I am not trying to convince anyone to do so. I am just presenting my opinion based on experience. The Mayans predicted the world will end in 2012, so I would be more terrified about what will happen in 11 months!

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Propecia and Healthy Sexual Function in Men? – Hair Loss Information – Balding Blog

Hi Doc, I had a question about finasteride, because I’m thinking of starting Propecia for hair loss and I’m worried about the sexual and other side effects. Basically, what is more responsible for healthy sexual function in males? DHT or testosterone? If testosterone is responsible, then shouldn’t Propecia help to increase sex drive – because speaking from a chemistry perspective, if Propecia reduces the forward reaction rate of the reaction that converts testosterone to DHT, then shouldn’t that lead to excess testosterone in the body? Unless Propecia inhibits testosterone as well?

Because I don’t understand how herbal DHT inhibitors like Procerin claim to have no sexual side effects, if they ultimately perform the same function. Unless of course there are other factors into play which I’m unaware of.

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We have written about this over and over. Here’s some bulletpoints:

  1. See your doctor (as only a physician can prescribe Propecia) and ask him/her these questions in detail after they take your history and examines your scalp to determine that Propecia is something that would be recommended.
  2. Propecia has a side effect of decreased erection/libido in 1 to 2% of men. This side effect has been greatly exaggerated on the Internet. Moreover, many other drugs that treat blood pressure from cholesterol lowering drugs (any many other drugs) can also develop depression and have a similar negative sexual side effect.
  3. If you have a negative side effect, talk with your prescribing doctor and you may choose to stop taking Propecia. The side effects are reversible.

We can all hypothesize about the biochemical reaction of Propecia and testosterone and DHT, but in the end it works for male pattern baldness… and ultimately it is your choice to take it. I do not mean to brush off or not answer your question on the mechanism, but it will spiral us down a never-ending hole of “if this” and “if that”.

Healthy sexual function in men has nothing to do with drugs, Propecia, testosterone, or DHT in normal men. If you are a healthy individual in a healthy relationship, then you should have a healthy sexual function with or without Propecia. Propecia will not enhance or impede your sex life or health in greater than 98% of patients. If you think it does, then talk to your doctor. Of course, if you have your testicles removed, then you will have reduced testosterone and DHT, and will have wiped out your sex drive. DHT comes from the degradation of testosterone in the body, so if you do not make testosterone, then you will have very, very low levels of DHT.

Procerin is not a medication or a drug. It is a clever marketing name for an over-the-counter herbal product (saw palmetto) that sounds similar in name to Propecia. Procerin is not regulated by the FDA, nor has it been proven to actually treat hair loss.

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Hair Loss from SSRIs? – Hair Loss Information – Balding Blog

I’ve seen several sources on the internet saying that SSRI’s like Zoloft CAN cause hair loss. But how likely are they to cause hair loss in terms of percentages? Do they have a 10% chance to cause hair loss, or maybe a 20% chance?

I’m a 31 year old male and have been taking Zoloft for the past 6 or 7 years, often at 250 milligrams, or 2 and a half pills per day. Whenever I got out of the shower, I always noticed that hair would be clogging up the drain. However, I never worried about it because I never looked like my hair was thinning or balding. Now though, my hair has been noticeably thinning for about 1 and a half years with a receding hair line on both sides and thinning on top and in front. Is it likely that taking Zoloft over an extended period of time caused me to lose hair at such an early age? Or could the Zoloft have caused male pattern baldness to affect my hair sooner (at 30 years old) rather than later? Could that likely have happened?

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ZoloftAs we’ve said over and over, the most common cause of hair loss in men is androgenic alopecia (AGA). This is often referred to as male pattern baldness (MPB). It’s a genetic issue and just as the term implies, the hair loss happens mostly at front and top (as you describe, in a pattern). Certainly many medications may list “hair loss” as one of its MANY side effects, but medications are often the last culprit. In other words, your loss may be completely unrelated to the medication.

There is no documented percentage of patients who experience hair loss from SSRIs that I am aware of, but in the end you need to speak with a doctor about this. With your doctor, you can discuss your options and obtain a good diagnosis of your particular cause of hair loss.

On a side note, for those who are always preoccupied about the sexual side effect risks of Propecia (1-2%), I believe SSRIs have a much higher percentage of sexual side effects than Propecia has.

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Rogaine Has Recently Lost Effectiveness in My Crown – Hair Loss Information – Balding Blog

Thanks for the great site everyone!

Here are my questions:

I have been on proscar for over 10 years. I have virtually no frontal hair loss, but the crown has been fighting me the whole decade. Rogaine has been great but has lost its effectiveness recently. My crown is not noticeable (mild combover) but it’s thin to me. What is the best option for a guy like me?

I’d like to do an FUE because although I’m not bald, I’m in my mid 30’s and I want to enjoy life. I should mention I have VERY thick hair everywhere else on my head..

Help guys… What do I do?

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A good examination is critical to giving you realistic expectations. With lots of hair, crown loss can be transplanted very effectively. For example, I (Dr. Rassman), had 1600 grafts in the crown many years ago.

With regard to Rogaine, it may run out of steam over time. Short of transplants, there is often little that can be done… but definitely maintain your finasteride.

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Minoxidil Applicator Brush? – Hair Loss Information – Balding Blog

I just saw a commercial for the Minoxidil applicator brush. Do you(or your patients) have any experience with this product. Do you consider it an advancement in terms of effectiveness or ease of use?

Link: Ultra-Mox Applicator Brush

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Minoxidil brushI haven’t seen this one before. So from what I gather, you load the brush with the minoxidil and then comb it through your hair to dispense the medication. It’s a clever idea, but I don’t really consider it any advancement in the drug arena or a game-changer in the effectiveness of minoxidil. If it’s worth $100 to you to not apply the minoxidil with your hand, I suppose this is an item you could use.

So while I don’t have any experience with this minoxidil brush product, I wish the makers well. It is a free economy. For the record, I also don’t own automatic tie rotating hangers or other extraneous late night TV gadgets. Any readers out there use this applicator brush? If so, we’d love to hear your thoughts on it.

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Hair Loss InformationIn the News – The Placebo Effect Works – Hair Loss Information – Balding Blog

Snippet from the article:

There’s little doubt that the placebo effect’s real, but it has always been argued that a person feels better because they think the pill is the real deal. But what if it works even when you know it’s a fake?

According to Ted Kaptchuk at Harvard Medical School and his colleagues at least one condition can be calmed by placebo, even when everyone knows it’s just an inert pill. This raises a thorny question: should we start offering sugar pills for ailments without a treatment?

In the latest study, Kaptchuk tested the effect of placebo versus no treatment in 80 people with irritable bowel syndrome. Twice a day, 37 people swallowed an inert pill could not be absorbed by the body. The researchers told participants that it could improve symptoms through the placebo effect.

While 35 per cent of the patients who had not received any treatment reported an improvement, 59 per cent of the placebo group felt better. “The placebo was almost twice as effective as the control,” says Kaptchuk. “That would be a great result if it was seen in a normal clinical trial of a drug.”

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Read the full story at Gizmodo — Placebos Can Work Even When You Know They’re Fakes

I am certain that the placebo effect also applies to side effects. If you hear you may get erectile dysfunction from taking a drug, how many people will report the side effect from taking the placebo?

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Hair Loss InformationIs Taking Propecia to Prevent Shock Loss an Indefinite Necessity? – Hair Loss Information – Balding Blog

Hi Dr Rassman,

Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!

I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.

I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.

Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?

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Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.

Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.

Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.

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Hair Loss InformationTaking 1/3rd Proscar Tablet? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

Many thanks for the detailed and trustworthy information you offer your readers. It is a true resource amidst the unreliable heresay elsewhere.

I am a 29 y.o. male — I started Propecia 1mg 4 years ago and it worked great until this summer when my hair started falling out quickly. My doctor increased my dosage to 1.67mg, which I filled with generic finasteride at Target(thank you again for pointing out the great deal there). It has only been a month, but I am hopeful it will work again.

Recently, my regular dermatologist (not the prescriber) asked whether the pill I am taking is scored and evenly distributed. I inquired with the pharmacist who said it was not scored and likely not evenly distributed. He knew of no generic finasteride that is.

What are your thoughts on the effectiveness of taking 1/3 of a tablet that I am not sure is evenly distributed. I looked in the archives and was able to dig this up, but it seems like the answer was inconclusive at the time and I am wondering if anything changed. It also dealt with Proscar, not generic finastertide.

Thanks so much

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I am not an expert on drug mixing, but I believe that the various ingredients are homogenized, so as it is made into a pill there’s no irregularities in the mix. If the ingredients were irregularly mixed at a pill level, then in theory it could be irregular from pill to pill… and I’m not sure if the FDA would allow that. I’m not well versed in pharmaceutical manufacturing policies, though.

As for taking the 1.67mg finasteride, if that is what your physician prescribed you, I’m not going to argue with that. There have been times where I’ve increased the dosage recommendation for individual patients if they notice hair loss accelerating after being on Propecia for years.

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Hair Loss InformationPropecia Halted My Hair Loss, But My Doctor Said Avodart Has Better Results – Hair Loss Information – Balding Blog

I’m a 24 years old been on Propecia for 2 1/2 years. Dr. Bernstein told me back then I have early frontal loss. I’m a NW2 but the corners & center of my hairline and my mid anterior are thinning. Ever since being on Propecia my hair loss remained exactly the same as then. So it halted it completely at least to my eyes.

I’m thinking of getting on Avodart since it has usually better results my dermatologist said, but I’m worried if I were to get side effects and get off and go back to Propecia, will my hair return to the way it was on Propecia (if I gain more hair on Avodart that is) and will the side effects go away or will I need to stop a DHT blocker completely? I have zero side effects on Propecia except I remember the first week I had a super high sex drive which passed!

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In my practice, I rarely recommend Avodart (dutasteride). It’s not FDA approved for treating hair loss, and there is the potentially higher risk of negative side effects, such as libido loss and erectile dysfunction, than that of finasteride. Plus, we are still unclear about sterility issues with Avodart, as there are suggestions that this may be a problem in a small number of patients. If you’ve seen good results with no side effects from Propecia, why push it by taking a much stronger medication like Avodart?

I don’t know for sure what would happen if you switch from Propecia to Avodart and then back to Propecia (or vice versa). I’ve received emails about it over the years, but each person is different.