Category: Drugs

Hello,

I’ve been on finasteride for three years now with some moderate success. The medication didn’t give me any regrowth, but after three years the miniaturized area is only slightly thinner than baseline, so clearly I have responded to the treatment to some extent. The problem is that I have elevated estriol levels (I am a male, by the way), and my doctor believes it’s a side effect from finasteride and wants me to quit taking the medication. However, I am reluctant to do so. Have you seen high estradiol levels in your patients who are on finasteride? This is not listed anywhere as a side effect.

I do not order standard or special laboratory tests for my patients who use finasteride 1mg a day for hair loss, because there is no utility in ordering these tests. There are many variations in test values and there is no use in finding out a test result unless you know:

1. Why you are ordering the test
2. What you expect to learn from the test
3. How you will interpret the test result, and
4. What you will do as a consequence of the results

So no, I haven’t seen high estradiol levels in my patients. You should ask your doctor why those tests were ordered.

I am in my late 40s and have receding hair and a slight thin spot at the crown. I’ve been taking Propecia for about 2 years now and while I haven’t noticed any hair growth, my hair seems to stay consistent. I am, however, unhappy with the decreased libido side effect. I would like to stop taking Propecia and try Rogaine or saw palmetto.

Would you advise this and if you would, should I stop the Propecia cold turkey or gradually stop it?

I can’t advise someone that isn’t my patient to start or stop a prescription medication, which is what Propecia is. I can just give general advice. There’s no weaning process when stopping the medication, but please talk to your prescribing physician about the best way to change your dosing. There’s a couple points you might be aware of, but I feel I should highlight for you just in case:

1. Any benefits you’ve seen from Propecia will start to disappear within months of stopping it, so if you want to try to maintain the consistency you’ve seen you might wish to ask your doctor about taking a lower dosage (some Propecia is better than none) to see if that helps with the side effects.

2. It’s also possible that the drug itself isn’t the cause of your lower libido and there’s another issue coincidentally going on. Stress, anxiety, and age can also be reasons for a lower libido. People seem quick to point the finger at medication first, but in reality people that don’t take medications still have these same issues every day.

Propecia is entirely elective medication for a cosmetic issue (you’re not going to suffer health risks by stopping it), so ultimately it’s up to you whether you want to take it or not.

Hi Dr.
I have enjoyed reading your blog. Throughout my life I have had thin hair but it has never bothered me. If I could keep it at the density that it has been I would be happy. Male Pattern Baldness does run in my family (especially my moms side) and a lot of my cousins have already decided to shave their heads. I have been lucky so far and am at an older age than they were when they started to thin. I thought I had dodged the bullet but I received a shorter than usual haircut this summer and noticed my hair looked a little thinner than usual.

I was into a dermatologist within a week and onto finasteride which helped me mentally more than anything. I still have a full head of hair and the only person to notice it looking thinner so far is me. As time goes on I wonder if it is really appropriate for me to be taking finasteride. Do you have an opinion on this? I have an appointment with a reputable hair restoration surgeon in a month. I made this appointment mostly to have someone tell me if I am really thinning and to make some kind of a “master plan” if I am. Surgery is nowhere in the plans for now.

My main concern is that I could possibly damage my hair by taking finasteride if infact it isn’t necessary. Any information you have on this would be greatly appreciated. Thanks again for your very informative blog.

Taking finasteride will not damage your hair, but you should not be taking finasteride if you do not have androgenic alopecia. There’s no reason to take unnecessary medication, and your doctor will be able to tell you if Propecia is helping. Perhaps your haircut didn’t reveal anything new, but it’d been so long since you’ve had it cut that short that you forgot what your short hair was like? I don’t know…

Really what you need is a good diagnosis, and after you have that, then you can discuss the treatment options and your ‘realistic’ ultimate goal with your doctor to see if Propecia will help.

Dr. Rassman,

I have been a patient of yours for over three years now and I recently visited your office back in August. After seeing you again it was established that my hair loss had not progressed from last year and had possibly even improved. Unfortunately, over the past month, I have been experiencing non characteristic loss. When I am in the shower, I have never ending clumps of hair coming of my head and clogging the drain. Also, when brushing my hair there is even more loss. Dr. Rassman, this has never happened before and I have no idea what to do. Is it possible that the Propecia that I have been taking since November of 2005 has stopped working for me and my genes are taking over?

All of the loss has been occurring since I have been out of town on a job. I seem to even have some kind of infection on the corners of my lips. I am sure the two things are not related, but I figured I would tell you.

Anyway, is this a normal experience for someone on the drug as long as I have been? Should I take more of it? Is it possible for a person to lose all of his hair immediately? Could this be a possible hair cycle or allergy? Again, I have no idea what to do and what to expect. I appreciate you taking the time to read this and your advice/help would be greatly appreciated.

Thank you and looking forward to hearing from you soon!

Hair loss can increase from stress amongst many other things, such as the normal acceleration of hair loss that occurs in some men (even those on Propecia). As one of my patients, please come see me and let me see if your miniaturization has increased.

Dear Doctor,

I am a 22 year old male who has been on Propecia for about 3 1/2 months. I have experienced a series of side effects that I believe are related to Propecia use. I list them here in order of appearance: thin/somewhat watery ejaculations (the first side effect I noticed, about a week into the treatment), loss of spontaneous erections, difficulty obtaining and maintaining erections, (the erections themselves are also weaker), and a loss of sensation in the genital area. I also believe I may have had slight penile shrinkage/penile tissue atrophy, and an increase in body hair growth.

I have become concerned about these side effects, and am pretty certain that they are not psychological, since I started Propecia being very certain that I would not suffer the side effects. I can attest that my sexual mechanism was optimal before starting Propecia, as expected for a man my age.

My question is, can I safely go off the drug? Can I expect that these side effects will clear up with time? Also, I have read about the effectiveness of reducing the dosage; what can you say about taking .5 or even .25 mg of Propecia daily? Should I switch to such a dosage now, or should I go off Propecia entirely, see if side effects subside, and start again with a reduced dosage?

I would greatly appreciate your help, as I am concerned.

Generally when you stop Propecia, the side effects disappear in a matter of days/weeks. Along with stopping the side effects, the value of the drug and all of its benefits will produce “catch up” hair loss, which means that your hair loss status will go back to what you had before you started the drug and you’ll lose any hair you would’ve lost had you not taken the drug at all.

I’ve advised some of my patients to try a lower dosage (0.5mg is better than none) and they’ve had some success with treating the hair loss and seeing a reduction in side effects, but it’s not an across-the-board finding that I can guarantee. Keep in mind that I’m not your doctor, and any dosing changes should be discussed with your prescribing physician.

Hello Dr. Rassman!

I don’t have a question for you, but I did want to let you and your readers know that Target’s in-house pharmacy has added generic finasteride to their list of cheap generics.

For the longest time, I was paying $72.00 for 30 pills and splitting the them into fourths. Today when I went in to pick up my prescription, the pharmacist informed me that the total was just $9.00! I actually had her check the computer again because I was so shocked. She said that a newer generic was now being sold at Target, hence the tremendous price drop. This is great news!

Just thought I’d share. Thanks for all the wonderful advice!

We called a local Target pharmacy here in southern California and can confirm this pricing for the 5mg generic finasteride. I’m not sure if that pricing is at all Target pharmacy locations, but once you cut the pills that’s 4 months of 1mg finasteride for $9! You will still need a doctor’s prescription for the 5mg, of course. Thanks for letting us know!

Doctor

You’ve said you take propecia. Why don’t you use minoxidil as well? Do you feel it would be of no benefit? To be honest if you don’t take it one would wonder why they should start.

Also how do we know all hair treated with minoxidil won’t become dependent? Is this just a theory or has it been proven and if so how?

Thanks for such an informative site.

To clarify, I did use Propecia for years, but I stopped using it some time ago. I hoped that my hair loss stabilized and took a chance by stopping the drug, and thankfully I experienced no further loss. One of my sons is still using it daily, however. I didn’t use minoxidil for a couple of reasons — mainly because the twice a day application was cumbersome to me, but also because I was looking to maintain and not necessarily regrow. The Propecia was found to be sufficient for that.

As for minoxidil dependency to existing hairs, the drug spreads to the surrounding area, so some people will find the dependence extended beyond where they applied it. Sometimes it even spreads to the face, and in women, facial hair growth is a side effect of minoxidil.

To touch back on the reason that I considered minoxidil to be cumbersome — before starting any drugs or treatment regimens, one must consider the compliance factor. A pill a day is easy for most. Washing your hair then putting on minoxidil twice-a-day everyday takes time and most men are not the best at keeping to this type of regimen. Most men simply quit after a few months before seeing any results. This ends up being a waste of time and money. A drug or a treatment plan is only as good as the person who is willing to follow the plan.