Category: Hair Loss Causes

I have several questions. I think it’s great that a doctor with your reputation and qualifications takes the time to offer feedback to so many curious internet users-it’s truly a great service.

I’m a 23-year old male with very slight hair receding and thinning at the front and temples (not noticeable to anyone but me, and two dermatologists said they might see the early onset of recession, but it was too early to tell). Out of 2 grandfathers, my father, and two uncles, only of the uncles has a receding hairline (and he is positive his did not start until he was in his early 30’s; could mine be due to a cause other than MPB?).

Searching through the internet and your blog, I’ve found an abundance of negative subjective feedback regarding Propecia-from long-term sexual side effects to long-term disruption of various endocrine system processes. Many say the side effects are more common than the 2-3% recognized by Merck. I know from your blog that you said, in your experience at your practice, the side effects are present in about 2-3% of patients.

I’m wondering: have you ever encountered a patient who complained of negative mental side effects? I discovered a few online users who claimed to have had their hormone levels drawn before and after taking the drug, and that the differences were substantial.

Also: how many patients, per your estimate, would you say are regularly taking this drug? I ask because I look at some of the forums for people claiming to experience long-term negative side-effects, and there are hundreds to thousands of users. So I’m wondering if this is 0.001% of patients ever prescribed propecia? 0.1%? 10%?

Finally: I truly just want to avoid having to have a significant hair transplant in 5 years. I’m using 5% minoxidil 2x per day, as prescribed. In your experience, is minoxidil less effective than Propecia? I’ve only been using it about a month; do you think it should stop my hairline? Finally, if I did end up requiring a hair transplant in 5 years, is it fairly safe to say the hairline could be recreated in a manner similar to the original?

Any advice or reply is much appreciated. Thank you so much for your time!

The potential market of 33 million American men who have pattern baldness is not close to penetrated. In an informal discussion with a Merck representative a few years ago, I was told that they sell more than 1 million prescriptions, but I do not know how the generic market has hurt the Propecia market. I don’t have any real numbers on how many people taking the name brand or generic, but it is sold in many countries and I’d estimate it is in the millions.

The forums are filled with spectacular statement about side effects of Propecia and if you read them, you do not get a fair and impartial view of these side effects. I’ve pointed out before that those with complaints (real or otherwise) are going to be the most vocal. You won’t see a whole lot of posts from the vast majority of users that have their hair loss stop or hair regrowing, because they have no real reason to go out of their way to write testimonials for a medication. If you think you’ve been wronged though, you’re more likely to voice your opinions. I can not tell you what the side effect incidence of people who stop taking the drug is after a week or a month, but it must be rare.

The one thing that I want you to take away from this post is that the half life of finasteride is measured in hours… and that means that most of it is out of your blood stream in a day or so. Some residual tissue presence might be in your system for as much as a week. What does this mean? It means that if you have side effects, you can stop the medication and be free of the side effects in a week or so.

Propecia (finasteride) is a better solution to balding for the young man than minoxidil, by a long shot. The best way to avoid hair loss (and a hair transplant) is to take finasteride daily and keep your fingers crossed that you started treatment in time and that your response is a good one. I wouldn’t expect the minoxidil to do much for your hairline, and recreating your hairline from a hair transplant is possible, but it really depends on what “original” hairline you’re talking about and how much hair loss you have (you might not want to focus all of the grafts in one area if you’re thinning throughout the scalp).

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Hi doc, can you explain this answer that you gave to a person that told you that he was shedding lighter and thinner hairs:

“Don’t focus too much on the hair that you lost. In normal periodic hair shedding we may lose both miniaturized and normal hair, since most adult men (50%) experience some degrees of balding at some time.”

So my question to you doc, is why do people shed miniaturized hair???

All hair sheds as it goes through their hair cycle. The “not visible” phase (telogen) lasts about 6 months. The weak hair that is miniaturized is more fragile and falls out with brushing and in those hairs, the hair growth and loss cycle is more active… and the hairs that are miniaturized have a short growth phase (and if they regrow at all, will have a longer telogen phase).

Thanks for providing this invaluable site. I am a 22 year-old male, Norwood 2. I have been experiencing a rash over the last month and I’m concerned it is related to finasteride. I do take Cipla’s Fincar (~1.25mg daily for 5-6 months), ordered from one of the semi-legal internet pharmacies, you know the deal. I realize this complicates things. The rash seems to flare up for a period of hours on a near daily basis. It usually appears on my arms, legs, torso and pelvic region. It is in the form of a series of raised bumps surrounded by a reddened patch of skin. It has a strong itch and is sort of painful when scrathed, more so than a mosquito bite. I have tried stopping the Fincar for a week and the rash did seem to stay away. I am concerned because I had one outbreak on my right pelvic region where I broke the skin from scrathing and that left a bad patch of swollen open bumps for days.

I am now trying to get the dose down to 1 to .75mg. On the higher dose I had testicular pain and a notable increase in libido as well as what seemed like a pretty miraculous cessation of shedding, this all after only two months. This makes me think the Fincar probably does contain finasteride though I know there is no way to be sure. I would like to know if you have ever heard of such a persistent rash from propecia in one of your patients. I know its listed as a side-effect… If it sounds like the Fincar is the source do you know if this type of reaction ever resolves over time or if lowering the dose might help.

Thanks again for your help

It certainly sounds like an allergic reaction, but I couldn’t tell you if its from the medication or something else entirely. You may be allergic to finasteride or possibly the one of the fillers in the pills (though that would be very unusual). The fillers do vary from manufacturer to manufacturer so you might switch to see the impact. I don’t recall a patient reporting a rash from finasteride, though.

Since you ordered from one of those “semi-legal internet pharmacies” am I to assume that you aren’t under the care of a physician? You might want to pay a visit to a dermatologist to find out more about your rash.