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Hi Doc. Thanks for a great website.

37 year old male, been on Propecia for three months now. Prior to Propecia, hair was falling out of vertex at a steady rate. Started Propecia and loss stopped immediately and completely within three days. One month later after continued Propecia use, hair begins falling out at same rate as before Propecia and continues falling out now.

I know that I can’t “build up a tolerance” to Propecia, so am I in a shedding phase? If so, how long will that last approximately? And is it a good sign that my loss stopped so dramatically at the outset of my treatment? Is that a sign of things to come after this shedding?

Any information would be appreciated. Thanks!

If this is not a short term shedding process, you could be in for trouble. I don’t have any idea if it’s a temporary thing or how long it’ll even last. Stick to the treatment and then work with your prescribing doctor. You might start to ask yourself if its time to consider adding minoxidil to the treatment plan.

Doctor Rassman, I’m curious as to your thoughts on the following article. I just learned of the development process for Propecia and was shocked to find they intentionally engineered the drug to match the hormone profile of pseudo-hermaphroditic children because they had smaller prostates and a lack of male pattern baldness. I can’t see any patient willingly taking this drug if they were aware of its origins. The entire concept seems drawn up by a completely mad scientist.

Only page 1 is necessary to read, the rest is just sycophantic quotations regarding Merck’s profits.

Link: Keeping the Pipeline Filled at Merck

I agree that what you read seems strange, but this isn’t only limited to Propecia/Proscar (finasteride). These types of discoveries in medication development are common.

Scientists often look to nature and outstanding traits/illnesses to understand certain diseases. When scientists found a group of a population with no prostate issues and no male pattern hair loss, they made a connection that it may have something to do with being pseudo-hermaphroditic, which led to the realization DHT had something to do with it. But the converse is NOT true: Just because you have low DHT does not mean you will be pseudo-hermaphroditic. Just because you take a drug to lower your DHT does not mean you will be pseudo-hermaphroditic. The hermaphroditic issues ONLY impact the fetus in the first trimester of pregnancy and not in boys or men. And even then, the dosage for this to occur in pregnancy is not understood.

Back to pharmaceutical discoveries — many drug origins are from strange findings. The common drug penicillin was discovered from molds. The widely used anti-wrinkle treatment Botox is from the poisonous toxin botulism. The flu shot many people get yearly is derived from viruses. The mascara that women put on their eyelashes are derived from earth worms. The first hormone replacement therapy drug to treat symptoms of menopause was made from the urine of pregnant horses. Certain blood pressure medications were derived from venoms of snakes. Coumadin is a rat poison that is used to thin the blood for certain patients to save their lives. My point is: medications can be very strange.

Hi,

I recently decided to see a doctor for my hair loss. I’m a 29 year old man and my doctor said the best thing was to start on finasteride and suggested that a prescription for generic proscar and splitting the tablets was the better way to go due to cost. I’m comfortable doing this but wanted to know the best way. Should I quarter the pills and then skip every 5th day or take 1.25 mg everyday?

Your prescribing doctor should have given dosage instructions. For my patients that cut the generic 5mg pill, I recommend they quarter the pill and take one piece daily. If you can cut it into 5 even pieces that would be ideal, but not likely done with ease. Skipping a day is not recommended.

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.