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Propecia, DHT, and Sperm

Hello Doctor:

Thanks for you candid forum. I have three questions for you. If I’m a male on Propecia to prevent hair loss, will taking protein supplements for body building militate against the benefits of reducing DHT by Propecia? And, how can I reduce the sexual side effects of Propecia; namely, the reduced sperm volume? Finally, is there any evidence yet that taking Propecia and its active agent long term will cause permanent side effects or potential diseases?

Thanks again

I’ll answer your questions in order and they are all good questions;

  1. Protein supplements will not change how Propecia works, namely, by blocking DHT formation. I WOULD warn you against taking any steroids which conceivably could alter hormone levels and diminish the benefits of the Propecia.
  2. The sexual side effects of propecia are often temporary, but if they persist for you, I usually recommend trying a half-tablet twice daily or even just once a day. You will get less than the full benefit (I am led to believe that 1/2 tablet may give you 80% of the benefit), but you will at least get SOME benefit and that is the important thing.

    Sperm volume and ejaculate volume are two different things. Ejaculate contains several body chemicals and fluids, not just sperm, and decreased ejaculate does NOT mean less sperm at all – as a matter of fact sperm levels for those with decreased ejaculate are usually still within normal levels, possibly higher. Decreased ejaculate volume was shown to occur in 0.8% of people taking propecia versus 0.4% of the placebo group in the initial studies (that decimal point is correct, it is LESS THAN one percent). Although the frequency of reduced ejaculate volume is reported small, in my experience after probing many men on this issue, it is far more frequent than the literature seems to suggest. If you are worried about potency or having problems with conception, I’d see a urologist and get your sperm count done.

  3. Finally, the long term data for finasteride (~15 years of data) does not show any permanent side effects or potential disease. As a matter of fact, the data so far indicates that there is less prostate cancer in those taking it. So there you go!


2006-04-14 08:34:34Propecia, DHT, and Sperm

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Do Birth Control Pills Treat or Cause Hair Loss?

Bottom Line with hair loss and birth control pills?

I read conflicting information about the birth control pills and hair loss. It can trigger hair loss yet is also a treatment for androgenic alopecia.

I experienced heavy shedding after discontinuing Ovcon 35 several years ago. I became pregnant shortly after stopping the pill, and the hair loss ceased. I had moderate TE after all three of my subsequent pregnancies. I am now finished childbearing (at 32)and looking for contraception. My mother has severe androgenic alopecia and I’m quite sure I’m destined for the same fate.

So, for my case (there are no other known health problems in myself or my family) should I take BCP’s to prevent the alopecia? I was thinking of trying Yaz or Yasmin because of the drospironone that is derived from spironolactone and has anti-androgenic properties. But is it the estrogen or the progesterone in the pills that cause the hair loss? Should I stay away from BCP’s completely due to my history?

You should have this conversation with your OB/GYN doctor. I do not prescribe or recommend birth control pills (BCP) in my practice, but more importantly you should not be taking BCP for hair loss. All medications have risks and benefits and potential side effects. As such, these matters are highly specific to each and every individual.

I wish I can give you a blanket answer saying one birth control pill is better than the other at hair loss or hair growth, but I do not know of any firm proof of what is good/bad for what. From a theoretical perspective (as you seem to have done your research), spironolactone does have anti-androgenic properties. From a practical and real world perspective, spironolactone does not stop or help with androgenic alopecia, which is why I do not prescribe spironolactone for hair loss either.


2008-11-13 13:34:31Do Birth Control Pills Treat or Cause Hair Loss?

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Propecia Maintenance Phase?

I have been using Propecia for about 8 years. Though no measureable regrowth, I feel it slowed or haulted the hair fallout and have been able to keep what I have. I do not believe I have sufferred from any of the “male concerning” side effects. My question is, is there a thing such as a maintenance phase? Meaning, instead of taking the 1mg tablet daily, can I take one every other day and still be alright?

Thanks

The need to take the same dose over and over again for life should continue. If you drop the dose, you run the risk of losing hair. If you do go for every other day, that’s your call to make… but I wouldn’t recommend it. Unlike your case, some patients have reported that after 5 years or so some hair loss picks up again, and in those patients I have been recommending an increase in the dose to 2.5mg each day, provided that there are no side effects. Discuss any prescription medication changes with your prescribing doctor.


2009-05-14 10:28:22Propecia Maintenance Phase?

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Do Hairs Within a Trichophytic Closure Grow At the Same Rate as the Newly Transplanted Hairs?

Hello Doctor,

I had a hair transplant with the Trichophytic closure method, I was wondering, does the hairs within the scar take the same amount of time to grow through the scar as the newly transplanted ones?

My scar looks good..however, I’ve noticed some small patches where hair hasn’t grown through yet.

Thanks again for this fantastic website

After a hair transplant surgery you may experience hair loss around the donor area with or without trichophytic closure. There can even be large patches of hair loss. The hair loss is temporary and it usually grows back after several months and it can take as long as a year. Transplanted hair takes several months to grow as well (up to one year). The hairs in the trichophytic area should grow at the same rate as the recipient area hairs.

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Propecia Success Rates

Hello Dr. Rassman,

Just wanted to start out by thanking you for this site. It seems like every time I get concerned about hairs falling out in the shower or sink, I check out your responses. LOL! Anyway, I am a 20 year old male who started taking Propecia 23 days ago (yes, I know, very precise). I noticed that the success rates of the medication are about 80% for preventing further loss and about 60% for actually growing back missing hair. Would these percentages increase for me since I am so young and just recently starting losing hair (1-2 years)? I am just so worried all the time that I might be in that 20% who gets the rotten end of the deal. I don’t want to be that 21 year old with a ring of hair around the sides and back. Just me worrying the weeks before Propecia is supposed to “kick in”…

Thanks!

Without seeing you or at least your photos, it would be impossible to address your concerns. It is true that young men (your age) will more likely get a reversal of some or most of the miniaturization, but that depends upon your balding pattern. You should get your hair mapped and from that, we can make the types of judgments you are asking about. What I can tell you is that in someone of your age, the success rate for reducing the rate of hair loss (or reducing miniaturization) is very high.

I don’t know if your numbers are correct, and though I’m sure I’ve seen actual percentages before, I can’t seem to find them at the moment. Where did your statistics come from? If anyone has a link, I’d love to see it.

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Do I have significant miniaturization?

The miniaturization doesn’t exceed 20%, which is, therefore, by definition, normal or marginal. To be exact, repeat the photo with the hairs cut short against the scalp so that an accurate count can be made. Vary the location as well so we will be looking at more than one place. Also map it against a photo so I know where the photos is coming from.

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ProRestora

Hey there.have you ever heard of a product called Prorestora? Claims to be fda approved. Thanks alot, really helpful site!

ProRestora isn’t by itself FDA approved, but it probably contains minoxidil (I couldn’t find a list of ingredients, so I’m just speculating). There are only two FDA approved hair loss medications — minoxidil and finasteride. Finasteride requires a prescription, minoxidil does not. Minoxidil is otherwise known as Rogaine/Regaine (depending on country). There are a lot of products that include minoxidil as the active ingredient since it is proven and available over the counter.

Either that… or it could be a scam. Even the bottom of their site says “All statements and information on this website have not been evaluated by the Food and Drug Administration“.

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Do men stop receding?

I’ve noticed that my dad has had the same semi-receded hair line for like the last 15 years. It has only slightly thinned out on the top since.

We are born with a patterned hair loss (inherited from family) that we will reach and then stabilize. That is most likely why your dad’s patterned hair loss is stable. Let’s stay that he had a Norwood 4A pattern genetically programmed, that means he, most likely, will never progress further to a Norwood Class 6 or 7 pattern.

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Prozac and Hair Loss

I’m 38, just had an HT and plan to have at least one more. Propecia gave me the beginnings of gynecomastia, so I stopped it. Currently I’m using minoxidil and shampooing 2x a week with nizoral, also using a laser comb 2x a week. First of all, is there anything I can add that will help, secondly, you mentioned that lexapro causes hair loss, does prozac also? Are there any SSRI’s that don’t? Will hair grow back once you’re off them? Thanks.

I think that all SSRI’s can cause hair loss; Prozac can. For men that lose hair from drugs like SSRI’s, the loss is rarely reversible if the patient has genetic hair loss. I would not count on it regrowing. I do not believe that the laser comb really works, but I do not see any negative from using it. the rest of your routine is reasonable and I can’t see any negatives with these either.

My best advice is that you need to see a good doctor who can manage your hair loss with you. I can understand that Propecia is not working for you and the breast side effects are rare, but they do happen. Breast enlargement or painful lumps in a male breast of any size are good reasons to consider stopping Propecia.

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Do you mind expanding slightly on this cardiac side effect of minoxidil?

Some of the symptoms include: chest pain; irregular or very fast heartbeats; dizziness or lightheadedness; or fainting. Minoxidil is a hypotensive agent original designed to treat high blood pressure. Minoxidil is a direct-acting arterial vasodilator. The most dangerous of the complications is pericardial effusion reported with minoxidil treatment both in patients undergoing dialysis and those with normal renal function. Pericardial effusion can be large and result in cardiac tamponade in some cases and if untreated can rarely cause death.


2020-02-04 12:44:00Do you mind expanding slightly on this cardiac side effect of minoxidil?