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Hi Dr Rassman I have a question regarding long term efficacy of Propecia in older men who have been using it for an extended period of time.

I am in my mid fifties and have been using it for 10 years and I’m happy with the results it seems to be maintaining fairly well. However I see posts on other hair sites (by users not doctors) who say it stops working. I tend not to trust some of these people as it sometime seems they are freely expounding personal experience rather than hard facts.

Can you shed some light on this for me?

I’ve written about this before, but if the benefits of this medication eventually becomes less apparent and if you should stop it, then you’ll surely find out if it was still working when you begin to lose more hair. In other words, it is best to continue it even if you think it isn’t working anymore, because it likely is still working and stopping the medication may cause you to lose any hair that it was holding onto.

As an aside, there is great evidence that this medication will reduce the risk of prostate cancer in men over 55 years old.

Hi
I sent you the fake Propecia press release a month ago. Here is another short article dating back to 2007 about people stopping finasteride thinking it didn’t work for them when they were taking a placebo after all.

Thousands Of Men Sold Fake Propecia

The article states, “Propecia is one of the world’s most copied drugs and it is an extremely easy drug to sell online as many men to feel embarrassed to go to a doctor to speak about their hair loss problem. The Propecia drug works for about 90 percent of men.”

And it continues, “It is estimated that thousands of men around the world have stopped using Propecia believing that it doesn’t work for them when in fact if they had used a real version of Propecia made by the drug company Merck they would have experienced good results and possibly hair regrowth.”

I’m not sure where those estimates came from, and seeing as how the article is a couple years old by now, the problem might even be worse, regardless of attempts to thwart it. Thanks for sending this in, along with the previous article you sent.

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.

I have a question regarding rogaine. I have thinning in the crown and front of the head too. I have read that rogaine can be beneficial for retarding additional hair loss anywhere there is hair. Thus, I split the 1 ml dose throughout my scalp rather than just concentrating it on the crown.

Would this stop the effectiveness of rogaine? I suppose I am not supposed to use more than one ml.

I would use the dose listed in the directions that came with the product that you purchased. You can put Rogaine on your crown and front area of your scalp, but it should only be placed in the areas where you want the benefits and not put in areas where the hair is good. As you know, it has not been shown to be as effective in the frontal areas.

I suspect you can use more than 1 ml, but there is a small risk of your body absorbing too much and you experiencing systemic side effects (such as headache, fainting, etc). I would think this risk is low, but it is something to think about.

If you are concerned you should ask these questions to your doctor and get a good medical physical examination to make sure you will have no issues. I am not your doctor and this is not a place to get personalized medication use advice, simply because I do not know your medical history.