Proscar Has Gone Generic in the US

Dr. Rassman,

It says here that Proscar has gone generic. Do you believe it, and what does it mean to american customers of Finasteride? I am particularly confused about the 180 days bit? Does it mean that generics of proscar will only be available for a 180 day window.

Thanks Doc

See Dr. Reddy’s launches generic Proscar in U.S..

Yes, Proscar (brand name of 5mg finasteride) has gone generic. Propecia (brand name of 1mg finasteride) is still not available in the generic form in the US. Some patients take Proscar and break the pill in 1/5 or 1/4 in place of Propecia because it costs less. This does not mean Proscar is available without a prescription in the US, but it now that it is to be available in the generic form, it should cost even less to take finasteride in 1mg doses (as long as you break the pill).


2006-07-05 15:51:00Proscar Has Gone Generic in the US

Do Older Women Lose Hair Due to the Length?

Long hairI am 58 years old (female) and have been letting my hair grow long – it is now past my shoulders – I have noticed a lot of hair loss when I wash my hair – is this due to the length of my and age? Thank you for your response

We generally lose about 100 hairs per day and if the hair cycle goes about 3 years, then the calculation of a 100 hairs per day is arrived at. The longer the hair is, the more detectable the hair will be as they will stick to your fingers in the shampooing process and in the drain. This goes for any age.

One lost hair on you could clog a drain and look like a handful if it is as coarse as it looks in the picture. As you know hair cycles and grows about a half inch a month. If you are 5ft tall and your hair is 5 ft long (example) then you have a ten year hair cycle and than means that all of your hair should fall out and be replaced in 10 years, one hair at a time. My great grandmother had hair length like yours when she was 110 years old, but she wore it in a bun and washed it a few times a year. It was evident that her length was far shorter than it appeared as the hair tangled and much of it never fell out.

PRP Is High Cost, Low Value for the Treatment of Hair Loss

I called this one place in Vienna, VA that says they have the “Best” Centerfuse and the Harvesting Kit known as “Terumo, which she also said is the top of the line and the best of the best for PRP hair loss. She said it’s $1,500 for PRP w/out A-Cell and $2K for PRP w/A-Cell. Expensive per treatment because of the top quality they use. Is it true because everywhere else in Northern VA and Washington, D.C they have packages of 3 or 4 treatments for $2K or $2,500.

My title page says it all: PRP is High Cost, Low Value for the treatment of Hair Loss.


2019-12-09 16:18:11PRP Is High Cost, Low Value for the Treatment of Hair Loss

Pull Test and Telogen Effluvium

Why is a pull test positive in cases of telogen effluvium but not in mpb. If a pull test was positive is this a definate indication of telogen effluvium

The pull test can reflect many conditions, including a variety of autoimmune alopecias, telogen effluvium, possibly even androgenetic alopecia when it is very active. The test constitutes grasping about 60 hairs between two fingers near the scalp, then pulling gently (but firmly) on the hair. A positive test will yield 6 or more hairs and it is often done on 4 different parts of the scalp.

Do not wash your hair for 2 days prior to doing the test. If you decide to do the test on yourself, do not keep repeating it as you can pull out more hair than you really want.

This would not be a reliable test for male pattern balding diagnosis, because the hair loss from this condition varies. I suspect that when the process is not active (like when a patient is using finasteride / Propecia), the hair loss has stabilized so that the pull test would or should be negative. There are much better ways to make the diagnosis of MPB than by using the pull test.

Doctor Availability

I recently had a hair transplant and I hate to tell you how much I paid. What I am writing about is that after the surgery, the the instruction sheet they gave me is very poorly constructed and when I tried to call the doctor to ask questions, I got a message telling me to go to my local emergency room. Is that an acceptable way to do business or are there standards that doctors must adhere to with regard to giving patients the information they need?

There are no standards other than the Hippocratic Oath which is: I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath. “To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”

The oath of Maimonides: Oath and Prayer of Maimonides is another iteration of this oath, possibly more comprehensive and more extensively used today. Somehow I sense that the concept of an oath is either not taken seriously today or manipulated to meet the ends of the oath taker. Let’s look as some lines in the Hippocratic Oath as it pertains to your question:
“Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain to look upon his children as my own brothers never do harm to anyone”. I take this to mean that our patients should be treated as our children, with respect and with regard to the entirity of their care. “Making a surgeon (any doctor) available to a patient he accepts as his/her responsibility” I read with interest and found no bounds to the timing of the responsibility possibly limited by reasonableness. “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing” Here I define the house as the body of the patient, again open ended with regard to time and mechanism and the failure to adequately communicate or make oneself available can clearly do harm so ‘Ill-Doing’ can be done by not taking this responsibility seriously.

With today’s technology is is easier to be a better doctor. For example, I carry a cell phone and EVERY patient has 24/7 access to me, even on when I am on vacation, provided that I have cellular reception. I constantly am trying to improve my written instructions and learn by each phone call. Even more importantly, I prepare each patient thoroughly prior to the surgery with:

  1. a book I wrote which is possibly the most extensive book in the world on hair restoration surgery;
  2. a one hour, private consultation with most patients (sometimes longer). After the consult I put my findings and recommendations into a three to four page detailed letter customized for each patient. That frees the patient up to listen and learn and ask questions of me during the consult, at the onset of the process;
  3. open house events which are well known all over the United States. We originated the open house concept in hair transplantation and during our Los Angeles Open Houses we sometimes have a dozen patient examples of our work that you can examine for yourself.

Education and preparation make post operative follow-up easier on everyone, patient and doctor. I set my standard of care high, to better serve my patients, starting at the time of our first meeting. So while you may not have received post operative care that met your standards (or that of NHI), the physician may have felt that they provided an acceptable level of care .

Question about topical minoxidil

Hey all, I am soon going to start using topical minoxidil. The only brand (Linn Minoxidil) I could get a hold of somewhat easily where I live (the Netherlands) is a spray. The manual says to spray six times on the balding spot. But I am a norwood 3.5-4, and hence would like to spray both on my diffusing crown and receded temples. The manual however does not specify how to treat multiple areas, i.e do I just do three sprays on the temple and three sprays on the crown? Or do I have to use the spray on i.e the crown alone? Was wondering if anyone here has faced this issue/knows the answer.

First, you must be aware that only 40 % of men will respond to the topical minoxidil. On the other hand, the oral form is 100% effective because it is metabolized in the liver into its active form. I generally prefer to agree with the manufacturing instructions; however, with the topical minoxidil that I am familiar with, one good application a day works well. I recommend applying it after a hot shower on a damp scalp to increase absorption. If you do not get a good response to the topical, you may assume that you are one of the 60 % of men who do not respond to the topical form. If you are committed to going the minoxidil route, the oral form requires a prescription. I have seen wonderful results from oral minoxidil.

Doctor Told His Patient that Finasteride Increased Prostate Cancer Risk

NEJMAs I’ve written in the past, I’m involved in an email group with some of the industry’s top surgeons. One of the topics that was recently brought up was a case where a patient was told, emphatically, not to take finasteride due to an increased cancer risk. Coincidentally, I received an email from a patient not too long ago with a similar concern… so I figured it was time to write about it again.

In a 2013 article published in the New England Journal of Medicine, the long term survival of participants in the prostate cancer prevention trial was discussed. It was reported that there was no increased in risk of death for those on finasteride compared to a placebo group. There was, however, a marked decrease in the overall incidence of prostate cancer in the treated group as compared with the placebo group. This was consistent with the original studies on the reduction of cancer incidence by as much as 25% for those who were treated with finasteride.

There’s a good breakdown of that NEJM article found at Cancer.org.

How to Quit Finasteride After 10 Years

I’ve been taking finasteride for over a decade. While it slowed my hair loss, it’s now at the point where I’m no longer happy with what I have, especially in the crown area. I was side effects free for the most part early on, but over time and distinctly this last year, the mental fog became noticeable and my libido has also taken a pretty big hit to the point of being a problem. It’s time to throw in the towel and buzz shave. So for those who have quit themselves or looked into it, is there an ideal way to come off the drug? Is cold turkey fine or should I space out doses to every other day to every third etc? I use Proscar split into 4ths but have been off for about 10 days due to prescription running out. I am getting some aches in the junk as a result.

If you stop the finasteride now, after 10 years, you will not only lose all of the gains you had over 10 years but all of the hair you would have lost in that same time period. Maybe your libido is lower because you are aging, not from the finasteride. Stopping it for 3 weeks might give you that answer.


2019-02-20 08:02:51How to Quit Finasteride After 10 Years

Doctors That Use the Densitometer

Dr Rassman
Do you have a list of doctors in the US that use and are skillful with the Densitometer?
Thank you

Go to the ISHRS website to look up doctors who specialize in hair diagnosis, treatment or hair restoration. Good dermatologists should also fall into this category. When you call their offices, before you make the actual appointment, ask them if they map out the degree of miniaturization on the scalp for quantifying the extent of balding or thinning. That is a better probing question than asking about an instrument I invented, since other doctors may not know it by the actual name I gave it. (FYI, the U.S. Patent I obtained for this was U.S. Patent #5,331,472 ‘Method and apparatus for measuring hair density’, issued July 1994).