Propecia Sufferers Are Misdirected and Belittled

In a recent blog post you wrote about sexual side effects associated with propecia use, “These side effects are reversible withing one to two weeks after you stop the medication.” You then went on to say that Dr. Irwig’s study in Journal of Sexual Medicine was not a scientific study.

When you read through the FDA hearing on Propecia (FDA link) Keith Kaufman of Merck talks about the 3.8 percent of finasteride users experiencing side effects versus 2.1 percent of the placebo. He then goes onto say that these patients then completed a validated sexual function questionare. I am not a doctor but Merck basically based these figures on self reporting, should those numbers not be considered scientific?

In July the Dr. Irwin Goldstein the Editor-in-Chief of the Journal of Sexual Medicine wrote “I think of the frequent phone calls I receive from distressed men with varying degrees of hair loss who have used 5 alpha reductase inhibitors and now have newly manifested sexual and cognitive complaints that often persist despite discontinuation of the 5 alpha reductase inhibitor. Often such 5 alpha reductase inhibitor users have sought help only to be belittled, betrayed, misdirected, and sometimes misinformed. In general, these patients feel deceived becuase of the lack of information warning them of the potential side effects.”

I am one of the individuals suffering from persistent sexual dysfunction after stopping propecia and it appears pretty certain to me that in a small subset of men the persistent sexual dysfunction is due to the medication.

I am not going to get roped into an anti-Propecia agenda. I will leave that up to those who regularly comment on almost every post where the word “Propecia” appears.

My heart goes out to you if you actually have long-lasting sexual side effects, but the questions of validity ring true to your cause of sexual dysfunction. I am not in a position to judge your problem or to put the pieces together for you. That must be between you and your doctors. I am a doctor, but the posts here are just my opinions on my blog. Some may not agree with me, but that is OK! As the disclaimer on every page says, BaldingBlog is not a place for treatment advice or diagnosis. If the readers want to discuss their issues on a professional basis, they can always make an appointment and see me.

I will post an interesting excerpt from the 1997 FDA Drug Evaluation Hearing that you quote (the last sentence particularly worth noting):

We attempted to obtain followup on all patients reporting sexually-related adverse experiences. Of the 36 patients on finasteride reporting these adverse experiences, 21 reported resolution of the adverse event while continuing finasteride therapy. Seven reported resolution following discontinuation from the study, and seven had persistence of the adverse event while continuing in the study on finasteride therapy. The pattern for patients on placebo was essentially similar, with most patients resolving either on or off drug, four patients reported persistence of the adverse event while remaining on placebo therapy.”


2011-10-27 11:46:19Propecia Sufferers Are Misdirected and Belittled

Do I have to stop losing hair to get a hair transplant?

I have been experiencing hair loss for 6-7 years now and my density has kept on decreasing. I have never been on Fin, however, I did try out min for 2-3 months and then stopped using it. I see a lot of posts that suggest an HT only after your hair loss has stabilized. but how do you guys determine that? I lose hairs every day. Should I get on fin and see it I stop losing hair, and then process for an HT ?

You don’t have to wait until you get bald to get a hair transplant. Stabilization is not always possible, even with finasteride. The key is to be able to predict with reasonable certainty, what your long term hair loss pattern will be. Most men must be 26 to be able to make this prediction and that allows the surgeon to build a proper long-term Master Plan for your future hair loss. I have had men keep up with their balding without running out of donor hair in the 29 years I have been doing this type of surgery.


2020-10-10 08:13:16Do I have to stop losing hair to get a hair transplant?

Proscar And Doxazosin Makes My Pulse Rate Go High

I recently started taking proscar in addition to the doxazosine I’ve always taken for BPH. I soon noticed that my pulse goes quite high (95-100 bpm)and stays there if I have a glass or two of wine; even hours after I stopped having wine. None of the literature mentions such a side effect, but is that the likely reason.

You need to speak with your doctor regarding these symptoms! You may have a heart condition unrelated to the medication you are taking. If medication is the only issue, I would suspect Doxazosine which can lower your blood pressure and cause a higher pulse rate. Your medical problem may be more than a medication issue. You really need to speak with your doctor.

Do Men with Immune Deficiencies (Like HIV) Have Less Chance of MPB?

Hi!

Do those with severe immune deficiency, like people with HIV, have a smaller chance of developing an advanced MPB? This is a question that struck me, since the immune system is what eventually attacks/kills the hair follicles if sensitive to DHT?

To understand the immune system and how it affects one’s HIV status and balding, it would take a few pages to elaborate. So to put it simply, the answer to your question is no.

The immune system does not attack and “kill” the hair follicles sensitive to DHT. Your statement is not correct. Hair loss from immune system issues reflect many forms of the autoimmune disease groupings, such as alopecia areata, but the immune system issues regarding HIV and alopecia areata are not related since the target of the antibodies are different, as well as the cause of the disease.

If you have HIV and have the genes for hair loss, you will have HIV and have hair loss (which will almost certainly accelerate if your HIV gets out of control or your diet is not healthy).


2008-04-07 15:02:59Do Men with Immune Deficiencies (Like HIV) Have Less Chance of MPB?

Do You Perform a FUT Test Before Surgery?

Dr.Rassman/Dr.Pak,
I understand that you conduct tests (FOX test) on potential FUE patients to determine their suitability, but do you offer similar tests to FUT patients (e.g. 3 cm x 1 cm excision / ~300 graft mini-HT to ascertain healing quality of recipient and donor areas, donor-strip scar assessment, health of grafts, growth/take of transplants, etc.)?

Thank you.

Unless there is an issue with the patient who has a history of poor wound healing or poor growth, we do not test patients for FUT (follicular unit transplant — also known as “strip method”) surgery. If someone would like a mini hair transplant, that would be another issue.

The FOX Test (for follicular unit extraction / FUE) is only testing 1 to 5 extractions. We do not transplant the grafts unless there is a strong desire expressed by the patient. Thus the FOX test is a very simple 5 to 10 min test which we offer at no cost.

Pull on the Hair and Rub Garlic On It for Regrowth?

I read about this hair regrowth technique on the internet about massaging the scalp, and pulling on the hair and at night rubbing garlic into the hair and sleeping with it (it suggested other things like nail scratching and brush scratching the scalp, ect. I tried it for about two weeks (the first week putting olive oil on every night before bed).

Now my hair, which was a bit receded on the sides has significantly receded on the sides and into the top. In only two weeks (and it was pretty stable before). I am wondering if any of these techniques (like the scalp massages, or pulling, or even the garlic) could have caused the losses.

I just feel so lost and a bit depressed as to why it changed so drastically and what to do about it, if I can just even get it back to the way it was two weeks ago.

Thanks so much for your help.

Rubbing on the hair and scalp can force out weak hairs, and that is why we suggest no rough scalp massage. Pulling on your hair absolutely will not help either. I have heard of such remedies over the years. Some of them are pretty funny, like keeping various animal droppings on your head while you sleep, pouring animal urine on the scalp, standing on your head for hours (just being upside down is thought to bring more blood supply to the head), and on and on.

What is wrong with going to a doctor who knows things that you do not, can diagnose what you can not, and can treat you with appropriate effective treatment modalities? The real cost to you is the time delays you are putting into getting to the root of the problem. To answer your question though, garlic won’t regrow your hair… but added to butter, it makes for a tasty sauce on bread.

Question About Topical Finasteride vs Oral Finasteride

Recently, I got a prescription for oral finasteride from my dermatologist. I’m a bit nervous to take the oral route due to the side effects that appear to be somewhat common and the possibility of the post-finasteride syndrome. I have learned that my pharmacy is able to compound 5% minoxidil with 1mg Finasteride into a topical solution. I was wondering if you had an opinion on this?

Keep in mind that topical only works where you put it. So, if you have hair loss where you don’t see it (like many people do when I perform a HAIR CHECK test), then these areas will still lose hair. Also, Post finasteride syndrome, I believe, doesn’t happen if you stop taking it after you find that even staying on it a month or so does not solve the ED problems.


2019-09-12 11:49:13Question About Topical Finasteride vs Oral Finasteride

My Doctor Told Me I Had Frontal Fibrosing Alopecia and That Is Causing My Hair Loss. What Is It?

Frontal Fibrosing Alopecia is an autoimmune disease found most frequently in women (See here: https://en.wikipedia.org/wiki/Frontal_fibrosing_alopecia)

Another interesting article on this subject discusses medications that may cause it and it can be found here: https://www.ncbi.nlm.nih.gov/pubmed/30259544.


2019-02-14 10:56:47My Doctor Told Me I Had Frontal Fibrosing Alopecia and That Is Causing My Hair Loss. What Is It?