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Dr. Rassman,

I am a 35 year old man who has become very stressed at the thinning of my hair. I always had very thick hair, even into my late twenties, but now, I am receding and thinning in the front and on top. It has become very noticeable due to the way I like to style my hair. (gels, spikey, short messy look) I now use disguisers such as Toppik and Pro-thik.

After reading up on it a lot, I have decided to try finasteride. My question is, can I get a presciption from my general physician? I have also been reading up on HT but the process and cost scare me.

Any words of wisdom would be greatly appreciated. Thank you.

Your family doctor certainly can write the Propecia prescription for you.

You indicated that you live in New York — so before jumping into drugs and not really knowing what you are doing, see Dr. Robert Bernstein in Manhattan and let him map out your scalp for miniaturization. Then you will know if your have genetic balding and if the Propecia is helping.

Dr. Rassman,
Ive had a skin infection for about a yr on my scalp. Ive been on many prescription meds like Ketoconazole, Selenium Sulfide, Salicylic Acid and Clobetasol. Ive gone through symptoms from heavy irritation, flaking peeling of oily skin on the scalp and hair-loss, scaling, buildup, dead skin-white buildup. Lately I primarily have inflammation and buildup but it is very little and very tiny and very thin flaking during combing when scalp is dry. I’m concerned about my hairloss, thinning, shortening-Its noticeable now and continues to progress from the hair line to about 1 inch inward but is not perfectly symmetrical. Most of the hairs that fall out are with the bulb attached and I do notice very tiny hairs remaining at my previous hairline. The only thing that gives me relief is clobetasol, because I still have lots of irritation/inflammation which Ive been taking for 2 months with 6% salycilic Acid. Is it a good idea to start Propecia or should I wait for the scalp infection to go away? I took a blood test that came back Normal. Thanks

Sounds like you have a major hair/dermatological problem. These medications (like the clobetasol) are heavy duty stuff. I can only guess at your diagnosis. Taking Propecia (finasteride 1mg) will not hurt and might protect you from some of the ‘stress hair loss’ you are experiencing. I would check the use of Propecia with your doctor, but I suspect he/she would go along with it.

I am a 50yr old male that has had six strip surgeries over the years. I have continued to thin and even the transplants have seemed to thin. Most noticeably is the mid scalp area. I would like to try low dosage Dutasteride (Avodart 1 pill weekly) along with propecia, which I have been on for about 15 years. The problem is I can not find a doctor willing to write a scrip, and I have been to several Dermatologist as well as my primary care doc. All say they are not comfortable with it. The low dose seem reasonable. I feel I must give this a try before it is too late.

Any advice? Thanks very much!

If you are continuing to lose hair, it just may be from your genetic predisposition to male pattern (androgenic) balding. All drugs have limitations and drugs alone cannot completely stop hair loss. There is a reason why most doctors (including me) do not routinely prescribe dutasteride. Dutasteride is not FDA approved for treating androgenic alopecia and it has a higher side effects potential than Propecia.

As for your continued thinning, including the transplants — this is unusual. I haven’t seen your before/after photos and I haven’t seen your case file, but if the grafts were taken from the donor area (and not higher or lower), they should not fall out with your hair loss progression.