Dear Dr –
I know there’s quite a lot of anecdotal, somewhat brutal indictment of finasteride on the web, some perhaps more grounded in reality than others. And of course, part of this revolves around frontal hair loss and so-called hyperandrogenicity, blah blah. You’ve given quite a lot of first-hand, practical and scientifically-based advice to folks who may be scared off by these reports.My question for you is the following: Have you yourself witnessed in your thousands of patients any number of these patients taking finasteride see their hair loss situation get substantially WORSE (particularly in the frontal regions) given, say, a year of regular finasteride treatment? And, if so, is there any case in your patient-load where you might speculate that the finasteride treatment itself accelerated the situation?
I have seen hair loss progression even while a patient was on Propecia, but I do not believe that taking the medication caused the loss I saw or accelerated it. I can’t think of any case where I’ve speculated that the reason for the hair loss was the medication prescribed to treat it.
Reports originally sent to the FDA by the pharmaceutical company Merck show that the 1mg dose of finasteride is as good as the 5mg dose of finasteride for treating hair loss. There may be an occasional patient who does better on a slightly higher dose (2mg), but as the dosage goes up the side effect risks become higher. Even in those cases, I have a difficult time delineating that a higher dose provides more benefit. I have suggested to some patients that have seen a cessation of visible benefits after some time on Propecia to increase their dosage, but so far the results have not been clear… and I’ve not recommended those few patients increase to the full 5mg.
As a male, it is possible that the impact of testosterone may be offset by Propecia (finasteride). Propecia may also have some beneficial effects on the general genetic balding process, but you need to discuss this with your doctor before doing anything.