Balding Blog

Hi, I’m thinking of taking propecia (my trichologist has advised that I would benefit from taking this medication) but, from reading your site I’ve just noticed the issue about risk of male breast cancer. My mum has had breast cancer and I’m concerned that this could cause problems for me now if I start taking propecia. Could you give me some advice on what to do as up until this point I was happy with taking the drug!

There have been two cases in the medical literature of male breast cancer reported with a patient on Propecia. The incidence of breast cancer in men as about 1% of female incidence. This alone may account for the finding in those two patients. It is not a high risk issue, even for those with a history of female breast cancer in the family.

Just wondering if it is known why Propecia is often not effective around the front/sides ? Is there any hope for a new drug in the works that may address the front/sides?

When Propecia works, it works where the hair loss is relatively newer. The frontal area is often the first place the hair loss starts but often it is not noticed until the hairs are fully miniaturized or lost and at that point Propecia is not effective. Propecia can work well in preventing rapid hair loss in the frontal areas when the drug is started early enough. There is clearly a difference between frontal balding and crown balding, which tends to start later, in the way the genetics are expressed.

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.

Hi doc. I am a 22 year old male and I have been on propecia now for about 13 months. It has been working very well for me, and I was even getting some regrowth at my temples and along my hair line. however, around the tenth month my hair started to get worse, and I started to loose more hair and my hair looks as though it is miniaturizing especially along the hairline and my temples. This has been occurring for the past 3 months and my hair does not seem to be improving at all. Is it possible that propecia is causing my hair follicles to become more sensitive to DHT or that my body has up regulated androgen receptors in the hair follicles to make up for the low amount of circulating DHT? I just wanted to know what I should do? Thanks.

It would be highly unlikely that Propecia would be causing your hair loss. The most likely explanation is that your genes are causing your balding process to continue, and Propecia can only do so much to arrest the process. It is possible that the hair loss process has itself, accelerated.

Since you are using Propecia, you must have a prescribing doctor. You should ask him/her to do a miniaturization study of your scalp to get some metrics knowing at least from this point forward, where your miniaturized hairs are and to what degree they are miniaturized.

I have been on Propecia for 10 years. I was out of the country and lost the bottle, so was off of it for 5 weeks. When i got back I started up again, but now obe month into restarting I am losing a ton of hair throughout the scalp. It is now very noticeable. Does that mean I lost the “propecia hair” for good after stopping for only 5 weeks? Will it come back now that I am back on it?

It may not all come back, but hopefully most will. The important lesson here is to stay on Propecia unless you want to undo the hair maintaining or regrowth benefits you received.

Lots of Propecia questions this week…

I am 21 and notice that my hairline is going. Should I start taking Propecia?

There are many important elements to your question and like all good questions, the answer may be more complex than you were expecting. There are many reasons for the hair line to move, the most common reason is the transition from having a youthful hairline to acquiring a mature hairline. This frontal change in the hairline occurs in 95% of young men and it is not reflective of the balding process. I can not tell you if Propecia will stop or slow this process down, but I suspect that it might considering that this is probably a DHT induced manifestation.

With regard to early genetic balding, I would get a good doctor to examine your hair looking for miniaturization of the hair shafts. The finding of miniaturization is an absolute sign of genetic hair loss, If you have it, Propecia is recommended to be started at the earliest appearance of genetic hair loss in the post pubescent male. Since genetic hair loss is a progressive process, the earlier you get a good diagnosis, and begin Propecia, the better your chance is to keep your hair for a longer period of time.

thanks so much for your reply i really appreciate it. i dont mind taking all the medication for the hair loss but i would rather prefer to get the hair transplant because it will last forever and then i dont need to worry about taking a tablet or putting minoxidil on twice a day. i would rather just get it over and done with so i dont have to worry about it anymore and it will also be good for my self esteem and confidence. what do you recommend?

Here, my age and experience come into place for value. If you are not going to get really bald because your final hair loss pattern is a simple Class 3, 3A or 4A, then you can take the view you discussed. If however, you eventually bald to a Class 6 or 7 pattern (advanced balding), then you will run out of donor hair before the process is complete, unless you are unusually blessed with very high densities. None of us have a crystal ball into our future. The question you should have is, “How bald will I become?” Hair loss is progressive, so chasing hair loss can be a losing proposition for some men. For that reason, I strongly suggest the use of Propecia because there is almost no down side to it, and it will slow down or stop the hair loss for some reasonable time so that you can enjoy your hair. Getting hooked on having expensive hair transplants surgeries on a yearly basis to keep up with progressive hair loss, until you run out of money or donor hair is not what you need.

Propecia is a simple, safe way to make sense of this entire genetic hair loss process.

I have a question for you … on merck site it says hair mass can thicken up to two yrs… but I was told it can thicken up to three yrs… is that true??? and when is the best time to take propecia am or pm???please let me know your answer… thanks

Propecia is best taken in the morning. The thickening of the hair shaft will, almost certainly, vary with the patient. In some patients the best fullness may be obtained in one year, in others it could take two years, and in some possibly three or more years.