Balding Blog

Hello Dr. Rassman. First, a huge thank you for this great site. It is an island of real medical information amidst the sea of misinformation of hais loss.

I have a question I believe has not been asked before. Can the switch from finasteride to dutasteride cause catch up loss?

After 4 years on 1.25mg of finasteride, 3 months ago I added 2.5g of avodart daily for two months, lowering the dosage to 0,5g daily after that. I mantained finasteride for the first month of avodart and stopped taking it since about two months ago.

As of now I am experiencing massive shedding all over the scalp (including the sides and donor area), with the characteristic white bulb of a telogen effluvium. Could this shedding be catch up loss from not taking finasteride, causing permanent damage, or does avodart “picks up” that protection and is just normal shedding from switching medication? Is it reasonable to expect my hair to grow back? I discussed this with my doctor, but he simply does not have your knowledge. I returned with my daily 1,25 of finasteride a few days ago, just in case, and will maintain a low dose of avodart for extra dht suppression.

Thanks for your time!

Changing many factors makes an analysis extremely difficult. I haven’t heard of a switch between medications causing catch-up loss, but I’m not sure why you were taking both medications and changing doses so much. Did your doctor prescribe this method?

Since you’re going back to your finasteride routine that worked for you before, I’d give it some time to see what happens. I’m not sure why you experienced a massive shed, and it’s particularly troubling that it occurred in the back and sides of your scalp. If your doctor isn’t knowledgeable about treating hair loss, you should try to find one that does. You should have your scalp examined and baselines measured so that you can know for sure what any treatment is doing (good or bad).

I said this many times, and it may not be something you want to hear, but in the end your genetic predisposition will win out. It is really not about total DHT suppression.

Hello Doctor,

I’ve written to you in the past about my initial experiences with propecia. When I started, I was worried I had side effects… but I couldn’t figure out if they were real, or in my head. I soon decided that I was going to stop worrying about it, and just continue on with the medication.

Soon after, the side-effects stopped! I’ve concluded that in my case, the side-effects were most definitely in my head. I’m also happy to announce that propecia has helped me go from a NW 3/4 to a NW 2/3!

I could not be more impressed!! I hope this encourages other men who are worried about side effects to stick it out a little while longer, and to not worry about it so much!

Thank for writing and sharing this with us. I would expect that your case would be more common if some men didn’t let the side effect potential get in their heads, but in any case, I’m glad it worked out for you.

I used Minoxidil 2% for about two years, then -through bad advice — stopped using it for about 4 months now. I just started realising the reoccurance of my hair loss. I will re-start immediately but am wondering if it is too late and whether I will lose all the hair that had regrown during the past two years?
Thank you very much.

Hair that is being lost or miniaturized, or new hair that grows from the drug does get minoxidil dependent so when the drug is stopped, the dependent hair often falls out. Minoxidil is thought to increase the length of the hair growth cycle, but can bring on new hair where there was none. If the hair fell out upon stopping the minoxidil, then a new cycle must kick in and that might take months. I would hope that some of the hair will return to the level before you stopped taking minoxidil, but I can not give you the assurance you are looking for.

Hello Dr. Rassman!

First of all, thank you for this spectacular blog, it’s amazing.

I’m a 21 year old who has been on propecia for about a year. I’m unlucky in the sense that I started thinning all over except for the sides and back since I was 17. I however decided 2 weeks ago I didn’t want to take propecia anymore because damn it, I don’t care what society thinks. I’ll be bald, proud, and won’t let something like hair stand in my way. I’m a man. I’m not supposed to be pretty, but manly.

My question is, how much catch up hair loss is there likely to be? I don’t feel like propecia did much for me. It seems like my hair’s a bit thicker… but not really, so… Is there any possibility I’m one of those people propecia did nothing more than a placebo to?

Thank you for your time and all the best!

It’s possible that Propecia kept your hair loss from being worse than it is, but it’s also possible that you are a non-responder to the medication. I really have no way to know, as I don’t have any hair bulk analysis to compare before starting the medication and today. You can look into having a HairDX test done to predict your response to finasteride.

If you do see catch-up hair loss after stopping Propecia, I suppose that means the medication was working for you. Your hair loss will eventually catch up to the point you’d be at had you never started the medication. So if the Propecia worked to some degree, any benefits will eventually be gone.

Hello Dr Bill,

I am 20 years old and I have been balding since 15 years old. Last year I started to use propecia. For a while, I saw its benefit. My hair loss stopped and some of them regrew. After one year, I quit using that because I had muscular side effect. I mean I had muscle loss, I think. Thus, my hair loss started again. I have visible frontal and vertex hair loss now. My doctor said there is no serious adverse effect of this drug. Well, I started using it again 3 months ago. I havent seen any benefit last 3 months. Hair loss is still continuing and I have no visible hair growth also. Is that normal? Is that a cycle?

Thank you very much
Have a nice day

I do not believe Propecia will cause you muscle loss or be adverse to any gains you might see when working out. Maybe you need to hit the gym more. In fact, there was a theory that Propecia actually gave you muscle mass due to the slight increase in testosterone.

With respect to your hair loss, I would follow up with your prescribing doctor. Stopping Propecia after some time will give you “catch up” hair loss and re-starting the medication will not give you back the hair you lost. Either way, you likely won’t see much benefits-wise after just 3 months.

hi. i took propecia for about 1-2 months. I suffered from a loss of libido and stopped taking it during the end of May. Its now mid August and my libido has not returned. Do I need to wait longer?

Propecia (finasteride 1mg) has a very short half life (about 4 hours), which means it would be almost completely out of your blood stream in one day. There are reported tissue binding that occurs, but that should be gone in a week or so.

Sexual side effects (decreased sex drive) associated with Propecia are relatively exaggerated and it occurs only in about 1% of men. If you continue to experience negative sexual effects after of month of discontinuing Propecia you should consider other underlying medical problems. Keep in mind that erectile dysfunction is a largely underappreciated and unreported medical condition.

Erectile dysfunction statistics:

• One in 10 men in the world have erectile dysfunction (10%) and it rises with age (30% of men in their 30s, 40% of men in their 40s and 50+% of men over 50).
• 30 million men in the United States have erectile dysfunction.
• 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
• Smokers have a higher likelihood of erectile dysfunction as well as men with high blood pressure (with or without treatment), diabetes, etc… Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age.

Stats source: MMHC – Facts About Erectile Dysfunction

Hi I have been on Propecia for over 5 years with little side effects except a little decreased semen. I missed dosing for over a week because I lost some of the meds. I started shedding alot but restarted my regime. Now I have premature ejaculation and a depressed mood. Is this temporary could stopping for 10 days and restarting have negative effects? Is it normal to shedding that fast from stopping the meds for 10 days? I was getting hand fulls

Your experience of these new side effects and hair loss is very strange only after 10 days of missing the Propecia dose. This drug, although out of the blood stream in 24 hours, remains ‘fixed’ to the tissues inside the cells for as long as a week. I have no answer to your question based upon how I know this drug works.

I would recommend that you follow up with your doctor.