Balding Blog

The concept of a nocebo (a psychogenic effect of a drug) has been discussed in the various studies which focus on the sexual side effects of the drug Propecia (finasteride). The significant ‘hype’ on the internet, has driven many people to the conclusions that if they take this drug, they will become impotent. As doctors, we must discuss potential and known side effects of any drug we prescribe, but what happens following the disclosures, the patients read the internet and find many, many panicky young men who report sexual impotence from taking the drug. Is it real? We don’t know but what we do know is that many studies from other countries have not shown the high sexual side effects reported in the United States. So is this a Nocebo effect resulting from panicky people who read bulletin boards and web sites which focus on this issue.

Dr. Robert Haber, a very respected hair transplant surgeon from Ohio, started to test the concept of a nocebo effect and the general side effects on sex drive and sexual performance using patients who came into his office. This is an early report of his initial findings.

So if tissue levels remain for 6 days, would topical application every 4/5 days be theoretically still somewhat effective?

Some amount of finasteride stays in the tissues for more than two weeks after stopping the pill. Daily dosing is the ideal way to build appropriate tissue levels.

I’ve seen a lot of your messages on reddit being very helpful for people combating baldness. If you have a moment I hope you could help me with a small question. In my mid 20’s I noticed my hairline begin to recede and went on Finastride. It seemed to work great. My hair recession slowed down significantly. However, when I turned 34. I began to notice my hair line was receding again. I’m aware that drugs like Finasride, more or less, just slow the process down. But I was alarmed at how quickly my hair seemed to be receding all of a sudden. It was like the drug simply stopped working. I panicked and with some research I found that Dutasteride was an alternative that’s been shown to be slightly more affective. So I switched, from 5MG of Fin(quartered) to 0.5 of Dutasteride. That was approximately 10 months ago and my hair continues to recede and thin, at what feels like an alarming pace.

So here is my question. Have I made a huge mistake in switching? Will I lose all the hair that I kept on Finastride even though I’ve switched to Dutasteride? I thought that if Dutasteride worked it would keep the hair that Fin was holding back. Or perhaps there was no slowing these effects any longer, whether it was Dut or Fin? I don’t know what to do.

Dutasteride and finasteride can be interchanged without negative effects. What you are describing is the inevitable changes in progressive hair loss and I doubt with the history you gave, that any medication will help you at this stage. If your hairline bothers you, a hair transplants is the only option.

I’ve been on finasteride for 3.5 years. Without it l would be fully bald by now (25) and it’s allowed me to keep a good amount of hair. Generally doesn’t look like l am suffering from hair loss. A bit thinner on the top but decent overall thickness.

I’ve had enough of taking the drug. I have come off it several times during those 3.5 years and l feel remarkably better off it. I feel more significantly more virile and energetic. When l take Fin my libido drops, brain is foggier and l just don’t feel as good. My face is rounder and less defined as well.

Are there alternatives to Fin that work?

If the hair received immediate benefits, it still takes time to grow out at 1/2 inch per month. It just takes time to see the impact on the growth of the hair follicle. We see that its greatest benefit appears in a year, with more in the second year on Finasteride. That is an observation that doctors have made over many years of experience.

Anyone know why Finasteride would take months to halt hairloss if it lowers DHT at its maximum in a week? from tressless

You performed hair surgery on me in 2009. I thought you might be interested in something I’ve discovered.

Since 2009, I have been taking Finasteride. It was very effective in stopping hair loss, and even regrowing some of the more recent hair losses. The problem was that after several years of taking the drug, my system seemed to become less responsive to it, and regrown hair started falling out again. I increased the dosage from ¼ pill to ½ pill. That was effective at stopping additional losses and some regrowth. Then, gradually, the new, higher dosage became less effective, as well. I then increased the dosage to a full pill per day. The same phenomenon of hair regrowth happened again. You advised me (see below) to not exceed the 1 pill per day dosage. The situation seemed stable, although not as much hair regrowth as when the drug was still relatively new to my system.

Then I came across an over-the-counter supplement that I tried. It is called Restore FX by North Star Nutritionals. Here are the contents:

Serving Size: 3 Softgels
Amount Per Serving:

Biotin 600 mcg
Zinc (as Zinc Picolinate) 15 mg
Copper (as Copper Sulfate) 3 mg
DL-Methionine 500 mg
Saw Palmetto (Serenoa repens) Extract 400 mg
Methylsulfonylmethane 200 mg
L-Cysteine 200 mg
Grape Seed (Vitis vinifera) Extract 200 mg
Yielding Proanthocyanidins 190 mg
Horsetail (Equisetum arvense) aerial parts 100 mg
Pygeum (Pygeum africanum) bark extract 75 mg
Yielding Plant Sterols 1.87 mg
Beta Sitosterol (from plant sterol blend) 100 mg
Gamma Linolenic Acid (GLA) (from Borage Seed Oil) 50 mg
Stinging Nettle (Urtica Dioica) Root Extract 50 mg
DIM (Diindolylmethane) 50 mg
Green Tea (Camellia sinensis) Leaf Extract 50 mg
Yielding EGCG 15 mg

Directions: As a dietary supplement, take 3 softgels (1 serving) daily with food.

I started taking this supplement in addition to the Finasteride in February, 2016. Over the next several months, I noticed the hair started regrowing thicker than it had ever done previously, even when the Finasteride was new to my system. Then, in July 2016, I decided to discontinue the Finasteride to see what would happen. Since discontinuing the Finasteride, my hair growth has stabilized, and no significant hair re-loss has occurred. That has now been nearly 5 months of stable hair growth without Finasteride (Restore FX only).

I have also noticed that since discontinuing Finasteride while still taking Restore FX, the adverse effect on sexual performance (e.g. decreased semen flow) has diminished.

Just thought you might be interested in my experience.

I read a lot in forums that if loses its effectiveness after 10 years. I’ve been on the drug since I was 19 at the first signs of miniaturizing. I may have confused the miniaturizing with a mature hairline. I’ve now been on the drug for 6 years and I’ve kept exactly everything I ever had, I had a Norwood 1 with small amount of thinning.

Maybe you were never balding and misjudged your situation. If I were to have seen you years ago, I would have done a HAIRCHECK test and if I didn’t detect hair loss with this accurate instrument, I would never have prescribed the drug to you.