Propecia Side Effects vs Avodart Side Effects

/by William Rassman, M.D./0 /

1.If I use PROPECIA and report side effects, will the side effects occur with another 5AR inhibitor e.g. DUTASTERIDE?
2.Finasteride inhibits the enzyme 5AR.So we will have more testosterone in our blood. Why can sexual side effects occur?

Thank you for your time.

  1. If you have any side effects associated with finasteride (Propecia), you will likely have side effects with dutasteride (Avodart). Dutasteride has the same mechanism of action as finasteride, but it blocks 5 alpha reductase type 1 and type 2 isoenzyme. Finasteride only blocks the type 1 isoenzyme. Please note that blocking type 1 and type 2 isoenzyme does not necessarily mean it will work better. More importantly, dutasteride is not recommended (nor approved by the FDA) for use in Male Pattern Baldness (MPB).
  2. Finasteride blocks 5 alpha reductase, which is an enzyme that converts Testosterone t0 Dihydrotestosterone (DHT). DHT is the hormone that has been linked with MPB. When taking finasteride there is a transient effect of more testosterone, but it is only temporary because your body has other ways of metabolizing the temporary increase in testosterone. Sometimes there may be sexual side effects (1 in 10 increase in sex drive or 1 in 100 decrease in sex drive), because testosterone is a hormone responsible for sexual drive (and many other normal body fuctions).

Medicines and Hair Loss

/by William Rassman, M.D./0 /,

Can my high blood pressure medicine (Triamt/HCTZ tab 37.5–25) cause my hair to have breakage?

Yes. Blood pressure medicines (and many other medicines) can cause hair loss. However, you should consider other sources of hair loss before focusing on a medication.

You should first be evaluated by your primary care doctor, because hair loss may be a symptom of an underlying medical problem.

A less than exclusive list of medications that cause hair loss are: allopurinol, arsenic, apirin, l-asparaginase, bismuth, bleomycin, boric acid, bromocriptine, carbamazepine, carbon monoxide, chlorambucil, chloramphenicol, cimetidine, colchicine, clofibrate, clomiphene citrate, coumarin anticoagulant, cyclophosphamide, cyproterone acetate, dactinomycin, danazol, diethyl carbamazepine, dipyridamole, doxorubicin, ethionamide, etoposide, etretinate, fenifibrate, gentamycin sulphate, guanethidine, heparin (telogen effluvium after 6-16 weeks ), hydroxychloroquine, ibuprofen, idoxuridine, indandione, indomethacin, interferon, iodine, isophosphamide, levamisole, levodopa, lithium, mepacrine, mercury, mesalazine, methisazone, methotrexate, methyl CCNU, methysurgide, metoprolol, mitomycin, mitrexantrone, morphine, nadolol, nafoxidine, nicotinic acid, nicotinyl alcohol, nitrofurantoin sodium, norethisterone, estrogens, oral contraceptives, para aminosalicylate, phenindione, phenprocoumon, potassium thiocyanate, procainamide, propanolol, selenium sulphide, sodium aurothiomalate, sodium valproate, spironolactone, sulphasalazine, tamoxifen, thalium acetate, thiamphenicol, terfenadine, trimethadione, troxidone, vasopressin, vincristine, vindesine, vitamin A, warfarin.

Sometimes I wonder if the hair loss side effect really occurs or if it is just verbiage that the drug companies put into their warnings to cover their legal ‘derriere’ in the event that it occurs. I so rarely see most of these drugs in action, so I am not really in a position to agree or disagree with what is published in the warnings posted on these medications.

Nioxin, Procerin, Bleaching, Laser

/by William Rassman, M.D./0 /

I am a 27-year-old black American male with European and Native American lineage. I have started noticing hair loss around 2 years ago. My hairline is receding in the corners of my scalp (starting the V) and I have noticed that the hair on top of my head is thinner (shorter) than the hair on the sides and back. Of course most other people don’t notice it but I think it is more so because either they don’t really pay attention or they want to say what they think I want to hear. I have started using Nioxin Shampoo and conditioner within the last month along with minoxidil on the top part of my head. I was wondering is this is a good solution or am I basically wasting my time. I use to take Procerin but I’m not sure that it ever worked. I still have a good amount of hair on the top of my head but I would really like to fill in the corner and make the top thicker. Also I want to bleach (maybe even dye) my hair and I was wondering would that accelerate my hair loss? Also, does laser therapy work? I just found this website today and I was really impressed with how genuine your responses seem. Thanks for your help.

As I’ve said previously, Nioxin makes a good set of products that are popular, but there appears to be nothing in it that will stop hair loss. I’ve also commented on Procerin and laser therapy previously. Good starting points for blog posts about lasers can be found here and here.

Dying your hair, when done in the hands of someone competent, should not have a negative impact on your hair. As long as there is not any chemical trauma, your hair should be fine.

Inflammatory Scalp Disease

/by William Rassman, M.D./3 /,

what is inflammatory disease on scalp ?? Is it different from male pattern baldness? I get lots of itching on my scalp…and directly entering norwood class 6… but my doc saw my hair under some glass which looks like a huge magnifying glass and said its male pattern baldness…

Inflammatory scalp disease is when there’s an inflammatory process occuring in your scalp causing hair loss. There will be macrocyte and other white blood cells releasing histamine and other chemicals to cause the inflammatory process. The diseases which can cause skin inflammation are psoriasis, alopecia areata, eczema, a variety of autoimmune problems, or infections. This is different for male pattern baldness (MPB), because MPB is caused by DHT attacking the follicles through growth interference and not by an inflammatory process. Some forms of inflammation do not cause hair loss, so you will need a doctor to help confirm your diagnosis, which sounds like what your doctor was trying to do for you.

How Can I Be Assured That Treatment Will Work For Me?

/by William Rassman, M.D./0 /,

I am 23 years of age and have a bald area in the front portion of my head. Many doctors who i have consulted told me that i have class 4 hair loss and can’t be treated by drugs. This may be true somehow because my hair started falling out from the age of 17 and i didn’t take a treatment then. Can you assure me that if i get treatment now, my problem will get resolved?

“In this world nothing can be said to be certain, except death and taxes.” – Benjamin Franklin

I can stop here with the answer, but if you’re not satisfied please read on:

I can not assure you that a medication will work for your hair loss. In fact, no one can assure you that any drug treatment will work. You stated that you were seen by “many doctors”, which I assume included an examination, and were still told that your hair loss couldn’t be treated with medication, yet you wrote to ask for my opinion. I suspect what the doctors were saying in ‘doctor speak’ is that Propecia usually does not regrow frontal hair so a Class 4A balding pattern (where all of the hair in the front is gone), I suspect the hair will not regrow. In a 23 year old (without seeing pictures of your balding) I would assume that there is still some hair in the frontal distribution and that what hair is there is miniaturized. Miniaturized hair will often respond to Propecia to some degree in a young man, even if it is in the frontal area. Unless you try, you will not know.

I suppose I should be flattered to be thought of as a hair loss authority to give you assurance on a medication. If your scalp has been examined for miniaturization and you have a diagnosis of Male Pattern Baldness (MPB), medication such as finasteride (Propecia) may work, but there are no guarantees.

If you need another medical opinion, feel free to make an appointment with me.

Suicidal Thoughts After Hair Transplant

/by William Rassman, M.D./0 /

I am devastingly depressed from my strip procedure…I made a very very bad mistake by doing a “fill in” procedure when I was 27 (something I regret more than anything) not realizing I would eventually get 2 other procedures of over 1000 grafts later and have a scar that I can not cut my hair short or shave my head…

I am having suicidal thoughts and wish I never did this at all..Id give anything to have no scars and just shave my head like I should have done. I was too young, uneducated and stupid at the time I made the decision for the first procedure. Now my friends with less hair than I have, Im jealous of.

Is there anyway to cover up this strip scar with FUE? DOes the donor area have to be shaved to do this? Will it cover it enough to cut my hair short again? Should I wait for potential hair multiplication someday?

Your opinion and expertise is appreciated. Im overwhelmed here..please help

Thoughts of suicide are a major red flag for me. When depression leads to such thoughts, then medical intervention is needed. You need to connect to your family doctor and discuss these thoughts, so that he/she can help you deal with a far more important issue than what is going on on the top of your head.

I do empathize with the trauma that you describe. From a medical and surgical viewpoint, these problems are not difficult to deal with, but they should take a back seat to your mental health. Just to list a series of options that may apply to your scar, they include: fascial techniques to reduce scars, transplants with FUE to fill in scars, and a Trichophytic closure technique that allows hair to grow through the scar, and camouflaging the scars to reduce their detectability. This is not meant to be a comprehensive listing, but just enough to tell you that once you get your mind clear and focused and can manage your suicidal thoughts, there are many options that can be considered for you.

With regard to things like hair multipication and cloning, I am disheartened when I read the rumors on the web telling that these technologies are around the corner. They are still quite a ways away from becoming a reality. See the Hair Cloning category for more.

Tribestan and Propecia

/by William Rassman, M.D./1 /,

Dear Doctor,
Recently I have been prescribed with Tribestan to boost my testerone level. But i have been taking Propecia for a year now and the effect from propecia is good and i am a more confident man now of course with more hair too.

My question is can Tribestan be taken together with Propecia? will it cause more hairloss? or any side effects?

Thank in advance. Desperately needing a answer… Best Regards

Tribestan is not a medication. It is a natural supplement that is available over the counter without a prescription. Since Tribestan is not a FDA approved product, there is no medical evidence for its efficacy or its precise mechanism of action. There are endless internet sites that promote Tribestan (as I have found), but there are no formal FDA approved or medical data on Tribestan, nor are there any studies that show safety and / or effectiveness. For those reasons there is no way for me to tell if there would be adverse effects when taken with Propecia. There is no medical evidence.

I do not know your medical history to know how or why your “testosterone level” is low. Perhaps you should be seen by your primary care doctor for a complete physical.

My Hair Keeps Breaking

/by William Rassman, M.D./1 /,

My hair keep breaking off in the same place (back and top of head); what can i do to stop the breaking?

It is normal to lose 100-150 hairs a day. However, if you are experiencing abnormal hair loss, you should consider being evaluated by a hair transplant doctor or dermatologist. If what you are talking about is that the hair only grows to a particular length and then breaks off, then you might work with your hair stylist and try to address the cause. Dryness could be the cause, so you might have to use a wetting agent, or if it breaks because you are rough in brushing it, use a thicker wide-tooth comb and be more gentle. Try various shampoos and conditioners, as there are many out there that may help.

Propecia in 20 Year Old Male

/by William Rassman, M.D./1 /,

I am a 20 yr old male who noticed a large amount of hair coming out while in the shower and during the day; I have also noticed visible miniaturization in the strands that fall out. I am about NW2 now, and I notice slightly less density on the very front of my hair line. At my age, are there side effects to taking Propecia? Are there any other courses of action?

Also, I am in Europe; do you know of my options here? (Is Propecia available/branded under a different name/does it require a proscription?)
Thanks!

The drug Propecia can be taken at any age. There are possible side effects, but they are rare and vary per person. Please review the many, many posts on this blog that discuss Propecia and side effects.

Some countries have not yet allowed the drug in, while others allow it to be sold under a doctor’s guidance and control. I am sure that if you ask your doctor for finasteride, you will find it in the 5mg dose and then would have to cut it into 1/4 dosages to treat hair loss.

Massive Hair Loss After Stopping Propecia

/by William Rassman, M.D./0 /

I wrote to you a few months ago and unfortunately my situation has worsened.
I have suffered a massive TE since discontinuing Propecia six months ago after six months of use.
I suffered intolerable sexual side-effects while using the drug.

Recently, the shedding has slowed a great deal but I have lost at least 50% of the density via diffuse thinning. And most troubling, ALL of my hair has become fine and wispy even the back and sides. It appears that all the follicles have miniaturized as a result of a hormonal backlash after abruptly stopping Propecia.

I am terrified that I am going to lose all of my hair. I am 46 and a diffusely thinned NW 2.

I really don’t know what to do.

Any suggestions would be most appreciated.

My quality of life is deteriorating, and my anxiety and stress are off the charts.

I often see men like yourself very upset when they come to my office after stopping Propecia. I always tell my patients that if they stop taking Propecia, they need to plan for ‘catch-up hair loss’, meaning that the time of taking the drug is wiped clean and the hair loss accelerates to where it would have been without the drug. There are other ways to deal with the negative sexual side effect than just stop taking Propecia (taking 1/2 pill per day works for many people). But the die is cast and you have lost your hair. You can try to take it at 1/2 pill per day and see if the side effect is still there.

One part of your information that troubles me is that you categorize yourself as a Norwood Class 2. There is an inconsistancy here between your statement “massive TE” which certainly does not make sense in a Norwood Class 2 patient. See a hair doctor in your area (use the physician search at ISHRS.org) and have your hair mapped for miniaturization so that it can be determined your true classification of hair loss, and so that hopefully a Master Plan can be made to help you along the way.

Transplanting Animal Fur to Human Heads?

/by William Rassman, M.D./0 /

Bear

You mentioned joking about transplanting animal fur to human heads.

Why isn’t this possible? Only because of an immune response to the hairs as a foreign body?

What animal did you have in mind? As if fur coats aren’t bad enough, what would PETA say?

You answered your own question — the body’s response to the hairs would prevent transplanting animals to humans (or humans to other humans, unless they are identical twins).

Blood Levels and DHT

/by William Rassman, M.D./0 /

hey doc, i recently had blood work done to check levels of dht. in a range of i think 25 to 75, mine was a 31. does this still mean im losing my hair or not? and at what levels of dht in the blood create hair loss?

Blood tests are not done to check hair loss. There is a much simpler way: a mirror! Seriously though, if you want to know if you are really losing hair you should have your scalp mapped for miniaturization to see if there is a pattern to your hair loss.

While drugs such as finasteride (Propecia) works by blocking DHT, there is no correlation with the DHT level and hair loss. Someone with a very high DHT level and without the balding gene, will probably never lose hair.

Trying 15% Minoxidil

/by William Rassman, M.D./3 /,

I am a 46 year old balding man presently at class 5. I have tried minoxidil up to the 12.5% concentration (Xandrox) but has not worked for me. I also have had one transplant session of about 400 grafts (not NHI) but most of the grafts are gone and obviously am not happy with the result. I just wanted to know if you would recommend my continuing the 12.5% minoxidil or even try the 15% treatment just to slow down the balding process and keep me from going to class 6 or class 7.

Your question is troubling me. Transplanted hairs are permanant and very successful so if yours failed, something is wrong. It is also troubling that you only had 400 hair grafts when you state you are a Norwood Class 5. That would hardly have an impact on your appearance. If your hair transplant was a failure, it is my opinion that you should follow-up with your original hair transplant doctor to discuss the failure with him/her. There are instances where patients believe their hair transplant was a failure because they also had ongoing hair loss. Could that be your situation?

Furthermore, if minoxidil 5% or 12.5% didn’t work for you, what makes you think 15% will work? Minoxidil, like all drugs, has its limitations and higher concentrations may have adverse side effects. Depending on your medical history and a good diagnosis of hair loss, I would also consider finasteride (Propecia) as another option.

Any Essential Supplements For Hair Growth?

/by William Rassman, M.D./0 /

i was just curious if there there are any foods, vitamins, supplements, minerals that actually dont grow or restore hair (because that cant happen) but are essential in the growth and building of hair that maybe i could buy from a health foods store or take? thank you once again.

If you are healthy and have a normal diet, your dietary intake of vitamins and minerals is more than enough. A doctor will regularly recommend supplements for pregnant women or the elderly. There are no particular vitamins that I expect will grow hair if these vitamins are not deficient in your diet.

Finasteride for Female Hair Loss?

/by William Rassman, M.D./0 /,

Ok doc, I just saw on the news (and the found it on the web) where it says Propecia is basically ok for women. Please comment on this new study.

Female hair loss treatment hope
Oral Drug for His Hair Loss May Also Help Her

My concerns for this treatment are the following:

  1. The study is very limited to only 37 women.
  2. The “new pill” is finasteride 2.5 mg (which is 2.5 times the strength of Propecia for men) with an added birth control pill to prevent pregnancy because of the high risk of producing abnormal babies, a known side effect of finasteride in pregnant women.
  3. Finasteride for women is not approved by the FDA for female hair loss. We know that in 1 out of 200 or so men who take the 1mg dose of finasteride, that there is some breast nodules (gynecomastia) as a side effect and this makes me wonder what the effect might be on women who carry genes for breast, ovarian or uterine cancer or who may have an early version of these cancers already growing in their body. If they take finasteride as used in this study, what will happen here? Safety is critical to FDA approval for a particular use, so I would worry that without adequate statistics, we will not know about this risk.
  4. The study was not a double blind randomized control study. Which in short means there can be a bias in the study.
  5. These stories are sensationalistic at its best, causing great interest for desperate women and providing misinformation to the non-medical population. Another example of media hype was this story from a few years ago: Lemon juice ‘is HIV-killing spermicide’.
  6. These articles will, without a doubt, drive doctors and women to gather and exploit finasteride for the treatment of hair loss. We will know, the wrong way, about cancer and other such risks in these women when it appears in the courts.