Hello Doctor,

I’d like to first thank you for such an informative blog, it has answered many of my questions. I am a 24 year old male and first started noticing hair loss exactly a year ago after moving from California to Maryland (Not sure if the climate change has anything to do with it). I have always had a lot (almost too much) hair, and other than my dad, all the men in my family have a lot of hair including both grandfathers that are well into their eighties. So I never considered hair loss as a possiblity and have been in denial for the past year. I finally felt like too much hair was falling out in the shower, and wanted to make sure if it was normal or due to mpb.

I visited a doctor, who to my disappointment merely glanced at my hair, and said that it is mpb (Which I found hard to believe as I didn’t think my hair loss was something noticable to the naked eye). He prescribed propecia, and told me to use it with rogaine or alone. Either way, I figured he was my Doctor, a dermotologist, and probably new better than me. It has now been 6 weeks that I am on propecia, and have been experiencing anxiety, aggitation, increased libido, and a great deal of shedding all over my head. The shedding is bothering me a great deal as I feel I am losing more hair than I ever was before, and as a result my hair density is becoming greatly reduced with my scalp slowly becoming visible. More importantly, now that I have been reading through your blogs about all the preliminary tests, mapping, and precautions you take before prescribing propecia to your patients, i’m wondering if I ever should have been put on propecia, or if I was just going through natural hair cycles.

I now have no idea what to do, i’m worried about continued use of the propecia if I don’t really need it and due to the side effects i’m feeling. And i’m scared to discontinue, not knowing if the hair i’ve shed will come back or not, and I really don’t want to cause anymore hair loss by stopping it’s use. At this point I would really appreciate any advice you might have for me as to what to do with the propecia. Also, if you recommend any doctors in the maryland area that I could see i’d appreciate it. Thank you very much for your time.

Kindest regards.

You really need to discuss these issues with your doctor, as there may be other medical problems unrelated to Propecia (finasteride 1mg) or balding. Generally speaking, increased libido is a very real side effect of Propecia (some people think that there is about 10% of men taking Propecia who report this, but I don’t have great statistics available). In contrast, 1% of men may experience a decrease in libido. I can’t tell you whether you should be stopping any medication that I didn’t prescribe to you.

It is true that you should start off taking any medication with a full understanding of what you are treating and what your realistic goals are. A miniaturization study is what I recommend at NHI before I’ll start a patient on Propecia. I do realize most doctors do not perform miniaturization studies, but I would advocate it. At the least you should have good photographs of your head with a short hair cut or wet hair so that the degree of hair loss is more visible.

Some reports available today indicate that even a quarter of a pill of Propecia (0.25 mg rather than 1mg) may have value for hair loss without libido problems. This approach works for those few patients who have experienced a negative impact on their libido. I generally feel that some finasteride is better than none, but that is my opinion and is nessarily not backed by others in the field.

I don’t recommend doctors as a rule, but you can use the physician search at ISHRS to find a doctor in your area and this list is narrowed to the doctors who do this ‘almost’ full time.