Hi Dr. Rassman,

I just wanted to congratulate you on your site. As always, it serves as a source of reliable information with little bias.

That being said, I have a question regarding a post that appeared on your site today (Oct. 1, 2008). You say “I can say with certainty that the notion of 30-40% of patients taking this drug (Finasteride) experiencing side effects is laughable. It simply is not true.”

However, you don’t comment on what you believe the actual percentage of Finasteride users have side effects? In your clinical experience (and those of your colleagues) , is it actually 2-3%? I realize that there are lots of forums that attack Propecia, and as you have pointed out, those with a complaint often shout the loudest. However, it’s stats like these (regardless if they are unsubstantiated) that make many men who are thinking about Propecia apprehensive about initiating therapy.

I’d be interested in hearing your comments on this. There are far too many sites/forums that portray Finasteride in a less than favorable light. I’m not implying that these side effects are made up, and that they don’t exist – I think you have been quite honest with readers that they do. But I think this issue needs to be settled. Are there any studies being conducted (aside from Merck) that are looking at the percentage of users that experience side effects? I currently have a decent amount of hair, and if I were to start therapy today, and just hold on to the hair I have for a few years, I would be more than happy. I know I am candidate for Propecia (through examination by a physician). However, I have been sitting with a full box of Propecia for a couple months now because I have been too worried to start treatment. My worries about potential side effects are only exacerbated by comments like these.

Please respond when you can.

Thanks!

While I am flattered, I do not believe it is up to me to settle anything. I simply give factual medical opinions to my patients and I also write such opinions on this site. The fact is that the negative sexual side effect of Propecia is about 1 to 2%. Based on my clinical experience with many patients who have been taking Propecia for many years, that statistic seems accurate. In fact, of those with side effects at all, more patients I see report higher sex drive than lower sex drive. Most have no side effects to report.

You are a man who is obviously concerned about side effects. Look at this this way — if YOU have a negative side effect, statistics should not matter to you. If you have a side effect, your statistic is 100% (all or none). That being said, the side effect is reversible and you have the option not to take it. What are you worried about?

I’m a 34 year old male with a norwood class 2 hairline. Most of the recession I’ve had was between the ages of 17-25 years old. The hairline has remained pretty much the same from 25 till now. I’ve always noticed some very minor thinning around the hairline probably not going back for more than 1-2cm (approx 1/4 inch)and it really hasn’t got too much thinner in recent years. A handful of intermediate/smaller hairs around the frontal edges and where the juvenile hairline used to be have gotten shorter over several years. I’ll probably get the scalp mapped for miniaturization to get a diagnosis of MPB or paranoia.

Assuming a diagnosis of male patterned baldness, I’m just wondering how effective Propecia is for men in their 30’s and 40’s for maintaining hair (not necessarily regrowing/thickening)? From your clinical experience what is the average time (years) before Propecia starts to lose its effectiveness (hair count starts to decline below baseline) for a man in this age group? Also since my thinning is extremely slow…would that also allow it to be effective for a longer period of time?

Thanks

For some men, I have seen regrowth that has lasted 10+ years with no loss of hair. On others, the drug has not worked as well. I have seen men with bald crowns regrow hair and men with slow loss and thinning crown areas with no benefit from Propecia. The best indicator usually is crown loss in young men, where the loss is mild and the scalp has many miniaturized hairs present.

Merck’s data shows that 90% of men studied in your age bracket still had benefits after year 5. You can find that here.

Hello Dr. Rassman,
I’ve read from old topics that many of your patients would travel to Mexico to purchase Finasteride before it was approved in the states. Do you still have patients that do this? There is obvious financial benefits from purchasing the medication outside of the U.S., but what about the products validity? When it comes to hair loss, you surely would like the product to be authentic. What is your thoughts on this? Thanks for your time.

I would think that when it comes to any medication you would want it to be authentic. There are many credible drug manufacturers outside the US, and you need to be sure that the drugs you are buying is from one of them. Here’s the top 50, ranked by revenue — List of pharmaceutical companies. If you buy Propecia in Mexico and it says Propecia on the bottle and looks like Merck’s product, it is probably the real drug. Granted, the packaging can be faked so we must all still be aware of drug counterfeiting. That is a real worldwide problem, so you should use your best judgment.

There is one way to get finasteride in the US from your local pharmacy much cheaper than Propecia, and that is by cutting the generic 5mg finasteride into 4 or 5 pieces. You need to have a physician willing to prescribe you a prostate drug (Proscar) to get that prescription, though. The 1mg generic (like the Finpecia pictured above) is still unavailable in the US due to patent laws.