After Taking Propecia for 6 Years, I Began Noticing Side Effects

/by William Rassman, M.D./2 /

Doc, I am an active, healthy 37 year old. After taking Propecia for 6+ years with little side effects, I started to notice a decreased libido, difficulty maintaining an erection, no morning erections, a smaller penis in the flaccid state and a feeling of “disconnect” (mind from penis). I stopped taking it 6 weeks ago and have not noticed a change, other than my hair loss has increased again. I have read on other sites men complaining of similar symptoms and claiming they are permanent. I have considered getting a testosterone level, A DHT level, FSH/LH, E-2, and Prolactin levels. I haven’t mentioned any of my concerns to my (female) physician. Any suggestions (other than discussing them with her? -which I will).

FreudDecreased libido and difficultly maintaining an erection are reported side effects that occur in 1 to 2% of men taking Propecia, but the same symptoms are prevalent in more than 2% of the men who are NOT taking Propecia. You may have other unrelated health issues (undiagnosed diabetes, blood pressure problems, etc) that can also contribute to this. That is why you are doing the right thing by seeing your primary care physician. See Propecia Gave Me Side Effects — How Can I Get My Sex Drive Back? for more.

As far as the DHT and testosterone or FSH/LH tests, I really don’t have an opinion, as your endocrinologist will be better suited to advise you on whether you need those tests. With respect to a smaller penis size, I highly doubt a drug is shrinking your penis… just as there is no drug that grows your penis size. With respect to a disconnect with your penis, you may want to see a counselor. I highly doubt this problem is from Propecia. I wonder what Sigmund Freud would say…

Tags: penis, sex, hairloss, hair loss, propecia, finasteride, libido, erection

Finasteride Operates as a Neurosteroid Inhibitor

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

Dr Rassman, if you would do a little more digging, you’d realize that besides inhibiting 5AR2 reduction of Testosterone to DHT, Finasteride also operates as a NEUROSTEROID inhibitor of Allopregnanolone and THDOC synthesis, neurosterois which can then no longer act properly on GABA-A receptors in the brain.

See page 3 for diagram: PDF file at CNS Drug Reviews

Also, from Journal of Neuroscience
“This may have implications on the clinical use of neurosteroid synthesis inhibitors such as finasteride (Propecia), because certain neurological disorders related to steroid hormone changes may be worsened by finasteride treatment (Herzog and Frye, 2003).”

From Journal of Andrology
Notably, preliminary studies indicate that, as in the rodent, finasteride may increase depression in men as a result of the loss of allopregnanolone (eg, Altomare et al, 2002; Rahimi-Ardabili et al, 2006).

This raises the possibility that lowered levels of the neurosteroid contribute to the reduced sexual desire reported for some patients.”

Clearly the dermatology community loves to downplay the true sexual, physical and mental health risks of this drug — to admit the truth would be financial suicide. The fact is, neurosteroid inhibition via Finasteride can effect one’s mental health, if one is susceptible to such inhibition.

Perhaps you should try the medication yourself for 2 years Dr Rassman, and see how less mentally sharp you become… in addition to the possibility of altering the androgen/estrogen ratio in favor of estrogens, developing gynecomastia, penile fibrosis due to depleted DHT levels, loss of morning and spontaneus erections, and prostatic involution — just for starters.

If you were to experience these issues as many other men have thanks to this drug, I doubt you’d be so dismissive of the effects of androgen deprivation therapy via 5AR inhibition.

I’ve been on Propecia for well over 2 years and I still have the mental capacity to run multiple businesses, develop new tools and techniques, perform surgery, and even write a daily hair loss blog. Not only have I not seen any negative side effects from the medication, but the great majority of my patients that take the medication haven’t reported these side effects to me either. Before I started this site, it was very, very rare that I had read/heard any reports like that. The Internet provides a very big megaphone for those that have problems, real or perceived.

I have posted your opinions and your references. I appreciate the time you took in collecting the sources and quotes. Clearly the readers need to draw their own conclusions.

Tags: finasteride, propecia, nerosteroid, inhibitor, dht, hairloss, hair loss

Lupus Nephritis and Hair Loss

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

Hi Dr. William,

I have been on steroids (Wysolone) for 6 months as I was diagnosed for Lupus Nephritis. I have lost hair significantly. Now the steriods have stopped, i need to know will the hair come back or is there something that I can try to stimulate hair growth.

Thanks

Lupus is one of the medical cause of hair loss. Corticosteroid (Wynsolone) is another potential cause of hair loss or hair thinning (as well as other side effects). The only medical option you may have at this time is topical minoxidil (Rogaine). As your hair loss was not a cause of male pattern baldness (I am assuming you are not male), drugs such as Propecia will not help.

Unfortunately there really is no drug or other treatments to grow back hair completely. There are many products out there that claim to grow hair, but I would take caution as there are no such products.

Tags: lupus, hairloss, hair loss, wysolone, steroid, corticosteroid

Stopped Diane 35 (Cyproterone) After 10 Years — Now I’m Losing Hair!

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

Hi Dr
My hair started shedding very badly 4 weeks ago. I shed 200-300 visible strands after a shower, and 5-6 strands every time I run my fingers gently through my hair. My scalp has also become very oily and scalp pimples have formed.

The only change that has happened to my lifestyle in the last two months was the discontinuation of Diane 35 (after 10 years) just 2 weeks before I noticed the shedding. I have done all the necessary blood work two weeks ago. I am perfectly healthy, with the exception of a low LSH and low ferritin (at 27). I do not have a stressful lifestyle. Do you think the sudden massive shedding was triggered by the discontinuation of Diane 35? If yes, in your experience, how long will this last and will my hair grow back?

Big thanks in advance. Your advice will be very much appreciated.

Cheers!

I am not an expert on hormone manipulation, but by stopping the Diane 35 (cyproterone) you obviously have made a change and your scalp hair has been impacted in some way by the withdrawal of the birth control pills. The blood work needs to be presented to your gynecologist with the questions you asked. Hair transplant surgeons do not have the patient population with women taking hormonal therapy or birth control pills.

Tags: cyproterone, diane 35, diane35, hairloss, hair loss, female hair loss, bcp

Weightlifting, Testosterone, Psoriasis, and Hair Loss

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

Hi Dr. 2 questions

  1. I was curious if you believe there to be correlations between weightlifting and baldness for those genetically predisposed to it Clearly testosterone increases when weightlifting which I guess may increase DHT levels?
  2. I have either scalp psoriasis or seborrhea I’ve seen many dermatologists over the years and have heard different things from different docs. Anyways I read that biotin supplements may help manage the issue as a sufferer yourself what are your thoughts?

Hi reader. 2 answers:

  1. There is no connection. I’ve written about this many times before.
  2. These oral potions / supplements just do not work for treating those conditions unless they have a steroid in them, which would be making them dangerous.
Tags: testosterone, exercise, weightlifting, hairloss, hair loss, psoriasis, biotin, hairloss, hair loss

Clumpy Ejaculate from Propecia?

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

I have read a few posts about this issue and it concerns me as it should be listed as a side effect for the use of Propecia if it happening even in a small % of people.

I am 32 years old, I started taking Propecia about 7 weeks ago. For the past few weeks I have noticed mild pain when I ejaculate. Also, very noticeable is the consistancy of my ejaculate. Some of it appears normal but there are small jelly-like ‘clumps’ in my ejaculate. It seems to be getting worse and I am concerned it will affect my ability to reproduce which I plan on in the near future.

If you could offer any advice I would really appreciate it.

Urologists are capable of examining your ejaculate and your sperm for motility. Considering your observations, you may want to go that route if you continue to be concerned.

Tags: propecia, finasteride, ejaculation, sperm, hairloss, hair loss

Hair Pulled Out in Attack

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

I have a family member that was brutally attacked and handfuls of her beautiful blond hair was pulled from her head with the roots. Will her hair grow back or has she been permanently damaged.

I have seen cases like this before, and I can tell you that the hair will most likely return in up to 6 months, if not sooner.

Tags: hairloss, hair loss, attack, pulling, fight

My Doctor Wrote Me a Prescription for Propecia — Should I Take It?

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

Hello!

First i’d like to say thank you for begin such wonderful source information on hair loss.

I went to see a dermatologist to find out why i’m losing my hair. All the Dr. did was look at my hair very quickly ( i believe i’m a norwood 3 , and i’m ok with that) no miniaturization test was given and told me its hereditary . The Dr. said that I will most likely lose a good amount of hair , I’m 34 years old .

He told me about propecia and wrote me a prescription. In your opinion should the Dr. have done other tests? Would it be ok for me to start the propecia ? I’d really like to move on and be happy that i’ve done what i can to stop or slow my hair loss .

Thank you for your time.

According to you, your doctor did not use his skills in the diagnosis in your case. While it’s likely the hair loss is due to your genetics and your doctor was right (particularly if you had a pattern develop corresponding to the Norwood Classification for hair loss), I assume that you paid for the doctor’s visit and expected a little more from him. Assuming that his diagnosis is correct, Propecia would be the right choice, but you seem to feel strongly that the doctor should do more than wave his hand over your head like a wand and be able to tell you the hair loss was hereditary. You have a responsibility, of course, to ask questions of your doctor. Questions like, “How do you know it is genetic?” and “Is Propecia the right choice?” Since I’m not your prescribing doctor, I can’t really answer that.

I feel strongly that we need to have a firm diagnosis and that good measurements are important to establishing that and possibly in keeping tabs on the progress of the balding if there is no visual change with regard to growth and fullness in 8-12 months. A miniaturization study isn’t going to replace any treatment for your hair loss — it’s just to initially get a baseline measurement so that you can follow-up in 6 months to a year to see if the treatment is actually doing anything for you. Some doctors just don’t want to be bothered with giving you a microscopic view of your hair loss, and that is disappointing to me and should be disappointing to any patient that experiences that. I recently wrote about performing this exam on your own head (you’ll need a video microscope that costs under $100), and you can read about that in Mapping Your Own Scalp for Miniaturization.

Some emails lately have suggested that they don’t think a mapping of your scalp really matters, and that’s fine if that’s your view. I suppose you also don’t like a mechanic to check out the problem in your engine before deciding you need a new transmission or even your dermatologist to run a biopsy before telling you that the mole on your body has become cancerous. I like to give people value for their money, and especially considering that at the present time I’m still doing these exams at no charge, I’d say people are getting a pretty good value.

We have developed a take charge approach to empower men and women to map out their own scalps and determine if balding is really present. I will review all miniaturization studies that are posted to BaldingForum.com and if you also upload a photo of yourself (and it’s fine if your face is blurred or cropped out) I am even willing to speak with you over the phone at no charge to help you decide what you have and what you should be doing about it.

Tags: miniaturization, finasteride, propecia, hairloss, hair loss, doctor, physician

Any Patient Results from Avodart Treatment?

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

Dear Dr Rassman
You have said that you have given some of your patients Avodart. Can you tell me what results you saw and what was the strength that you used? Thanks

AvodartThe few times I’ve prescribed 0.5mg of Avodart (dutasteride) for off-label use in treating hair loss, it has been successful but I must tell you that I did not do this with a research minded scientific approach. I didn’t see any substantial regrowth, but essentially the drug ceased further loss in patients that saw their hair loss start again after a number of years on Propecia. Again, this is just for a limited few that I’ve prescribed the medication to. I haven’t had reports of any side effects, but those patients had no side effects from Propecia either. I’m still concerned about long term use and safety when taken for treating hair loss. Like everyone else, I’m awaiting the results of the clinical trials completed earlier this year in Korea.

Tags: dutasteride, avodart, hairloss, hair loss, propecia, finasteride

How Long Do I Keep Minoxidil Applied During the Day?

/by William Rassman, M.D./2 /,

Doctor I read one of your posts and have a related question. In the post you indicate at-least 1 hour to keep minoxidil before taking a shower. I want to clarify this as I too don’t like keeping the medication all day because of its greasy and sticky look.

In addition, I have searched your blog in regards to a good Shampoo…Can you suggest one besides Nizoral, as i use it once every week as suggested by the manufacturer. But want to pick a good brand for daily cleansing….You have suggested to pick the one which suits, however i was wondering if you can still suggest some ingredients or brand to help.

In addition, I want to indicate that I have been on Propecia for 4-5 months and Strongly believe its helping me slow my hair loss. I’m 28/m and now have started using Minoxidil.

Minoxidil should be applied after a shower when the pores on the scalp are open and the circulation from a hot shower increases the blood circulation. The use of minoxidil foam in the morning will solve the greasy feeling and many people prefer it to the liquid. It is also reported that the foam (5%) works better. If you let the medication absorb for at least an hour or so (I’d say 2-3 hours to be safe), you can wipe it off.

I have no suggestion on a shampoo at this time, but I am considering bowing to requests to write reviews for the various hair loss products out there in the marketplace.

Tags: minoxidil, hairloss, hair loss, nizoral, shampoo

Elpecia?

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

have you ever heard of Elpecia? it is suppose to be a generic version of Propecia. i ordered it from a canadian pharmacy but the shipment came from India

thanks

ElpeciaThere’s a lot of names that generic finasteride is sold as, with many of them being of Indian origin. I haven’t heard of Elpecia before, but it wouldn’t be shocking to know that yet another generic 1mg finasteride pill is being sold (illegally). I did a Google search and could only find a single reference to Elpecia being a name for generic finasteride, but I couldn’t say whether what you bought is even legitimate.

Note: The “logo” there is my great Photoshop work. Do not confuse that with the real logo, if there is one.

Tags: elpecia, propecia, finasteride, hairloss, hair loss, india

Mapping Your Own Scalp for Miniaturization — The Video!

/by William Rassman, M.D./

As promised, I’ve uploaded a tutorial video for the miniaturization mapping. You can find the thread with the video at BaldingForum. I encourage you to sign up at the forum to post any questions you might have about the video or the process, as well as posting your miniaturization results if you’d like me to analyze them.

See the video at BaldingForum.com!

 

If you missed the first 2 parts, be sure to read up!

  1. Mapping Your Own Scalp for Miniaturization, Part 1
  2. Mapping Your Own Scalp for Miniaturization, Part 2
Tags: miniaturization, map, hairloss, hair loss, mapping, baldingforum

Half the Face Grows a Fuller Beard

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

My boyfriend is always concerned that he grows more hair on one side of his face and then the other side is more sparse. It’s like someone drew a line down the center vertically and the left half grows more and thicker hair than the right- he says. I don’t really notice but it always bothers him- is there something he can do to fix this? He is 25 years old and has no other hair issues (like on his head or rest of body). Is there a term for what happens on his face? and how to fix it? Please respond!! I can’t find anything on the internet about it! Thanks!

I would want to examine him and count the density of the hairs on one side and compare it to the other side. He might try minoxidil on one side of his face to see if that evens out the growth. A scientific term for hair growing more sparse on one side of the face doesn’t come to mind, though.

Tags: hair growth, facial hair, beard, mustache, moustache

Fibrosis of the Scalp?

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

What is fibrosis of the scalp for woman. Is it something that can be cured and how can you prevent this from happening?

Honestly, I do not know what this term is reflecting. I assume it has something to do with the thickening of the scalp tissue, but I need it put into context so that it is a question that I can try to respond to.

Tags: fibrosis, scalp, hairloss, hair loss

Time Between Minoxidil Applications?

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

how long is minoxidil need to be apart after a application. Is 8 hours apart ok?

CowThe recommended application for minoxidil is twice a day. I suppose 12 hours apart is best, but that may not be practical to fit into your day.

Many years ago I had a dairy farm with nearly 150 cows. If you think about nursing mothers, they feed their babies every few hours and get their best milk production based upon the need to keep up with the close feeding schedules. For my farm, I figured that we would get the best milk production if we milked the cows every 8 hours, but I could not afford to do that and few workers would cooperate with me on this idea. Most of my farming neighbors started milking at 7am and then at 3pm so that they could have breakfast and dinner with the family on a reasonable time schedule that coordinated with their childrens school schedule. By spacing the milking 16 hours at night, the cows filled up with milk for overnight, which in the world of ‘biologic feedback’, they were telling their bodies to slow down milk production. As a compulsive person and to solve the problem, I decided to milk the cows at 3am and 3pm, but because of my heavy surgical schedule I just could not do that. Instead, I woke my wife up at 3am so she could milk the cows until 6am at which time the day crew came in and took over. What I’m saying is, life is full of compromises. If you can’t get that perfect “every 12 hours” between minoxidil applications, then yes, 8 hours apart (like the dairy farmer) should be fine.

And for the record, I am presently divorced.

Tags: minoxidil, hairloss, hair loss, regaine, rogaine, application, milk, cow