Why Have You Changed Your Mind About Taking More Finasteride?

Dear Dr. Rassman,

recently you wrote on this blog about having advised several of your patients seeing a certain loss in efficacy of finasteride treatment to higher the dosage from the regular 1 mg per day to 2.5 mg (half a proscar). In older entries, however, you are strongly advising against that therapeutic “move”. Could you please explain why you seem to have changed your mind on this and what conditions you´d like to see fufilled before making such an increase in dosage!

Thank you so much!

There have been more and more complaints by some patients that over the long term, Propecia seems not to prevent the advancing balding patterns that they are experiencing. Because of the high interest in Avodart in some individuals who are not getting control of an advancing balding pattern (without its FDA clearance), there seems to be a consensus by some of the prominent doctors in the field that 2mg of Propecia (or 2.5 mg of generic finasteride — which is a half of a Proscar/generic finasteride pill) may be better in some of these individuals and worthy of a try. Please note that I’m not suggesting that people increase their dosage on their own without talking to their prescribing doctor.

As long as there are no negative side effects, I believe it is a better option than Avodart, which I am reluctant at prescribing until I get more comfortable with the FDA clinical trial that just completed. I will try to understand this better at the ISHRS meeting next month in Amsterdam, where the Avodart study will be discussed. Once I know more, I’ll post it here.