Dear Doctor,

I hope you are fine. I have a weird problem.

I am losing hair since last 4 years and I shave off my hair (completely bald) once in 4 months. Few years back, my dermatologist mentioned that I had Androgenetic Alopecia and I was thus placed on that medication for quite some time. After taking medication and doing relevant tests, it was found out that my DHT levels are low. But for some reason my hair still falls out!

Looking back at my history, my hair grows long for 3 months (and I dont lose much hair in these three months – 4-5 per day) and they start falling out rapidly in the fourth month (20-25 per day)! In the fourth month they become so weak that if one would gently smear on the head, my hair would come out on his hand!

My question is why does the hair keep falling out when it grows long, in spite of me being on the medication – dutasteride (0.5mg per day), rogaine foam (twice daily) and nizoral (thrice a week).

Doctor, my hair loss worries me quite a lot. In the last four years, you can actually notice that the density of hair on my head has reduced drastically!

I will be grateful for your advice and help.

Hair growth is unpredictable. Contrary to the cycle of hair loss and growth that you report, I am skeptical that you can see it in 4 month cycles. Measure it by mapping out your hair for miniaturization and then you can prove it either is happening or not.

Using all of the medications like a shotgun won’t get you more hair growth, and although not likely, it’s possible that your hair loss is from causes other than MPB and thus medication wouldn’t help anyway. Perhaps seeking out another dermatologist for a second opinion might be worthwhile. Also, it’s normal to lose around 100 hairs a day.

Hi Dr. Rassman. Congratulations for your great blog!

I’m a 22-year-old male with early hair loss. I took 1/4 of proscar daily for five days before having to stop due to the side effects. Apart from low libido and diffculty in getting an erection, these included very dry skin (never thought rubbing the index and thumb could be so unpleasant!), some discomfort in the prostate area, apparently water retention (i.e. urinating little and darker while drinking the usual amounts) and somewhat of an overall bloating of my body, which I put down to the excess fluids but seemed to produce increased tenderness around the nipples, esp. the left one. Since gynecomastia is the one reaction I am by no means willing to put up with, I thought better safe than sorry and quit the medication right away. It has been a few weeks since, however, and everything seems back to normal. I am very concerned about the hair, so I was thinking about starting again with a much smaller dose of finasteride (something like 1/8 of proscar every third day), and increasing it every two weeks or so all the way up to at least half of what I tried initially. Then my question is whether you have tried this approach to successfully manage side effects such as mine in your practice.

Thank you very much for your valuable time.

You should work this out with your doctor. The internet is not the place. I haven’t started patients on a low dose and gone up from there, but I often suggest that lower doses of Propecia may have value for the few men that have sexual side effects from the drug.

Hello,
My question in in regards to potential long term side-effects of finasteride/propecia? I was perusing an article on the internet about the possibility of the long term side effect of it. Then a doctor commented in an article that he questioned the prolonged use of finasteride and said something to the effect of “remember phen, fen?” and we don’t know the potential long term side effects of finasteride yet.

So, did this doctor make a “blanket” statement or do we not yet know all we need to know about propecia?

I’m the kind of guy that doesn’t like to take medication unless there’s something “wrong with me”. So is this safe to start taking? I just didn’t like the reference made to phen fen. Thanks in advance.

Does anyone know everything about anything? The answer must be obvious, so even after 13 years on the market, there could still be surprises. They may not be all bad however, as there are always some good that comes out of such medications. In this case, we know that cancer of the prostate risks are reduced with steady use of the finasteride 5mg dose and many experts think that this will spill over with the 1mg dose. Cancer of the prostate and preventing hair loss (or slowing it) should be considered against the down side risks, of course.

We each need to make these judgments, but over and over again I hear men tell me that they WON’T take pills. Just the other day a 28 year old man demanded that I point him to an herbal for preventing hair loss with an emphasis on “certainty” motivating him. As he was demanding my herbal recommendations, I thought, “I am but a poor doctor giving advice, so please be reasonable with such questions.”