Hi Dr. Rassman, I just have a few questions. Basically, I’m 24 years old and I have had (from what I can tell) diffuse pattern thinning on the top of my head. This has progressed for the past 3-4 years now as the hairs are becoming gradually more and more miniaturized. However, it wasn’t particularly noticeable until about a year ago. At this point (as it began to bother me) I went to my doctor and upon his recommendation I obtained some Propecia.

Anyways, after the first week I had some side effects (erectile ones) and it was recommended to me that I should take a half dose. I did this for about 10 months, and from what I can tell, the half dose didn’t seem to have much effect on slowing down the miniaturization (although, who knows it may have). Finally, about a month a half ago I got up the nerve to try the full dose everyday. The great news is I am not having any side effects. However, a friend of mine told me about a study (which I also looked up online) in which it was shown that there really isn’t much of a different in potency between the 1mg and .5mg dose. This makes me apprehensive about whether the full dose will make a difference.

1. So my first question is, do you think I should take Propecia for another year on the full dose before I make conclusions?
2. As for my second question, does Propecia have a propensity to work less/more/the same on people with a patterned diffuse hair loss in your experience?
3. My third question is related to my family genetics. I have two uncles who are bald. Both of them thinned out around their mid-30s and had the typical norwood-scale baldness pattern with a bald spot in the back that gradually got bigger until they finally started fully balding on the front and crown around 40. I don’t have this. Does that mean anything of significance, other than the fact that I probably have this issue from their genetics?
4. My final question is, I met soccer star David Beckham at a dinner a little over a year ago and he had what appeared to be the same kind of diffuse hair loss I have now at the time. Since I watch a lot of soccer, I couldn’t help but notice recently that his hair is significantly better than it was when I met him. I took another look at some pictures on the internet and its almost like he completely grew his hair back. How is this possible? Have you heard anything about what he did? I know you have been asked this before, but I figured I would ask again since I know for a fact that he was thinning at the time.

Sorry for such a long email. Any comments you can make would be greatly appreciated! Cheers

1. From what I recall, the difference is not that big between half dose (0.5mg finasteride) and full dose (1mg finasteride) of Propecia. I believe half dose is about 70 to 80% as effective as the full dose. In your particular case, I cannot really say if the problem is dose related, but as you do not have side effects from the drug now at full dose, I do not see any reason for you to cut back to half a dose. I’m not your prescribing physician, so discuss this with him/her. Remember, Propecia is not a cure for balding. Some patients will have some hair growth in the first year or two. Some patients will have no further hair loss. Some patients will continue to have hair loss. In the end, all of these patients taking the drug will continue to lose hair to some degree, albeit at a SLOWER rate than if you were not taking Propecia. You see it may not be a cure, but it slows the hair loss down.
2. Propecia works for angrogenic alopecia (genetic male pattern balding). You self-describe your hair loss as “diffuse”, but I have a hard time believing you actually have diffuse hair loss. Diffuse hair loss would mean the back of your head is thinning as well. If you actually have diffuse hair loss (even in the donor area), then Propecia would likely not work for you. I would see a doctor for a diagnosis and a miniaturization study to document what you are treating.
3. Male pattern hair loss is genetic, but if you have it, you have it. It doesn’t really matter if your uncle, cousin, grandfather, father, or brother is bald because it is very difficult to associate a predictive inheritance pattern.
4. I didn’t think David Beckman was thinning or balding from the many pictures I reviewed of him asked by various readers. It is possible that there is a difference in lighting or hair products or perhaps even medication. I really have no way to know. Your definition of diffuse hair loss is peculiar to me though, and perhaps we are not on the same page here. I would love to examine you if that is possible.

Hi Doctors,

Thanks for all the great insight and help. Recently, you’ve had a few posts about frontal hair loss. My question relates to medical (non-surgical) options for treatment and why drugs only seem to be effective for the back/crown of the head. I realize that today’s most effective medicines, Rogaine and Propecia, only are scientifically proven to work in the back/crown of the head. However here is where I get caught up:

If DHT is one of the primary causes of MBP and these drugs, specifically Propecia, block DHT, why then are benefits not typically seen in the front? Likewise, why is Rogaine only medically proven to be effective in the back?

I realize that science doesn’t yet have the exact answer, but given your vast experience and exposure, could you venture a guess as to why these drugs do not affect frontal hair loss the way they affect back/crown loss? In your experience, do users of these drugs see a benefit in frontal loss as well?

Many thanks!

The impact of Propecia on the frontal hairline has not been impressive, but it clearly slows down loss in the frontal area. This is the results of observation on thousands of people. The same applies to the crown where both Propecia and Rogaine seem to have value. But everyone is different and responds differently to medication.

I do not know why there is less hair regrowth on the front than the crown with Propecia and I do not want to make a fool of myself for guessing.

i was wondering is rogaine safe. i hear that rogaine causes heart attacks but you know how people are. i just had a hair transplant and wanted to see if it was safe. thank you doctor

High doses of Rogaine (minoxidil) can drop your blood pressure and may not be a good idea if you have existing heart disease. I can imagine some case where a person uses minoxidil and has one of a variety of existing heart conditions, and the medication causes a drop in blood pressure leading to a heart attack… but that is theoretical and I have not actually heard that such a case exists.

So to answer your question, Rogaine does not cause heart attacks.