In a recent post (Propecia and Coffee) you mentioned that some people believe that the increase in urination from drinking coffee and/or alcohol might diminish the impact of Propecia.

I currently drink about 1 gallon of water a day and because of this I urinate a lot. Could this prevent me from seeing maximum results from Propecia? Should I drink less water?

With respect to the post you are referring to, I never stated I believe in the theory that urination will make Propecia less effective. People write about these things on the Internet and the speculations get propagated (as I have probably contributed). So no — I do not think drinking and increased urination contributes to less efficacy of Propecia. I wouldn’t worry about it.

But, isn’t drinking a gallon of water a day considered excessive? I’d be concerned with possible water intoxication or hyponatremia.

Hi Doctor –

I was using propecia (Finax 1mg) since Nov’2009 till Feb’2010, I was also using minoxidil 5% tropical solution. During Dec and Jan I experienced palpitations and Feb I felt stress around my face and chest which turned out to be high blood pressure 145/90. This did not happen for a month and then again suddenly I have started palpitations and sometimes feel stress. I have stopped the usage of both the medicines since 3 weeks but nothing seems to work.

Please help me out with how much time it should take to get rid of these side effects, do I need any medication that can help me wash this off easily… I have developed sleeping disorder as well. My physician who advised me for this is not ready to believe that these medicines can cause these issues.

Looking forward for you help. Thanks

Here are the listed rare side effects for topical minoxidil — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in hearing or vision; difficulty breathing; excessive, sudden weight gain; fainting; lightheadedness; increased chest, arm, or shoulder pain; increased heart rate; pounding heartbeat; swelling.”

And here are the listed rare side effects for finasteride — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast enlargement, lumps, pain, or tenderness; nipple discharge; testicular pain.”

So what you describe as stress in your face could be an allergic reaction to either medication, but this doesn’t explain your blood pressure spike. In fact, minoxidil is taken in pill form to lower blood pressure. Stress is a likely reason for any abnormal sleep patterns, and the stress itself could be from your health. What troubles me is that you still are experiencing issues even after stopping the medication, leading me to wonder if your symptoms are unrelated to your hair loss treatments and could possibly signal a serious (undiagnosed) underlying medical issue.

I’m planning to travel out to LA for a consultation [from overseas]. How far in advance do you recommend booking an appointment.

One final question. A few folks have mentioned nasty sheds that are associated with rogaine, and in particular with rogaine foam. If you read the blogosphere, it’s enough to scare one stiff. In your experience, how frequent are the sheds and do they often result in a negative cosmetic change in the short term?

Thanks

The more notice you can give for an appointment, the better… but if you’re in from out of town with a fixed schedule, we’ll do our absolute best to fit you in whenever you can stop by. I look forward to meeting with you.

As for minoxidil shedding, I think its pretty rare but I honestly haven’t kept much referential data on it. Since it is an over-the-counter medication (meaning a doctor’s prescription is not needed), I don’t have much follow-up with patients regarding it. If the shedding does happen, it should stop within a few months… but it doesn’t happen for most people.

Hi Doctor,

Thank you for maintaining this great and informative blog and answering all our questions.

I was on propecia for 9 years until last year I was prescribed Avodart because propecia was losing its effectiveness. I decided to go off avodart after a year and go back to propecia. The dermatologist told me to give it a year before deciding to switch back. It appeared to me that my hair loss had increased slightly on avodart and the side effects built up after a year were a bit too much – slight loss of libido, slight ED. After a week of switching from propecia my hair loss accelerated substantially. Could this be catch up hair loss – maybe avodart was not working for me – or could this be a shed as of a result of restarting propecia.

Thank you.

There is no drug in the world (yet) that completely stops hair loss. Avodart and Propecia work in similar ways (the two drugs are not drastically different in the mechanism of action) although there are reports that Avodart is better at stopping hair loss, particularly when Propecia benefits have been exhausted. I personally have not seen a worthwhile benefit of taking Avodart because:

1. My patients that have taken Avodart have not noticed a significant change in hair gain/loss.
2. Sometimes the risk (of sexual dysfunction, etc) outweigh the benefit of (marginal) improvement over Propecia.
3. I rarely prescribe Avodart, so my personal experience is admittedly limited.

While I will never know what is going on with your specific case, your experience is real and there may be the correlation you are asking. However I would not think your hair loss is from “catch-up” hair loss for not being on Propecia as you were still taking Avodart and you only noted the hair shedding after starting Propecia. Coincidence? Maybe.

Some of the posts on this site about minoxidil frightening! I have used this for 2.4 months and this scaly bumpyness has covered my ears and spread down my forehead to nearly my cheeks. This has pretty much entirely happened in the last 1-2 weeks. It is uncomfortable and looks bad and i hope it goes away! someone said this could be permanent in one of these posts. Any idea here?

More important question: After 2 months of treatment the lymph nodes on my neck front and back have swollen up, mostly on one side. They havent gone down and its been 2 weeks. Also parts of my head are sore to touch – this came on suddenly so i cant be sure if its a reaction or an unrelated medical issue.

Any advice or feedback – at what point do i need to go to a doctor? Thanks

It could be allergic reactions to an ingredient(s) in the minoxidil, but really just from your descriptions alone — “scaly”, “swollen lymph nodes”, “sore”, “spreading” — you should’ve seen a doctor by now. What are you waiting for?

Rash or hives are a known rare, but severe allergic reaction to this medication… however, it’s odd that you’ve been using the medication for months and just started to see these symptoms in the last couple weeks, which makes me wonder whether it is coincidental. Any of these things might unrelated to your minoxidil use, and there could be other medical issues you have to worry about. See your doctor!