First of all, I just wanted to let you know that I have found your blog very useful.

I am a 24 male and for the last couple of years I have noticed my hairline receding and then my hair getting much thinner. I look back at pictures from 3 or 4 years ago and I am in awe at how much my hair looks different. Anyway, I have tried rogaine for about 4 months and have not seen much of a difference, plus it is kind of a pain to use. In fact my hair seems to just continue getting thinner.

I would like to try Propecia, however, I am in medical school and I really cannot justify using that much loan money for propecia, if you know what I mean. I have noticed that you and others suggest using 5mg generic Finasteride normally used for BPH as an economic alternative. I would like to ask my doctor about this option. My question is whether this is considered ethical/legal and how physicians usually respond to this.

Thank you for your time

There are no ethical or legal issues associated with prescribing finasteride for androgenic alopecia. There is however a financial issue, as finasteride 5mg is about $30-$60 for 90 pills and finasteride 1mg is about $150 to $200 for 90 pills. If you cut the 5mg finasteride in four parts, the 90 pills should last you 360 days! This drastic difference is based on U.S. Patent laws that give protection to Merck, as they have the rights to manufacture the 1mg dose of finasteride up until mid-2013. The 5mg finasteride is available as a generic because the 5mg patent expired already, so the prices are way, way lower.

As far as doctors are concerned in prescribing medications, as a medical student, I hope you will soon find that there are hundreds of medications with generic versions that are exactly the same and just as effective as their branded counterpart. Consider this when you prescribe branded medications to patients after the drug companies wine and dine you.

On a final note, there is an ethical issue to the patient if they decide to cheat the system by getting the generic finasteride 5mg using their insurance card. The insurance companies may approve finasteride 5mg thinking you are treating a prostate problem. Finasteride used for androgenic alopecia is not covered by insurance.

Dear doctor,

I am a male of 22 years old. I am experiencing very slight recession of my hairline at this moment almost invisible for the human eye. I also have some shedding which freaks me out a lot(not an understatement) because I always have got extremely thick hair and never noticed any shedding. My dermatologist prescribed me minoxidil and the second appointment because I was still worried gave me a prescription for Finasteride 2.5 mg. She said I could take it ‘preventive.’ Is this true? My pharmacist forgot to write the dose on the box so I have been taking 5 mg for one month. Is this dangerous; should I start taking the right dose now(i.e. 2.5 mg or just keep on with the 5 mg.

Thanks a lot in advance

What you are doing (taking 5mg finasteride daily) is not dangerous, but it is not the right dose. For the treatment of androgenic alopecia, the correct dose of finasteride is 1mg a day.

In your case, there is nothing you are telling me that you were even diagnosed with androgenic alopecia! You should not be taking any drug for preventive measures. Perhaps you need to find another doctor and a pharmacist.

I understand that a 1mg dose of Propecia is recommended. What I want to know, however, is how much more hair grew at a 2mg dose vis-a-vis the 1mg dose — 10% more? 15% more? I know these data exist. So, what incremental improvement might there be with a 2mg dose?

While it’s quite possible that the data for 2mg finasteride hair loss treatment benefits exists, I don’t have it, I don’t recall seeing it, and I’m not sure if it was ever made available to the public.

I do know that there were studies that looked at high dose and low dose finasteride (prior to Propecia becoming available) for treating hair loss. More is not better and I am not aware of a 2mg study showing any additional benefit. The stories that I do hear are anecdotal.