hey doc, love your blog as usual. you are truly one of a kind. There is a question that has been bugging me from quite some time.

there are a lot of people who claim propecia accelerated/aggravated there hairloss. even though it is anecdotal but I am pretty sure it happened to alot of people. every blog/forum/youtube/etc people claim it made there hairloss worse and it did not work. Maybe had those people not taken propecia they would of lost that hair later than earlier.

My question is: why doesn’t merck list that as a side affect of propecia? I mean comon they can’t flat out deny it. Its not like one person complains from the accelerated balding, As I mentioned I have read that in hundreds of blogs/forums. Im sure you get hundreds of emails where people bombard you on how finasteride made there hair loss even worse. I have actually read many questions you have posted where people have asked you this and claimed it. You replied by saying “its just there natural MPB and genetics beating propecia”. yes that can be the case, but common. These people specifically stated how as soon as they started propecia the rate of shedding increased so much to prior being on the drug. Then 6 months to a year, the hairloss was in a worse state, and simply the drug did not work but make everything worse. I mean people are not stupid. I mean genetics will win down the road, but what a coincidence that as soon as propecia is taken, hairloss gets aggravated and leaves the hair in a worse state.

Its not right. people take propecia to stop there hairloss, and yet it makes it worse and its adds on to there problems and stress. I mean propecia is said to not work in the front, and the majority of people complain on how it makes the front the worst. That could be due to the T levels. as testosterone is an adrogen as well.

You barely see any success stories from propecia, usually the negative outweigh the positive.

I really hope you post this question on your blog. I know you(dr.rassman) is not a merck employee or representative, but I you post this question. ON a personal note, I have been taking propecia now for the past 6 weeks, and by the 5th week, my hairloss has been alot. My pillow gets loaded with hair, shower, and comb. Prior to this I was still losing hair, but the rate has definetly increased. I mean one can tell if he is shedding more than before. This was the 2nd time trying propecia. the first time was for like 2 months. The first time not only did the hairloss accelerate, I developed alot of acne as well. Especially on the scalp, and chest were I did not have before. Even tiny little pimples across the hairline as well.

I have read about reflux-hyperangrogencity (not sure if its true or not). merck should invistigate these claims more through, and list hairloss as a side affect.

thanks in advance

At most, my answer to your email is an educated guess using personal experience from our nearly 20 years in hair restoration.

If you believe a drug that is supposed to make your hair grow is making it worse, then discuss this with your doctor and consider stopping it. In my years of treating patients with Propecia, I have rarely heard them say the drug made their hair loss worse, and of those cases where there was some acceleration of hair loss, it was only over a very short time frame (1-3 months at most). When this happens, it is thought that there is a readjustment of hair cycling that causes this short term phenomenon. I have heard patients complain that they are continuing to lose their hair while taking Propecia, but not a faster rate (other than the very few who see this readjustment discussed above). Perhaps your Internet research is indeed anecdotal as you state.

On a similar note, over the many years, I personally have not seen any patient that we treated with Propecia complain of persistent sexual side effects after they have stopped taking the drug. I do know there are Internet sites and very passionate readers of BaldingBlog who do not back up my experience on this matter. So for those who believe Propecia is causing a negative outcome to their hair loss issues, then I strongly recommend that you speak with your doctor and consider other alternatives. Just remember that drugs will not stop hair loss completely, but they often do slow it down considerably.

Finally, consider certain observational bias that is part of human nature. If you start Propecia, you are going to be more vigilant on the progress of your hair loss and will likely be looking on your pillow and mirror more so than before you started taking the medication.