Hi Dr. Rassman,

First of all, kudos for the very informative and educational blog – I have used it extensively to become knowledgeable about the options available for MPB. My question concerns propecia and the impact of lowering DHT in the follicle…By taking propecia – one reduces the amount of DHT being generated by the body but what of the levels in the follicle? The conversion of testosterone to DHT occcurs in the prostate gland, liver and skin but how does propecia reduce the existing DHT molecules in the follicle? By halting the conversion – would the DHT levels in the follicles reduce on their own (over time) and result in either reduced hair loss, hair re-growth or increased fiber size?

I am not aware of any studies of what or how DHT is doing at the follicular level, so I really cannot get into the exact biochemical process behind hair loss and hair growth related to DHT.

However, in general DHT does impact hair follicles for those men who are specifically predisposed to androgenic alopecia (also known as male pattern baldness). So the concept behind Propecia (finasteride) is to lower the DHT level in your body and thus diminish the impact of androgenic alopecia. For a specific biochemical approach to your question, I will defer to the biochemists.

Snippet from the article:

It’s getting harder for me to deny that I’ve reached middle age, and the most obvious sign is that the men in my life are losing their hair. Many men struggle to come to terms with hair loss and yearn for a way to turn back the clock. Although I’m no expert on the subject, I’ve suggested they look into Propecia, a medication used to treat male pattern hair loss.

Invariably, they’re intrigued. It works by preventing testosterone from turning into another hormone that causes hair loss. Over five years, the majority of men who take the drug report that their hair loss slows, their bald spot gets smaller and the appearance of their hair improves. However, the threat of drug-related side effects such as impotence, male breast cancer and perhaps prostate cancer has caused many of my friends to seriously reconsider the importance of a full head of hair.

Read the rest at the LA Times — So what’s the risk of taking that medication?

You should always weigh the risk vs reward for any medication, and this article touches on Propecia side effect risks. The bigger message in this piece is how oftentimes people will give more weight to the negative than the positive. Regardless, the FDA is looking into ways to make drug information easier for the consumer to understand so you can make the choice that is best for you.

Hello Dr.

I am on finasteride for hair loss and dutasteride for my prostate. Is their potential risk or benefits from combining the two since they are similar compounds. I am also on TRT hence the prostate growth prevention.

Thank you

I would ask this question to your prescribing doctor. I do not know your complete medical history or your issues. If you are being prescribed finasteride (Propecia) from one doctor and dutasteride (Avodart) from another doctor, you need to tell each doctor your complete medical history and ALL the medications that you are taking.

In general, taking these medications should be fine. If you are on dutasteride daily, the finasteride may be unnecessary.

Have you seen anyone who has ever used dutasteride topically for temporal recession and had good results from it? I have heard through the grapevine that mixing the contents of one 0.5mg dutasteride (avodart)gel pill with aloe has helped some people maintain thick hair in their temple region. I think they also were taking oral finasteride while using avodart topically.

Propecia isn’t a cure as you’ve said, so it only seems natural to try to find a supplementary treatment to keep as much hair alive on the scalp as possible! I know you can’t recommend this experimental approach as avodart isn’t FDA approved to treat hair loss yet, but I figured I’d ask. It seems if other topical hair growing agents like bimatoprost (LATISSE) can be applied topically to the skin and still benefit for the follicle, the dutasteride gel would have to have some benefit for thickening the miniaturized hair (even if it’s not taken orally).

What do you think? I seriously doubt putting a DHT inhibitor on the scalp would cause any harm and am really thinking of trying it.

There are no medications that I’ve seen really work to treat or stop temple recession… and I have never heard of topical dutasteride used for treating hair loss by a legitimate doctor. Not sure where your grapevine source got his/her info, but it probably isn’t worth experimenting with unproven lotions and potions.