96 Percent of Men on Propecia Have Persistent Side Effects?!

/by William Rassman, M.D./25 /

Hello Doc,

Please go through this ridiculous article in Yahoo.

Link: For Some Men, Propecia’s Sexual Side Effects May Be Long-lasting

Please tell me what you think.

Thanks

There are a great deal of claims that may accurately reflect the patient example, however, the documentation and balance of the presentation is poor and heavily biased. Read it accordingly.

It’s worth pointing out that this recent hysteria is just based on interviews with 54 men, where the participants reported their own issues after stopping the medication. Even more important is to note that these men were recruited from PropeciaHelp.com, an anonymous web forum where men post about problems (real or otherwise) they have from the medication.

The surprising 96% figure gives the media a good, scary headline to get people interested in watching or reading their report. For example, I just saw a quick 20 second segment on my local morning news that said “96% of men have persistent side effects”, but provided nothing else beyond that. It’s very alarmist and misleading.

Tags: propecia, finasteride, hairloss, hair loss, bias, irwig

In the News – Finasteride and Dutasteride Don’t Decrease Cancer Risks

/by William Rassman, M.D./2 /

Snippet from the article published online June 20, 2012:

Finasteride use marginally increased the incidence of prostate and overall cancer at a level of statistical significance. Dutasteride use significantly increased kidney cancer risk. Dosage analysis showed that lower doses of finasteride were associated with higher overall and prostate cancer risks.
…
The major limitation is the lack of important data in the NHIRD, such as prostate cancer histologic grades, smoking habits, alcohol consumption, body mass index, socioeconomic status, and family history of cancer.

Read the rest at The Oncologist — A Population-Based Nested Case-Control Study in Taiwan: Use of 5α-Reductase Inhibitors Did Not Decrease Prostate Cancer Risk in Patients with Benign Prostate Hyperplasia

This study seems to go against the grain of some of the original studies which showed some protective effect of finasteride in the overall population, however, the original study used the 5mg dose. This article suggests that the results of lower doses might be a problem.

I know I’m going to get a bunch of questions about this one, but I can not comment beyond what is in the article. I’m just presenting it so you’re informed.

Tags: finasteride, dutasteride, cancer, hairloss, hair loss

How Can Some Men with BPH Still Have Hair?

/by William Rassman, M.D./0 /

doctor Rassman, How come there are people who have BPH or even prostate cancer and still have a full head of hair? We know DHT is a cause of an enlarged prostate and prostate cancer, and DHT causes hair loss as well. There are so many people with a full head of hair that get BPH and prostate cancer and then there are bald people who don’t have prostate problems at all. What is the connection there? I am kinda confused. So some people don’t have the genes for hairloss and have the genes for BPH and then DHT does its work?

Let’s make it simple —

Genetics cause male pattern hair loss. If you have the genes for male pattern hair loss, DHT is what ultimately causes the hair loss. If you do not have the genes for male patten hair loss, then you can have all the DHT in the world and you will not have hair loss.

Prostate cancer and benign prostatic hyperplasia (BPH or enlarged prostate) has nothing to do with genetic hair loss.

Tags: hairloss, hair loss, cancer, prostate, bph

Why Is Propylene Glycol in Minoxidil?

/by William Rassman, M.D./0 /

what is the purpose of propylene glycol in minoxidil? why not just alcohol and minox only? thanks.

Propylene glycol reportedly increases the skin penetration of the minoxidil. Perhaps a chemist might be able to shed more light.

Tags: propylene glycol, alcohol, minoxidil, rogaine

Is a Norwood 3 Pattern Rare?

/by William Rassman, M.D./2 /

Is staying at a norwood 3 rare?

Dear Dr Rassman,
My father (70) and brother (48) are both pretty advanced norwood 3’s, yet they have no hair loss on top or at the crown at all. I am 28 and it looks like I am starting to head the same way. Is it rare for men to reach norwood 3 and have no further hair loss on other parts of the scalp? I ask as I rarely see other men with this same hair loss pattern in everyday life. Just about always there is some crown thinning too it seems. If you are a norwood 3 does that make you a good transplant candidate as the hair loss is limited to a smaller area?

Thank you

Norwood 3I think the answer to your question is all around you — they’re shopping at the mall, walking out on the street, sitting at a restaurant… or as you note, take a look at your family! Many men are Norwood class 3 and that is their final hair loss pattern. These men make great hair transplant candidates. Of note, only about 7 to 8% of men in the world are Norwood 6 or 7.

It’s very important to note that the Norwood classification chart is not meant to be used as way to chart the progression of hair loss. It is meant to be a description of all types of hair loss patterned men. I would think more men are Norwood 3 than Norwood 7 by a long shot.

So no, I wouldn’t say a Norwood class 3 is rare at all. It’s possible you don’t see men with similar patterns because they’re treating this loss.

Tags: hairloss, hair loss, norwood

Should I Take Vitamins to Balance Any Dietary Deficiencies?

/by William Rassman, M.D./0 /

I’ve noticed that you’ve said that hair loss could be accelerated by an insufficiently balanced diet.

Would it be advisable to take multivitamins to ‘cover up’ any deficiencies in my diet?

Perhaps you read something out of context. Please point me to this post you are referring to.

In general, if you live in a civilized world and have a normal diet, I do not believe you need extra supplements for hair growth or to treat hair loss. I realize many people take these supplements and vitamins, so the choice is up to you. Certainly, taking vitamins has no downside and may have an upside even if you are not deficient. Vitamins like E and D are sometimes low in regular diets and if there is little sun exposure, taking Vitamin D may have value.

Tags: vitamins, hairloss, hair loss

In the News – Popular Herbal Remedy Birthwort Causes Cancer

/by William Rassman, M.D./1 /

Snippet from the article:

A toxic ingredient in a popular herbal remedy is linked to more than half of all cases of urinary tract cancer in Taiwan where use of traditional medicine is widespread, said a US study Monday.

Aristolochic acid (AA) is a potent human carcinogen that is found naturally in Aristolochia plants, an ingredient common in botanical Asian remedies for aiding weight loss, easing joint pain and improving stomach ailments.

The ancient herb has been touted around the world for thousands of years for everything from gout to childbirth, but scientists now know it carries serious risks of causing kidney disease and urinary cancers.

Read the rest — Herbal remedy blamed for high cancer rate in Taiwan: study

I am posting this because in our search for natural herbs to protect ourselves from disease and to impact our known risks, many of us seek out traditional Chinese medicines. Sometimes the risk from using such herbs, as you can see here, are enormous.

The herb is commonly known as birthwort.

Tags: Aristolochia, cancer, herbal, kidney disease

Should I Stop Minoxidil Now That I’m 50 Years Old?

/by William Rassman, M.D./0 /,

According to the National Institutes of Health, minoxidil is most effective in stimulating growth and slowing balding in people with recent hair loss who are under the age of 40.

I’m 50. Using minoxidil for 20 years. Never thought it was doing much but was never sure what would happen if I stopped. It can’t still be effective after all these years can it?

If you stop it, your minoxidil dependent hair can fall out. After 20 years of use, I would stay on it.

Tags: minoxidil, rogaine, hairloss, hair loss

Switched from Taking Propecia In the Evening to Taking it In the Morning

/by William Rassman, M.D./0 /

Dr. Rassman,

I started taking finasteride (1 mg) back in early March of this year. Each evening I would take my daily 1 mg at about 6 pm to about 7 pm. Reading your blog, I have realized that testosterone levels are at their highest in the morning after one wakes up from sleeping. For the past few days I have been taking my 1 mg at around 9 am. I am doing this because – in theory, at least – this should improve the effectiveness of the medication I’m taking. I am not suggesting that Propecia hasn’t done anything for me because it certainly has – my hairline is actually proceeding! I just want it to work even better – if it can.

My question is: Will this sudden change affect me negatively in any way? I don’t imagine that it would, given that the information that comes with my medication says nothing about what I’m bringing to your attention.

I just want to be extra sure.

Thanks a lot!

PropeciaIt really doesn’t matter when you take Propecia, so long as you remember to take it every day. Dosage consistency is more important than what part of the day the medication is consumed. I’ve written before that taking it in the morning is best, but there’s no proof that says morning dosing works better. It was just my opinion.

Propecia does work on the hairline. In some cases it may help slow down further loss and on a few occasions I have seen it reverse frontal loss (very rare out of thousands of cases I have treated over the years). I tell my patients not to expect the medication to regrow a receding hairline, but if it does do it, that’s an added bonus. Propecia works best on the top and crown areas of your scalp.

So to answer your question — if you switch from taking Propecia in the evening to taking it in the morning, I wouldn’t expect any problem. But just be consistent.

Tags: propecia, finasteride, hairloss, hair loss, hairline

I Took Propecia for 10 Years, Then Quit 4 Months Ago — Now I Want to Go Back On It

/by William Rassman, M.D./0 /

After about ten years of being on Propecia/finasteride I quit four months ago. Before I quit I felt my side effects were minimal: a little anxiety, reduced ejaculate output, loss of morning erections, and some reduced erection stamina. After I quit (cold turkey with assurance from two urologists I would bounce back virtually immediately), I felt a substantial change, specifically a reduction or elimination of side effects. Admittedly it took a scary, long road to get here.

However, despite all of that, the significant hairloss I have suffered has made me regret my decision. I want to go back on but only if I’ll likely regrow what hair I lost or at least increase the density of the hair I have. What do you think I should do? Should I resume the finasteride at a different dosage? Different amounts a week (i.e. once every other day)?

You should talk to your prescribing doctor. I don’t know your medical history and this is a prescription medication. It’s possible a reduction of the dose may provide some benefit and eliminating the side effects, but this is something you and your doctor should discuss.

You needed a good Master Plan before you started it, when you stopped it, and now with the decisions before you, again you need it more than ever. Your doctor should help you with this Master Plan for your future management.

Tags: finasteride, propecia, hairloss, hair loss

Do I Skip Every 5th Day of a Quartered Proscar Tablet?

/by William Rassman, M.D./0 /

Hi,

I recently decided to see a doctor for my hair loss. I’m a 29 year old man and my doctor said the best thing was to start on finasteride and suggested that a prescription for generic proscar and splitting the tablets was the better way to go due to cost. I’m comfortable doing this but wanted to know the best way. Should I quarter the pills and then skip every 5th day or take 1.25 mg everyday?

Your prescribing doctor should have given dosage instructions. For my patients that cut the generic 5mg pill, I recommend they quarter the pill and take one piece daily. If you can cut it into 5 even pieces that would be ideal, but not likely done with ease. Skipping a day is not recommended.

Tags: hairloss, hair loss, proscar, finasteride, propecia

Mixing 2% and 5% Minoxidil

/by William Rassman, M.D./0 /

Doc

Bad reaction to Rogaine foam.. 5% PG formulas cause irritation. If I mixed 2% and 5% together in the same bottle would that be a problem?
The goal would be to get something a little stronger than 2% but less irritating that full 5%.

Thanks

Mixing the two liquid formulas of different strengths should not produce problems. Hopefully it will provide you with some results and less irritation. Good luck and let us know how it works out.

Tags: minoxidil, rogaine, hairloss, hair loss

I Have a Lot of Scabbing a Week After My FUE Procedure (with Photo)

/by William Rassman, M.D./0 /, , ,

Hi Doc,

I had a FUE done with 3000 grafts exactly 8 days ago (photo attached).

My concern is that there seems to have been a lot of scabbing or crusting (what is the difference between the two anyway?).

The scabbing/crusting started coming off in places near the restored hairline and it now looks like a river delta (i.e. lines where there is no hair/crusting/scabbing with pockets of crust/scab/hair).

Is this normal? Or is it due to trauma (e.g. scratching) or bad surgery? I know when I am awake, I do not touch the area (I have worn a bandana lightly from the day after the surgery, but only for a few days and first 2 nights). Sometimes at night, I inadvertently brush my hand against the recipient area and wake up.

My doctor advised me to start washing once a day from Day 2 onwards with a spray bottle with a mixture of baby shampoo and water (and rinsing with plain water from the spray bottle) which I have done.

Should I be trying to get rid of the scabs/crusts with light finger pressure when shampooing or should I wait for the 10th day before trying any of this? It is difficult to see the hair due to the black scabs/crusts, but the transplanted hair is there.

Thanks!

 

The crusting is very bad, which means that your management of your scabs was not good. We rarely, if ever, see this degree of crusting. How is the scabbing in the donor area at the back of your scalp?

Be very careful not to rush to take these crusts off. Use a shampoo and leave it on for 10 minutes and then gently, very gently rub in the shampoo. The crusts will slowly loosen and eventually they will come off. Give it another 10 days and hopefully the problem will be gone.

The scabbing/crusting (interchangeable words) is pretty intense, but hopefully there is no problem with the grafts because of it. Of course, follow up with your surgeon if you are concerned.

Tags: hair transplant, aftercare, hairloss, hair loss, surgery, crust, scab

After 4 Months on Finasteride, I See Regrowth at the Hairline But Not at the Crown

/by William Rassman, M.D./0 /

Hi Dr. Rassman,

I am a 21-year-old that has been on finasteride (1 mg) for almost four months now. The good news is that I have noticed that my hairline is now actually proceeding – a phenomenon that is supposedly rare. However, I have not been able to detect (and it may be because I have not given it a close-enough assessment) any re-growth on my crown – something that is irritating me, considering that this drug is supposed to be most effective on the crown.

Anyways, my question is: When exactly is the best time to take my 1 mg tablet of finasteride? Someone asked this question in the past. Your response was something along the lines of: “early in the morning” or “in the morning”. For the past few months, I’ve been taking my tablet every single day between 5:30 pm and 7:15 pm. Because testosterone levels are at their highest in the morning, should I be taking my tablet sometime right after midnight or when I get up in the morning at around 8:30 or so?

Thanks a lot! I love your blog!

Your result are rare. Propecia is mainly effective on the top and the crown (not the front hairline). But if it works, then stay on it. The crown may respond within a year on the drug.

There is no right time or optimal time to take Propecia. The goal is to take it everyday at about the same time. It has more to do with remembering to take the medication. We can theorize about when would be the best time to take Propecia based on your hormone levels, but I do not find this to be of a realistic or clinical significance.

Tags: propecia, finasteride, hairline, hairloss, hair loss

Using Minoxidil and a Concealer

/by William Rassman, M.D./0 /,

im using minoxidil 5% but i want to also use prothik concealer,can i use both at the same time and does prothik clog the pores and cause further hair loss. thanks

Be sure to apply minoxidil right after a good shampoo and wait at least 15 minutes before using the concealer products. Clearly, you should apply the minoxidil to the scalp, not on top of the concealer.

ProThik (or any other similar products like Couvre, DermMatch, and Toppik) doesn’t cause hair loss.

Tags: minoxidil, rogaine, prothik, hairloss, hair loss