I am a 50yr old male that has had six strip surgeries over the years. I have continued to thin and even the transplants have seemed to thin. Most noticeably is the mid scalp area. I would like to try low dosage Dutasteride (Avodart 1 pill weekly) along with propecia, which I have been on for about 15 years. The problem is I can not find a doctor willing to write a scrip, and I have been to several Dermatologist as well as my primary care doc. All say they are not comfortable with it. The low dose seem reasonable. I feel I must give this a try before it is too late.

Any advice? Thanks very much!

If you are continuing to lose hair, it just may be from your genetic predisposition to male pattern (androgenic) balding. All drugs have limitations and drugs alone cannot completely stop hair loss. There is a reason why most doctors (including me) do not routinely prescribe dutasteride. Dutasteride is not FDA approved for treating androgenic alopecia and it has a higher side effects potential than Propecia.

As for your continued thinning, including the transplants — this is unusual. I haven’t seen your before/after photos and I haven’t seen your case file, but if the grafts were taken from the donor area (and not higher or lower), they should not fall out with your hair loss progression.

This is not a personal question but a more general one. If i’m not mistaken, those who suffer from MPB have a variation of a gene that makes their scalp sensitive to androgens, while DHT is potent androgen – it’s still just one hormone. Why isn’t stronger anti-androgens being used? Obviously, you’d have to be castrated to fully eliminate the risk of going bald.

My question is, who or whom decided that DHT is where the line is going to be drawn? What made them not go further down the road, as there’s still loads of money to be made for the pharmaceutical companies.

I don’t think anyone necessarily just decided that DHT was the sole cause of hair loss. It is just one piece of a puzzle not yet fully solved. As I have said many times in the past, DHT is not the sole cause of hair loss. Your genetics are also the cause of androgenic hair loss. DHT is just one factor that we have discovered for men who have the genes for balding. If you do not have the genes for balding, DHT does not matter.

Big pharma and other companies are still working on various ways of treating hair loss with varying degrees of success.

I’m 22 have some heridatory hair loss in my family.

I can noticeably see miniaturization on my hairline and the corners receding. my front hair is thin, but the rest of my hair is thick. most like norwood level 3.

I have spent hours trying to find the right product to thicken my frontal hair and too stop any further receding. but theres so many products out there I cant decide. for a young person in the first signs of frontal balding what would your advice be on a product to prevent it.

thank you

There are no products that are guaranteed to thicken the hairline, but Propecia has worked to regrow hair on rare occasions in that area. I wouldn’t count on it regrowing the hairline, though. I would expect it would at least slow the loss down (particularly in young men with early hair loss, such as yourself). It is a prescription medication and you’ll need to talk to your doctor about it.

There are a lot of products out there that claim to do things they just can’t do. After all… if they worked as claimed, you probably wouldn’t see so many men out there with receding hairlines.

I was just wondering about the doctor saying that going off the medication does not reverse breast enlargement. That is, frankly, a bit scary. Websites like Livestrong.org (not exactly Encyclopedia Brittanica but I’m tempted to trust it) say that all the side effects of propecia are reversible. Can you clarify?

Link: Livestrong.com

In my experience, the few patients who had breast enlargement did not always reverse. I find that this one complication is the most persistent of all side effects and some of the patients ended up treating the breast lumps with surgery.

Dr R
Perhaps a rhetorical question but…..
amid all the blog postings, magazine articles, support groups, “chest pounding”, editorials etc – why has there not been a well-controlled, scientific study that has prospectively followed a group (perhaps 200-300) of men who begin Propecia for a period of several years? This type of study can then quantify the incidence of persistent sexual dysfunction (that is said to be common), use nocturnal penile tumescence to document further; understand any baseline factors that can possible predict who is more likely to have such an effect, and explore/evaluate all the differential diagnoses that predispose to erectile dysfunction or libido problems (psychological including social issues and life stresses; concomitant medications; coexisting medical conditions such as diabetes, hypertension, lipid disorders; endocrine abnormalities including testosterone/prolactin levels; cigarette smoking; chronic alcohol use; vascular problems, etc) as well as influence of different therapeutic options.

Such a study, which could be done outside of the influence of a pharmaceutical company, seems to be able to be done by any leading urology academic center that sees large number of men placed on Propecia, and would be relatively inexpensive and noninvasive. At present, the field seems to be highly dependent upon retrospective questionnaires in men who have these effects, and an absence of extensive data.

I completely agree. We need to have a statistically valid audience for a good prospective summary. Unfortunately, that type of study will take years to obtain and someone has to pay for it.