Hi Dr. Rassman,

I’ve been on Propecia and Rogaine for 3 years and have been delighted with the results……up until now. Propecia and Rogaine thickened the hair all over my scalp and slowed the regression of my hairline. Unfortunately, it’s becoming apparent that my crown is now thinning, an area that had been strong prior to treatment.

I’m 28 now, and, if possible, I’d like to keep my crown hair for another few years, what are my options?

1) Would upping propecia dosage ever be advisable for a 28 year old?
2) Should I consider Avodart off-limits until it is FDA approved for hair loss?
3) What would you do if you were in this situation?

I’ve a check up with the doctor (who I’m very happy with) that originally prescribed the treatment in a couple of weeks, and will pose the same questions to him. However, your opinion is really important to me, and will help inform any decisions I may have to make. All the best

Upping the dose of Propecia (finasteride) usually does not work in your situation. Rogaine (minoxidil) is fairly effective in the crown and worth trying. Avodart (dutasteride) is an option and some doctors will prescribe it, however, the long term risks of sterility are there (probably remote), and the side effects are more frequent than on Propecia.

Try the minoxidil and give it at least 6 months. Then reassess your situation.

Good afternoon Doctor. To make a long story short just want to say I am a 28 year old male with early hair loss, and my derma gave me an rx for the drug avodart to stop hair loss. He didn’t give finasteride as he said its weak, and avodart is better. he told me about all the side affects of both drugs such as erection problems, gyno, low sperm count with avodart, etc. and basically said its my decision to pick which one, propecia or avodart so I choose the more effective one. I honestly do not care about the side affects, I’m single and I could care less if I have erection problems from avodart. My hair is more important than sex lol.

But anyways my question is that does avodart from clinical experience and studies does it work on hair loss better, or its about the same as propecia? The reason I’m asking is because avodart is more expensive, so if it the same as propecia might as well take the cheaper one. My dermatologist said it blocks type 2 5AR way better than propecia, and that the type 1 blocking ability of it will do nothing for hair loss as type is negligible and not proven to cause hair loss. From your practice, are the patients that take this drug doing better than the ones on propecia?

My first choice for a drug treatment is always finasteride (Propecia) and in the generic form it costs about $3/month. So yes, while Propecia is probably the cheaper option, it is also the only oral drug approved at this time by the FDA for the treating genetic hair loss (the other is topical minoxidil).

There haven’t been a ton of studies comparing the two for treating hair loss, but the one study that stands out in my mind is from late 2006, where 416 men were studied over 24 weeks. The results showed dutasteride was more potent and resulted in a superior hair growth count based on photos. But that is just one study over six months time, published nearly seven years ago.

One does not have to give up their sex life, nor does one have to take crazy risks with this decision. The incidence of sexual side effects from finasteride is 1 to 2%. Avodart (dutasteride) might work better in some men, but the side effect risk is much higher. I would criticize your doctor’s view on these two drug choices, and will point out that you are welcome to get another doctor’s opinion. Some doctors who do not specialize in these areas may not have all the information.