The immediate possible side effects is one issue, but I’m curious about long-term effects down the line. I know that low DHT levels has been associated with poor cognitive skills as men get older. Aside from that, what are the long-term effects of having this chemical in your body for say, 10 years or so. I don’t want to make a decision that helps me now but screws me later.

We see that finasteride becomes less effective as a man ages because their testosterone levels drop and subsequently, their DHT levels drop as well.  Finasteride is a DHT competitive inhibitor (blocker) that is about 70% effective so as the DHT levels drop with age, the impact of finasteride drops off. For hair loss, the good news is that in most men, the rapid hair loss occurs in younger men in their 20s when finasteride is most effective and as a man drops his DHT levels in his 30s and 40s, the hair loss usually, but not always slows down. The a classic article in the New England Journal of Medicine many years ago, 25000 men were reported, half of them on finasteride and the other half not.  All of these men were over 55 in the study. What the study learned was that those men on the drug had a lower incidence of cancer of the prostate by 25% compared to the study group. So the long term effects of finasteride may be good for the prevention of cancer of the prostate. This reported study only went out 7 years, so I would imagine that younger men who took this drug in their 20s through their 60s, would have a much lower incidence of cancer of the prostate, the #1 cancer in men.

I took finasteride 1,25mg daily for a month. After a week or so I started to have gyno symptoms: stabs of pain in my chest, sensitivity in my nipples and general discomfort in my chest. I quit and after a couple of weeks I was fine. Decided with my derm to get back on Fin but this time 1,25mg eod but after a week the gyno symptoms came back. So, is it possible to have symptoms but not growing tits? Or if I have symptoms I will grow tits for sure?

With the return of these symptoms, it is likely that you are not a good candidate for this drug. You can try cutting the dose down to one pill every 4th day and see what happens.

Since you have lots of first hand experience with this topic, I have a couple questions for you about hair loss treatments. I greatly appreciate you taking the time to read this:

1) Approximately how many patients have you prescribed finasteride? Out of these patients, approximately what percentage would you guess experienced side effects? Have you ever had a patient who ended up with long term side effects after stopping the drug?

2) Why do you believe Propecia is so widely feared, while other drugs known to have sexual side effects (mainly antidepressants) don’t carry the same baggage?

3) Do you believe Minoxidil can maintain a man’s hair on a long term basis?

Over my years in practice, I have prescribed thousands of men the drug finasteride (~50,000). I have seen sexual side effects reported to me in about 4% of these men. When I see this sexual complication, I often reduce the dose. Over time with a reduced dose, half of these men can take the drug without the sexual side effect (libido decrease and ED problems).

The internet is good and bad. The bad is that too many forums focus on negativity so we hear more about the negative side effects than the positive ones. I always tell my patients about one of my sons who went on finasteride and found an increase in is sex drive. How often do you hear about that one. Also the legal climate with class action law suits against Merck is like a circus, join the circus, claim impotence and possibly become rich. Not a bad scenario. This climate clearly colors what we hear.

Minoxidil can not prevent the genetic hair loss from happening. It may grow new hair in places like the crown, but the results are not dependable nor predictable and the results are not dramatic.

I am sure you get a lot of similar hair loss messages but I am really distraught and was wondering whether you could give me some advice on my situation.

I’m an 18 year old girl and went on an 8 month course of accutane from December 2015-August 2016. My hair started falling out in handfuls half way through the course. I stupidly continued taking accutane until the 8 month point because my derm promised me that it would stop 3 months after coming off the drug, and that he’d “never heard of anyone losing more than 10% of their hair”.

As you can imagine, I kept losing hair at this rate until I’d been off accutane for 4+ months. I was pulling out handfuls, probably 600 hairs a day, and crying every day.

It began to slow a bit, to a daily loss of 200-400 hairs. This is what I’m currently losing, 8 months after accutane. I had such incredible, sleek hair but now I have about 40% of it left.

I’m losing ALL my regrowth. I sit at my desk and see 1cm hairs on my laptop, and lose a lot of 1-3 inch hairs.

Is this chronic TE that could continue for years? Do you know if this kind of thing can even sort itself out over time?

I’m really reluctant to go on Minoxidil. Would it work and help my hairs stay in anagen? Would I be risking more shedding?

I’m just so scared about this as my derm/doctor have no clue and just tell me it’s TE that will resolve. My derm even tries to pretend that accutane can’t cause hair loss, so I’m reluctant to trust his advice and go on Minox.

Do you think accutane could have caused a change in my body that means I permanently will lose my anagen hairs at a max of 4 inches and that I won’t ever grow my hair back?

I put the entire comment here for you to read. Sometimes doctors just don’t connect with their patients.  Although this poor young girl has almost certainly hair loss from Accutane (use to threat Acne) the doctor should balance the complexity of the acne, the accutane and the emotional impact on this young woman. It is unfortunate that she had to reach out on the internet to get someone to respond to her problem.

If you have a hair transplant and you are under 30 and male, the risk of shock loss is high enough that the drug finasteride almost wipes out that risk. Shock loss causes an acceleration of your genetic hair loss problem.

Question:  Hello sir! I thought i’d reach out to someone who’s actually a professional. So i’m 19 years old and definitely lost a lot of volume in my hair really quickly in the last few months. I started Fin 1mg almost a week ago now. Took 4 pills so far. However i started feeling numbness in my penile region on the second day and now i feel it in my rectal area. Is this the so called nocebo affect?

Answer:  I just read an article (just published) that suggested some neurological problems in the nerves that innovate the pelvis area with the drug finasteride.  This is very new to me and the article is only an abstract so I can’t be critical in my analysis of it, but if you are having such side effects, stop the medication and it should go away in 2-3 weeks or so.

The frequency of Erectile Dysfunction in men in their 20s is about 20%. Also, it is not unusual nor abnormal not to have a good sex drive. If you are worried about it, see a doctor and get your testosterone level checked to see if it is hormonal. The impact of finasteride is independent upon your original sex drive and erectile function if you decide to take it.  It all depends upon the importance of your sex drive to you, independent of your hair loss and the treatment of it.