Comment by William Rassman, M.D.:  I have been prescribing this drug for years. The problems that is discussed below have generally not been seen in most of my patients. Any drug, ANY DRUG, runs some risks when it impacts your body function like hormones, mood, etc…  When you take any pill, you must recognize that this is a man made item and although the FDA may clear it for safety and effectiveness, there is no guarantee that you will not develop some unusual problem like the many discussed below by this very knowledgeable person. I felt that this comment was important to make. You should know that I am now taking finasteride and my son has been on it for 15 years and neither of us have seen any problems with this drug in our system.

The fact that this poison is still being regularly prescribed undermines the legitimacy and perceived objectivity of the American medical system and the pharmaceutical industry. There have been plenty of publications that have come out over the decade that have shown 5-alpha reductase inhibitors to be dangerous, even to those who appear to respond well to them, which I’ll link at the end of this comment. I am glad that the FDA was objective enough to deny the approval of these drugs as chemo-preventative therapies – who knows how many lives would’ve been destroyed if they’d been approved for that – and that they decided to finally label the drugs with serious warnings, but it’s not enough.

The risk of full-blown Post Finasteride Syndrome, while apparently low, is not something to dismiss. Additionally, the odds of developing side effects increases with time. These drugs have been shown to chronically lower neurosteroid levels, the most significant of which being allopregnanalone, which is responsible for anxiolytic, anti-depressant, pro-sexual, and other important effects. And as it turns out, DHT isn’t useless after puberty like many people seem to claim. There is no way to screen for who is at risk for post-5ARI syndrome and who isn’t. Even if the odds are low, you’re playing with fire. And many men who don’t develop the condition will still eventually have milder side effects, like a loss of morning erections, weaker erections, lower libido, increased anxiety or depression, etc. all to save a few thousand hair follicles. How do physicians justify this? It’s one thing to prescribe it for a hyperplastic prostate (and even that’s questionable), it’s quite another to prescribe it for vanity. Any physician that considers prescribing this drug for hair loss, as far as I’m concerned, should never be allowed practice medicine again, and should be sued for malpractice and negligence. Clearly they’ve never considered “first do no harm”.

Many physicians’ ignorance of what they’re prescribing is astounding, and the denial of a very real condition when it happens is, at the very least, cruel and pathetic. This sort of science-denial is akin to climate change “skeptics” or evolution deniers. I don’t think I need to explain why this is a terrifying trait to see in a licensed physician. The science is in and has been for years now.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064044/

https://www.sciencedirect.com/science/article/pii/S0960076017301024

https://www.researchgate.net/publication/308996540_Exploring_the_neural_mechanisms_of_finasteride_A_proteomic_analysis_in_the_nucleus_accumbens

https://www.ncbi.nlm.nih.gov/pubmed/28289563

https://link.springer.com/article/10.1007%2Fs11930-015-0061-y

There is a risk with any medication and Propecia (finasteride) is no exception.  It is hard to surround the statistics on the permanent negative side effects reported here by this reader. Some say that the negative sexual side effects that are permanent are as frequent at 7,000 out of the millions of men taking the drug.  That is a small number, but if you are one of them, it is 100% for you.  Every medication has risks and I always inform my patients of these risks and never push any medication on them. Those men with great results from taking the drug will argue with this author, but everyone is empowered to make their own decisions once they know the facts.

Not every complaint about permanent sexual side effects are real. One of my patients took finasteride and reported impotence in 2 hours, before the drug peaked. Although I told him to stop the drug immediately, he refused and said he preferred impotence to hair loss. His call! Not what I would recommend.

I need your advice regarding reflex hyperandrogenicity.  I went on propecia in March of this year.

The doctor who prescribed me the drug told me to come back in 6 months for an evaluation. Within probably two weeks, I started to experience what I thought was the usual shedding. I was obviously concerned and turned to discussion boards where I found countless responses indicating that the shedding, regardless of the severity, was just part of the process.

I wanted to believe that that was the case so I carried on. I was (and still am) experiencing hundreds of lost hairs every day, increased (though admittedly not drastically) acne, increased sebum production, increased sexual function for about two and a half months. Finally, I went to see the original doctor who prescribed it and another doctor. They both confirmed that this is not anything close to normal. Actually, the second doctor (not the prescriber) told me that he had prescribed Propecia to thousands of patients over the years and he had seen maybe a dozen patients who responded like this.

Obviously, I am distraught. I don’t know what to do. I am one week off this Propecia and still shedding like crazy. I have lost maybe 60% of my hair. The hair loss is all over my head, but it’s worse on the crown and the sides (I NEVER experienced loss on the sides before Propecia). Both doctors told me cautiously that some of it may grow back eventually. The saddest thing is that my male pattern baldness wasn’t even that bad. I was losing my hair for sure, but I turn 40 next month and I probably would not have got to this point for a good number of years.

Most of the hairs I’m losing are thick dark hairs and most have NO bulb on them.

So my questions are:

(i) Given your experience, do you believe that some of my hair may grow back?

(ii) Is there anything I can do or any product I can use, to increase my chances of getting my hair back?

You have to wait it out for a full year to give finasteride a chance. Minoxidil, an additional medication, also works best for the crown (not the hairline) and it also takes a year. When used together, you will have a better overall response. Hair transplants become an option if this approach does not solve your problem.

I am a cosmetologist and have been so for over 25 years. I’ve been doing extensive research on hairloss for several years. Recently I’ve been experiencing hair loss myself. I have rosacea, the kind that results in acne like bumps. It creeps into my scalp also. After finding out that I have an inflammatory condition found in my lungs, it’s all starting to make sense. My pulmonologist is drawing lines connecting inflammation in my skin and scalp to this. Many people who have acne or other inflammatory conditions also experience hair loss. This is believed to stem from inflammation brought in by either infection, autoimmune disease or allergic response. I have rosacea and hair loss. I’ve not taken any oral antibiotic for this, although it has been prescribed (minocyline) . This drug is used to treat inflammation, not so much as an antibiotic. I’ve used metrocream on my face with no great results. My dermatologist switched me to soolantra and it is working wonders on my breakouts and redness. She says this cream works to fight against the allergic response to skin mites. It is so interesting that the inflammation is due to an allergy. It’s probably also in my scalp too. If you have an inflammatory skin condition, you most likely also have the same in your scalp. Because of the cycle of the hair growth and shedding, you might be experiencing hair loss a while after the inflammation began at least 6 months or so. I’m curious how many of you have experienced other inflammatory problems like IBD, joint pain, high blood pressure.

Stress from inflammatory disease can be a cause of hair loss. It sounds like you solved the problem. Your story is a good one so thanks for posting it!

I underwent a MRI of my head about 2 months ago. It lasted 50 minutes and included with and without contrast. It was to confirm the swelling in my eye was thyroid eye disease and not something else. Since this condition started 15 years ago, I was confident if it was anything to be alarmed about I would have known a long time ago. I was not informed about possible hair loss and didn’t know of any real concern with having the MRI, along with being a registered nurse and not wanting to seem non compliant. I went along with having the MRI . Within a couple of weeks of the MRI I started to loose LARGE amounts of hair! This continued for a month! Now I am back to losing the normal amount of hair daily, but I now have a third of the hair I had before the MRI. If I had been informed about the possibility of extreme hair loss ; in my case I would have had the luxury of NOT having the MRI and risking so much hair loss!!!!

The stress that you may have gone through could accelerate hair loss. When the stress abated, everything went back to normal. I don’t believe that the MRI was responsible for your hair loss.

A 10 months Finasteride shed is unlikely. It is more likely an acceleration of your primary genetic hair loss.

Absolutely huge finasteride shed 10 months in has anyone recovered from this? from tressless

This is cobblestonning of the skin from the grafts that were transplanted with too much skin not trimmed away. The pattern is not good as it is not random as hair should be. This will call attention to the cobbling that we see. These grafts may have to be removed with FUE if it bothers you enough after the hair has grown in

For a typical Indian, assuming that you actually had 5,700 hairs, which would extrapolate to ~3900 grafts, this would be considered over-harvested. The average “Indian” hair density has an original hair population of about 80,000 hairs.  The photos confirm your suspicion of over-harvesting. The maximum FUE for a typical Indian should be limited to about 3,000 grafts or 4,700 hairs with another possible 3000 grafts or 4700 hairs performed with a strip surgery to prevent donor area depletion.