I Have a Consult With NHI Next Month…

Hi there,

I have an appointment to come and see you guys in about a month or so (combining it with a California adventure) but I had a question that I wanted to send you in advance.

I started proscar 1mg/daily last September, but cut down the dose (and also took it irregularly) this summer. Over that time, I started to notice a lot of shedding – which I never observed before, even before the starting propecia.

I had cut down the dose at the beginning of the summer because I felt that I’d put some fat on my midsection and in my breasts – I’m in pretty good shape, so the change was noticeable – that I thought was due to the propecia. Since I didn’t know if it was even doing anything, I cut it out. And then brought it back! Since September, I’ve started again at 0.5 mg/day. But I’m still shedding.

What I’m wondering is if I should just stop taking the medication again so that I can establish a non-propicia’d baseline with you when I come for my consultation, which I neglected to do before starting the drug in the first place and which I regret. Or, should I stay on the 0.5 mg/day and then increase it to 1.0 after seeing you to see if there’s improvement?

Hope that’s not too confusing. I’m just trying to have something clear established so I can figure out what hair I’m losing and at what rate. I like the idea of having an empirical baseline. I guess I don’t mind the minor chubbification if I know that the propecia’s doing something. But I want to know that it’s doing something!

Just wondering if you had any thoughts. Anything you could offer would be appreciated. Thank you so much for this resource.

First and foremost, lets discuss the facts. Propecia is a brand name for finasteride in 1mg. Proscar is a brand name for finasteride in 5mg. For the treatment of androgenic alopecia (AGA) the recommended dose is finasteride 1mg (Propecia) taken orally once a day. Some take 1/4 pill of Proscar (finasteride 1.25mg) once a day. Ideally, you should cut it in 5 pieces, but that is difficult to do with a small pill. Taking more than 1mg of finasteride will not be of benefit with respect to your hair loss issues. More may just cause increased incidence of negative side effects. Taking less (finasteride 0.5mg for example) is about 70 to 80% as effective as the full 1mg dose.

In general, Propecia does not cause shedding. I realize other websites and forums state this (and we’ve published emails about this), but it is not something I usually see in my practice. If you are seeing shedding and you think it is from Propecia, then I will take your word. But you should also note these important facts:

1. Propecia does NOT stop hair loss forever.
2. It takes 6 to 12 months of taking Propecia before you see any effect with consistent use.
3. Your genetic predisposition will always win over Propecia in the long term (which could be years).
4. When people start taking a medication to do something, such as taking Propecia to stop losing hair, you will generally be more astute to any changes in your hair (that you would have never noticed).

That all being said, I can’t tell you what you should or shouldn’t do with your prescription medication dosage, as I didn’t prescribe it to you and I’m not your doctor. Talk to your prescribing physician to help figure out what you should do next and then when you come in for your visit to my office, we can go from there.