Hey doc, This site is great. Anyway, been on propecia about 8 months. Hair isnt really any better def a little worse. So what do you think a person like myself, chances are of seeing any improvement in the next 4 or so months?

Did you see a doctor before you started Propecia? Did you get a miniaturization study to see how much of your hair was thinning (miniaturized)? Did you document the process by taking pictures before you started the medication? These are some of the basic things I would look for if a patient of mine states they are continuing to lose hair while on Propecia.

Propecia is not a magic pill and it does not cure or stop hair loss completely. It just may be that your natural (genetic) hair loss is rapidly progressing and Propecia cannot stop it completely. Perhaps without Propecia you may be bald by now. But all of this, I am merely guessing.

I would follow up with your doctor to see what your progress has been. I really cannot predict your future, but if all baseline tests are done, you can have an objective idea of where you are going. At the least start the baseline measurements now (better late than never) and then see what happens in 6-12 months if you stay on the medication.

Hey Doc,

I have been on proscar split into 5 for 19 weeks. At about week 14 I noticed a lot of hair loss at the back of my head in the permanent area. The hairs that fall out are full thickness/growth and have a ‘bulb’ of skin from where it was joined to my scalp. I now lose more hair from here than anywhere else on my head and running my fingers through my hair just above my neck results in 5-10 hairs to come out at once.

Would you think this is TE? And if so would you recommend me to let it run its course? It doesn’t worry me because it is the permanent area I am just curious.

Regards

For those that aren’t familiar with the “permanent zone” of hair — it is the sides and back, as seen in the remaining hair of a Norwood Class 7 balding person (see image at right). We call it the permanent zone (or “donor area”) because the hair is not effected by male pattern baldness.

I cannot say if you have telogen effluvium (TE) just from your description. It is quite unusual for finasteride to cause thinning in the permanent area… and in fact, I’ve never heard of it happening. I would go back to the doctor you received the medication from and have him/her reassess your permanent area that you are concerned about. Your description of seeing 5 to 10 hairs fall out when you run your fingers through your hair is subjective not scientific… and it will not give you the answers you need.

You should have gotten a donor hair density measurement, which shows how many hairs you have in a given area. You also should have gotten a miniaturization study evaluation to see if there were hairs that were thinning. Of course, this may be an ideal case scenario for some, but that is the standard way I run my medical practice.

I recently saw a doctor about my problem of excessive shedding several months after finasteride therapy has started. He told me that around the 11th to 16th week, there can be sudden shedding, sometimes on a massive scale. The entire phenomenon fits the description of a telogen effluvium. In the case of finasteride use, the telogen effluvium appears to be a reaction to the sudden change in the systemic levels of the sex hormone, DHT.

First, I would want to examine you, do a hair pull test and map out your hair for miniaturization, as I typically do. I am not doubting that this could be a case of telogen effluvium (TE), but over the internet, the diagnosis by me can not be made. If you are impacted by finasteride, stopping it is an option.

The loss of hair on an acute basis may be a TE and that would explain a large amount of hair loss between the 11th and 16th week, but the cause of TE is often mysterious.

Dear Doctor,

Now i’m using Finasteride for 7 months and the results are good. Hair is regrowing and i’m losing less hair then before. (average 10 hairs a day). I’m a 20 year old caucasian male.

But now I started with Minoxidil (2%). I noticed that I’m losing more hairs than before (25-30)(Only when I comb my hair!!) I’ve been using Minoxidil for 2 weeks. But I don’t know if i have to continue this procedure, because it doesn’t guarantee any regrowth and now i’m losing more hair then before… I’ve read that you can lose more hair in the beginning with minoxidil, but now i’m losing 20-30 hairs more each day(!)then normal, how will the benefits compensate that on the long term?! Continue or not continue the procedure, that’s the question!

I hope you understand my question.

I do understand your question, but you need to understand that it’s normal to lose 100+ hairs a day. 20 to 30 hairs on your comb each day shouldn’t be a cause for concern. The hair loss from minoxidil is documented for the first two months when hair cycling is accelerated. There is good science to this effect. Likely what happens is there is a “resetting” of the hair cycle as the hairs fall out to get ready for new, stronger hair to grow.

Most patients tend to stop using minoxidil because they are worried that the hair loss will continue. Some patients do continue with the minoxidil and should see the loss stop after 2-3 months as the new hair cycle takes over. It takes patience of at least 6 to 12 months of using minoxidil for benefit and at least 1 year for maximum benefit. Ultimately the decision to use it is yours.