Dear Doctor Rassman,

Once again thanks for this brilliant blog and useful service that you provide your readership with.

I’m 25, been on finasteride (1/4 proscar) since Sept. 08 and I have had no problems at all. My hair loss has stabalised and I’ve seen some thickening up around the top middle of my scalp so you could say I’ve reacted well to the drug.

However, around the start of July this year I’ve been experiencing really bad itching all over my body. I’ve been to my GP a few times with it (having trouble sleeping at night) and they have done some blood tests – everything fine except slightly lower than normal pottassium levels. The GP has suggested that finasteride could be the cause, but when discussing with my prescribing doctor he believes it is unlikely as itching is such a rarely reported side effect (perhaps 1 in 700 cases) and if I was to have an allergic reaction it would have shown itself within the first few weeks of taking the drug. I wondered what you thought about this.

My prescribing doctor also suggested that if i want to try and come off finasteride for 3 – 6 weeks, there wouldn’t be any long lasting hair loss and I would know during that period whether it was the finasteride causing it. Do you think that if it is finasteride, coluld it be one of those symptoms that goes away with continued use?

I haven’t found many articles discussing this issue specifically on the blog so I would be interesred to read your opinions.

Many thanks.

I think you are very well informed and I agree with your doctor that you should try to come off the finasteride to see if there is an allergy, but the likelihood of the drug causing of your itching is low. You might want to shorten the period you are off the drug to 2 weeks, though. Being off of finasteride for 2 weeks will have minimum impact, but keep in mind your itching may just go away on its own and there may be a false correlation.

If you’re taking generic finasteride, I also wonder if you’re now taking pills made by a different pharmaceutical company (perhaps without realizing it). There could be a difference in a filler ingredient that you’re allergic to.

I started using Propecia 5 years ago at the age of 25. I wasn’t sure if my stress level was affecting it (went through a really horrible breakup) or if I was having genetic hair loss. So I started to take it and all was fine. 2 summers ago I stopped taking it thinking it was probably just stress and 2 months later, I noticed the hair was indeed falling out. So I started up again. Until 2 months ago i was taking propecia but then just decided to switch to finasteride as many of my friends and clients (I’m a hair stylist) swore by it and so I switched.

I’m noticing my hair has thinned as if I stopped taking it altogether. Is this possible? I have the 5mg finasteride and cut into quarters.

Also, I was reading online about symptoms of testicles/penis “feeling cold” and shrinking frequently is related to the propecia/finasteride usse. I have had A LOT of that and am wondering if it’s related since the prostate is directly involved.

I appreciate the time you give in reading and answering my questions. Thank you.

Taking generic finasteride 5mg and dividing in to quarters is the same as taking Propecia (finasteride 1mg). There should be no difference at all between the two, except for cost savings and the requirement of cutting the 5mg generic pill.

I might just be under the wrong impression, but from the brief description of your history, it seems you are not being followed by a doctor and almost blindly treating your hair loss issues with medications that may or may not be right for you. You really need to see your doctor and discuss these concerns with him/her, as you may have other medical issues not related to finasteride use. Shrinking testicles and a cold feeling are not usually side effects of taking finasteride. Even in the remote chance that it is, you cannot afford to not get it checked out. You may have a medical condition causing your problems. See your doctor, please!

Hello,

About 3 months ago I switched from Propecia to the generic Finasteride 1 mg manufactured by a Thai pharma company (bought overseas). Also, for the last 4 weeks I have trouble sleeping and irregular sleeping patterns due to international travel (ie. jetlag, time difference etc.). Lately I am noticing excessive hair loss in the bathroom sink (about 3-4 times my average) after a shower. Should I attribute that to the lack of proper sleep or to a potential ineffectiveness of the generic Finasteride? I had been on Propecia for over 5 years before I switched, which represents an “investment” as you can imagine.

Thank you.

Hair loss is genetic. I doubt jet lag or proper sleep has anything to do with what you are describing, but stress might.

Generic finasteride and Propecia (finasteride 1mg) are the same medication, just marketed differently. Unless you are getting your finasteride from a shady Internet site (particularly the sites that sell prescription meds without a prescription required), I doubt it has any clinical significance. Keep in mind there are many reputable overseas drug manufacturers, but I don’t know which maker or brand you ended up with. In the end, if you are unsure of the validity of your medication, share your concern with your pharmacist or your prescribing doctor. The ultimate decision of going back to brand name Propecia is up to you.

For the record, I routinely prescribe finasteride in two ways:

1. Generic: Available in 5mg strength, with instructions for the patient to take 1/4 pill a day (generic 1mg finasteride isn’t sold legally in the US due to patent laws).
2. Name brand: Propecia, which is already the 1mg dosage that is FDA approved to treat male pattern baldness.

I leave the decision up to my patients whether to take a brand name versus splitting a generic. I do not see any difference with respect to clinical results; the only difference is financial saving. If you are worried about the generic finasteride, then go for Propecia and then there should be no doubt.

Dear Dr. Rassman,

reading your ISHRS-post concerning the korean Avodart study left me a bit confused and raised several questions/remarks: You talked about a colleague of yours reporting two of his patients have become sterile on the drug. Luckily, this sterility turned out to be reversible. First of all, after thinking about this a little while, I wondered how they have even found out to be sterile given that under no circumstances you should have unprotected sex while on dutasteride due to a potential risk of harming unborn life.

Secondly, there is a study discussing the effect of both active ingredients, finasteride and duasteride, on semen paramaters in healthy men. I´m citing from the abstract that can be found on PubMed.org: “In both treatment groups total sperm count was significantly decreased at 26 wk (D, -28.6%; F, -34.3%) but not at 52 wk (D, -24.9%; F, -16.2%) or the 24-wk follow-up (D, -23.3%; F, -6.2%). At 52 wk, semen volume was decreased (D, -29.7%; F, -14.5%, significantly for D) as was sperm concentration (D, -3.2%; F, -7.4%, neither significant).”

The study dates from May 2007 and was conducted by scientist of the University of Washington, Seattle.

Now my question is: Given the results stated above as well as the information you got directly from Merck, posted earlier on this blog, don´t you think the sterility the two men faced was due to the intake of dutasteride IN COMBINATION with some genetic predisposal to fertility problems if the changes in semen parameteres aren´t that dramatical?

And second: Is there any evidence or even theory this sterility could be irreversible?

Many thanks in advance!

I just reported what I was told by my colleague who was concerned about the sperm count of his son, so he did a test to determine what it was after the dutasteride was give for 6 months. He did it with another one of his patients (maybe more, but he only told me of two) and no sperm were seen on the count.

I don’t want to panic people reading this who are on dutasteride, but I might suggest that they check their sperm count maybe once a year or so. If the Korean dutasteride study had included the sperm count, it would’ve saved us the focused concern on sterility as a complication of the drug (temporary or permanent).