I’ve been on propecia for almost a year now and I noticed that I’ve started shedding hair after 2 months into the medication. Its almost a year now and I am still shedding hair, it looks like its becoming worse. The hair that is shedding has also become finer than usual. You mentioned that shedding usually occurs for a while and we should carry on for at least a year. Its a year now, so should I continue the medication?

It seems that your genetic predisposition may be winning the battle over Propecia. You should see your doctor who prescribed you the medication and discuss your options. You may consider adding Rogaine or even increasing the Propecia dose* (but again, discuss it with your doctor first). You may even consider having the HairDX Test for Finasteride Response done, which may explain a failure to respond to the drug. Have you had the status of your miniaturization compared with your pre-Propecia status? That would give you a great deal of information if you had that test done as miniaturization should have decreased on the drug.

* I have recently blogged of increasing the dose of Propecia on select few patients. This does not mean it works necessarily but for those few patients who have no side effects and are continuing to lose hair it may be worth a shot. Keep in mind there is no clinical study to suggest this approach is the solution.

Hi,

I’ve been going for hair transplant surgery last 2 months and after the surgery the doctor recommend me to take propecia to maintain my existing hair as i was indicated of suffering from Male pattern hairloss. Just 3 days ago i start to apply Proscar and split it into quarter 1.25 mg as financial problem and use it daily without side effect so far. Surprisingly my hair stop to fall off immediately as only used for 3 days..

My question is now i am taking 1.25 mg of proscar daily, and i plan to switch to Propecia 1 mg after 2 years from now on. Is there any case of intensive shedding happened if switching from Proscar 1.25 mg to Propecia 1 mg? As most of the cases is only mentioned switching from Propecia to Proscar for cost saving.

Thanks for your sincere advice.

Cheers.

Proscar and Propecia are both the drug finasteride just at different doses. Switching between them is no problem at all. The difference in the 1.25mg dose and the 1mg dose is relatively insignificant.

Hello Doctor,

For the past year I have noticed more hairs in the shower and also when I comb my hair. I am 22 and my hair loss does not seem to stop or slow down. I have noticed over the past year that my hairline has receded in the temple area. Also, the sides seem to be thinning and receding. I went to my doctor and told me the hair loss may be due to stress since he found no pathology from my blood test and he said I may use Rogaine. I have not used Rogaine. Based on my observation I am at Norwood Class II. I am worried my hair problem will get worse but not sure if I should start medication. Are these symptoms of MPB? Propecia workes best at the vertex yet I do not have much thinning or hair loss in that area. What would you recommend I do? I know that the earlier I deal with hair loss the better, but if I start early will Propecia still have its effects 10 years or more from now? Also, I do not have much money so would you recommend I take a generic of Proscar?

Thanks

You’re in LA, I’m in LA. You can come in for a free consultation and find out about your hair loss for sure. I can test your hair for miniaturization and we will be more certain if you are really balding and where you might go with it.

I can’t make drug recommendations without seeing you, but I can provide general info. Propecia does work best at the vertex, but it will halt or slow the hair loss all over the scalp. Rogaine also works best in the vertex. Propecia will still have effects for as long as you take the medication, but as hair loss is progressively a game of tug-of-war, the Propecia will possibly not be able to hold on to as much hair as time goes on. I’ve had patients that have been taking it for a decade without problems, and then there’s some that I’ve increased the dosage for due to lackluster visual benefits after 5+ years. Everyone is different. Generic finasteride 5mg (Proscar) is a lot cheaper than Propecia and is the same medication.

Dear Dr Rassman,
According a study done on behalf of Merck, patients treated with 0.2 mg finasteride showed approximately an increase of 61 hairs versus an increase of 77 hairs in 1 inch square treated with 1 mg of finasteride over the 6 month period. So can we say that taking 0.5 mg of finasteride may yield nearly the same results with 1 mg treatment

You are correct. We have known about this for many years (and have reported it here), though the standard dose is 1mg. For those who have unwanted side effects, taking 1/2 of the standard dose of Propecia should be considered, which we have been advising for many years.* Some of the original studies suggest that 1/2 the dose can be 80% as effective as the full dose and 1/4 of the dose could be half as effective as the full dose.

The original Merck study wanted to know the best and most effective dose, and the statistical data suggested 1mg. This was across a large population and if you assume that there is a bell curve, there is a wide range of responses. That also may mean that as many people as impacted by 1/2 the dose with 80% effectiveness, one might see that a sizable proportion of the population may require a higher dose than 1mg. When we see the response fall off, or a poor response, we are now recommending doubling the dose provided that the side effects do not appear.

*As always, discuss any changes to your prescription medication dosing with your prescribing doctor.

Dr. Rassman,

Good info is provided in this blog, I want to ask you a question regarding a previous posters comment on Generic Finasteride. Your response to the blogger was to purchase Generic Finasteride at Cosco or Wallgreens instead of ordering generic Finasteride online. How is this possible when Merck was granted an extended patent until 2013 (See Wikipedia on Finasteride)?

Also do you think its safe cutting the 5mg into 4ths which will be 1.25mg approx? Thanks!

Generic Propecia (1mg finasteride) isn’t legally available in the US due to the U.S. and International patents held by Merck, but generic Proscar (5mg finasteride) is available in the US and that’s what I was referring to. When cutting the 5mg pill, you’ll likely have some crumbs, so it might be a little less than 1.25mg. Regardless, I don’t think it’ll be a problem. If you can cut it into 5 equal pieces, that would be ideal… but not practical and the dose clearly does not have to be exact (as discussed elsewhere on today’s posts).

Dr Rassman,

I’m in my mid-30s and have been experiencing hair loss for the past 5 years. I feel like I’m at the stage where I need to decide if I want to take finasteride or not. My biggest concern is the side effects.

It seems that more and more I hear (both on the news and from friends who are doctors) how doctors are seeing a greater prevalence of male gynecomastia. The often sited reason for this is due to the increased use of finasteride (both for prostate treatment and hair loss treatment). Of course, it could just be that gynecomastia in men makes for an interesting story on a slow news day…

My question is, do the number and types of side-effects experienced by your patients on finasteride agree with published studies?

In reading this blog you do make mention of how some of your patients experience side effects, but you’ve never made mention if the number of side effects you’ve seen clinically are more, less, or the same compared to the numbers posted by Merck.

I’ve had 2 patients in the past 2 years that had gynecomastia. Both stopped finasteride and it went away. Most of my patients are on Propecia/finasteride. I would tend to agree with the statistics published by Merck.