Dear Dr. Rassman,

recently you wrote on this blog about having advised several of your patients seeing a certain loss in efficacy of finasteride treatment to higher the dosage from the regular 1 mg per day to 2.5 mg (half a proscar). In older entries, however, you are strongly advising against that therapeutic “move”. Could you please explain why you seem to have changed your mind on this and what conditions you´d like to see fufilled before making such an increase in dosage!

Thank you so much!

There have been more and more complaints by some patients that over the long term, Propecia seems not to prevent the advancing balding patterns that they are experiencing. Because of the high interest in Avodart in some individuals who are not getting control of an advancing balding pattern (without its FDA clearance), there seems to be a consensus by some of the prominent doctors in the field that 2mg of Propecia (or 2.5 mg of generic finasteride — which is a half of a Proscar/generic finasteride pill) may be better in some of these individuals and worthy of a try. Please note that I’m not suggesting that people increase their dosage on their own without talking to their prescribing doctor.

As long as there are no negative side effects, I believe it is a better option than Avodart, which I am reluctant at prescribing until I get more comfortable with the FDA clinical trial that just completed. I will try to understand this better at the ISHRS meeting next month in Amsterdam, where the Avodart study will be discussed. Once I know more, I’ll post it here.

Dear Dr Rassman
You wrote an answer to someone yesterday saying this:

“The issues of safety and effectiveness have not been fully explored in the youth like you with Avodart. Without that information in a research controlled, FDA approved study, there is no way to tell the answer to your question. Unfortunately, the manufacturer has not elected to sell into the hair market, despite the good blocking effect that Avodart has on the targeted enzyme. The FDA has certified this drug for prostate disease and I suspect based upon this, the drug should have no impact on the egg fertilized by the sperm of a man taking the drug, or when having unprotected sex during pregnancy”

Does that mean that they do not want to put Avodart on the market for hair loss after all? Please Advise!!! Thanks

The answer you’re referencing is something I wrote way, way back in February 2006, before official trials for using Avodart as a hair loss treatment took place. I’ll know much more about Avodart after the International Society of Hair Restoration Surgeons (ISHRS) meeting next month in Amsterdam and will post what I find on the blog.

Hi Doc,

I have been on propecia for over 4 months and had to stop due to side effects (started developing gyno). Couple of months passed and I started seeing massive shed which is probably the catch up hair loss. Since I cannot go back to propecia/fin, is there any topical treatment (other than rogaine) that can help slow down this process? I am not looking for any regrowth at this point, but just want to make sure the catch up hair loss can be controlled at all? Thanks for your valuable suggestions.

I just had a patient who reported gynecomastia along with some sexual side effects from Propecia, and after he reduced his dose to 1/4 of a pill (0.25mg) he was able to continue taking the drug without side effects. It is only a report by one patient though. Most of the patients who have had gynecomastia usually do not tolerate the drug even at lower doses and when there is gynecomastia, there is often other libido and erectile dysfunction side effects as well. A quarter of a pill is better than none, so I would recommend trying a lower dose of Propecia before completely quitting on this medication. Minoxidil (Rogaine) is the only other FDA approved hair loss medication, so your choices are limited.

Dear Dr. Rassman:
I have a question about finasteride as a topical solution. There is much speculation that topical usage of finasteride is as effective as oral administration. I even heard that some chemists are grinding finasteride and dutasteride into some vehicle like alcohol and apply it topically. There is also a company (www.hairgrowthmd.com) selling combined minoxidil and finasteride as a spray product and claiming the success with no side effects. Considering the fact that finasteride has large molecule size ( C23H36N2O2 with a molecular weight of 372.549), it is hard to predict that the topical form is to have any effect on the hair follicles (they have to penetrate the epidermis and enter the capillaries in the dermis and subcutaneous layer). As far as I know, FDA has approved only oral administration for 1mg a day for male patterned hair loss.

Do you have any opinion or suggestion regarding to use finasteride in a topical form?

P.S. There is also one publication on this: “Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol 2009;75:47-51”

thanks

I would like to believe that the problem is solved with topical finasteride, but I need a good solid peer reviewed article to make these claims credible. The study you mentioned does conclude with, “Finally, we suggest replication study of more samples, with longer period and assessment of patients’ satisfaction after treatment.” — and I agree that it needs more work done before one could reasonably conclude that a topical finasteride is as good as the oral treatment. The problem I see is that if it is not effective and you take the topical preparation instead of the oral proven medication, you will lose hair irreversibly the longer you delay treatment.

How long do you have to be taking Propecia to then quit and see “catch-up” loss? I only took it for 3 months and quit due to sides. My hair loss never really stopped, and I heard it took a year for a real effect. Is that enough time to cause accelerated shedding/loss thru the catch up process as opposed to the regular speed of the balding process? I mean, my “real” pattern three months on should not be that much worse.

I believe you are probably safe, as you have not taken the drug long enough to get the benefit you would lose by stopping it.

I am male and in my late 20’s and starting to see that my hair is thinning. I was on propecia for a very short time and had to stop do to side effects(breast pain and ed). I tried cutting down the dose (without stopping) but the side affects continued. I’ve read on a few sites including wikipedia that Sweden claims finasteride has permanent sexual side effects. Has anyone found something to take with propecia to eliminate or block side effects? If you think I should give it another chance how would you suggest I go about it? I don’t want to take minoxidil because how it works is fairly unknown. If topical Spironolactone works for acnea doesn’t that mean it does absorb into the skin enough to compete with dht receptors? Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris.

If I decide to try topical spiro, is it something my gp can prescribe? if not could you varify if the much talked about Dr. Richard Lee is credible (or atleast not another scam). I’m not opposed to a hair procedure but because I’m just starting to thin I’m not sure how and how often it would be done and the cost. I know this was lengthy but it’s much appreciated

I do not know of anything that will block the possible breast and erectile side effects of finasteride that a tiny percentage of men will see. If you experience erection issues, Viagra or Cialis will likely solve that. For my patients that might see a side effect (real or otherwise), cutting the dosage is better than stopping it completely. In other words, some finasteride is better than no finasteride if you want to treat your hair loss. Most men will choose the hair transplant approach if the side effects are a problem, but the risk of shock loss in young men with transplants is the other side of that coin.

Spironolactone is a prescription medication, so while your doctor could prescribe it to you, he/she might not be willing to do so. That article you referenced is over 20 years old, and spironolactone is still not a popular hair loss treatment for men… so that should tell you something about it’s effectiveness. And as for Dr. Richard Lee, he has a number of customized minoxidil and finasteride treatments for sale via his website, one of which I have written about before.