The Propecia Timeline

/by William Rassman, M.D./1 /

I understand that you’ve answered questions similar to this multiple times, however I’m still having a hard time putting the overall logic of this drug together…

First of all, here is my situation. I am 25 years old. I began experiencing light thinning around the crown and in the mid-anterior area about 6 months ago. It seemed to progress very slowly, but 3 months ago I decided to begin propecia 1mg daily. I experienced one or two days of VERY noticeably shedding about a month after starting the drug (I brushed my hand lightly over the top of my head once and saw dozens of hairs fall into the sink one time). I don’t know if this was caused by the drug. I have now been on the drug for 3 and 1/2 months. I now have noticeably more hair loss than I did at the beginning, when I comb my hair I see 10-20 hairs fall out. Am I too optimistic in believing that I should experience good results because of my age and that I began the drug within a few months of my hair starting to thin? Is how quickly you get results an indicator of how good those results will be?

You indicated in response to another reader “When Propecia works, it works very fast. You may not see the full impact for 8 or so months, but you do not have to wait to get the benefits”(March 21 2007). What is the difference between “impact” and “benefits”? One occurs very fast, the other takes 8 or so months? I’m confused… And I’m not necessarily asking you to make a premature prediction about MY results (although if you you felt like it I would be interested), I’m moreso just trying to understand the logic of how I should evaluate my response to the drug over time, so that i can make a more educated decision about whether to continue putting a foreign substance into myself for cosmetic reasons.

Thanks for your time.

The biochemical connection at blocking the DHT occurs in days or weeks after starting the drug, but as hair grows at 1/2 inch per month, it takes time for you to see the results. In addition to this, the impact on each hair may be different depending upon the degree of miniaturization and I believe that this is real, but there are no studies on this that show any science behind this statement. What we do know is that the benefits of Propecia seem to increase over time (up to two years) so my last statement may be the mechanism behind the incremental benefit that is seen. The decision to take Propecia is a personal decision for each man who is balding and all we can do as doctors is advise our patients on what we know.

Tags: propecia, timeline, hairloss, hair loss, dht

Finasteride and Gynecomastia

/by William Rassman, M.D./0 /

I plan to take Proscar (split into 4/1.25mg each) but my biggest concern is breast enlargement. What would be the best way to determine I was experiencing the side effect? I am very slim with zero fat (like a 33″ chest) and chest is pretty flat. I’m wary that it can be harder for one to notice a gradual change so would taking photos from the side and comparing every week be an idea?

How likely would any change in feeling (tenderness, pain etc) be an indicator of gyno starting to occur? If I noticed a slight increase in breasts and stopped Proscar immediately would the size return to normal – and how long may it take? And at what point does it no longer become reversible? Thanks.

Breast tenderness and breast enlargement are different — one may not be indicative of the other. Each person is different, and as that particular side effect is extremely rare, I can’t say for sure where the “point of no return” is. It varies from person to person. Just try not to get too obsessive about it, but if you do begin to notice anything strange, then discuss it with your prescribing doctor. You won’t just wake up with man-boobs overnight and certainly, the side effect is so rare that it shouldn’t be cause for worry.

Tags: gynecomastia, hairloss, hair loss, breast, finasteride, propecia

Can I Apply Rogaine to the Vellus Hairs at My Hairline’s Corners?

/by William Rassman, M.D./0 /

Dear doctors at Balding Blog,
once again, I would like to take this opportunity to thank you for your great work. It is really really much appreciated from everyone out here. I have a question which I have not seen answered, so I hope you can help me out.

  1. I believe I am a guy with naturally high Testosterone levels. I have a very high sex drive, and I believe this is causing my excessive testosterone to be converted into DHT. Do you think that is logical? How do I reduce my sex drive?
  2. I have been on Propecia for 10 months. How long do you think I should wait to see results? My hair has been slowly thinning, and now I can’t even comb it properly.
  3. I have a receeding hairline, especially at the corners. However I can see tiny vellus hairs at the corners. Should I start applying Rogaine in that particular area?

Thank you very much for your time. I wish you and your team all the best always

  1. I do not suggest that you try to reduce your sex drive, but if you think that your testosterone level is too high, get it tested.
  2. The results of Propecia take at least 8-12 months to see benefits, but that benefit may just be reduced hair loss, not hair growth.
  3. You can apply Rogaine to the corners, but you will have to wait at least 8 months to determine if it works.

Thank you for your well wishing. I hope I helped.

Tags: rogaine, minoxidil, propecia, finasteride, hairloss, hair loss

Topical Zinc Can Block Minoxidil

/by William Rassman, M.D./0 /

Dear Doctor,

regarding the use of zinc together with minoxidil. Please note at the end of this page (HairLossFight.com):

“There are studies in regards to the use of topical zinc. However, zinc will form insoluble salts when it reacts with minoxidil/azelaic acid, rendering all of the ingredients ineffective.”

The above email was received in response to Can Zinc Block Minoxidil?. Thanks for sending this in.

Tags: zinc, minoxidil, rogaine, hairloss, hair loss

Testosterone, DHT, Acne, and Propecia

/by William Rassman, M.D./0 /,

First, I would like to Thank you doctor for having this blog. I just have a couple of questions that I can’t seem to get an answer too, and I decided to ask an expert like you. I would really appreciate it if you answered this question, as it is stressing me out lately. Firstly im 23 year old male with thinning hair, and these 2 questions are a reason I am reluctant in using propecia. My dermatologist prescirbed me the propecia but he was in such rush the day I went, and I coudnt ask him my questions. I still have my prescription but I am reluctant to use it.

If DHT(the by-product of testosterone) is responsible for angrogenetic alopecia in genetically predisposed males, then why does the increase in testosterone (or even normal levels testosterone) from taking propecia aggravate more hairloss or even aggravate more hairline hairloss(as I have read in numerous internet hairloss forums, from people complaining of more hairloss from propecia)? Isnt DHT suppose to cause the hairloss and not just testosterone by it self? Or does testosterone cause hairloss as well by itself? If the testosterone will cause hairloss then what is the point of taking propecia as it will only block DHT but that will just let the testosterone or sometimes the increased testosterone that results from propecia take over and continue the hairloss in genetically predisposed males.

Also doctor I also suffer from acne as I take topical clindoxyl gel and topical differen to correct that problem. I have read numerous medical articles that DHT is a cause of acne, then why does propecia sometime cause acne as a side affect? I know its a rare form of side affect but I have read people complaining from propecia causing acne or increasing there acne. If propecia inhibits DHT, and DHT is a culprit for acne, then shouldn’t propecia help out with clearing the acne problem instead of aggravating it? Or does the testosterone cause acne and propecia raises testosterone and thus cause more acne.

I Am really confused here. I really do want to start using propecia so if you can take the time to reply and answer my question, I would really appreciate it Doctor. Thanks again

These are questions you should ask your doctor, not us here. There is a feedback loop in the human body so when the DHT drops, the testosterone goes up to compensate for it. This is the best explanation I can give on the process. Testosterone does not cause hair loss until it is converted to DHT. That is just the way it is.

I am not an expert on acne so you should see your doctor or dermatologist on these questions. I haven’t a clue why Propecia might cause acne. I haven’t seen that in my patients, and as hormones aren’t fully understood, the connection is difficult to make.

Tags: acne, hairloss, hair loss, testosterone, dht, differen, clindoxyl

If I Take Finasteride, Can It Effect My Child’s Growth?

/by William Rassman, M.D./0 /

Dear Doctor

First of I would like to congratulate you on this wicked resourse, I have a buring question wondering you can shed some light on. One of the common side effect of taking Finastride is that it directly effects the sperm making it watery etc. We planning for a baby and I am wondering taking Finasteride will directly effect the child, growth etc? I have not yet seen my GP but everytime I put my hand through my hair I get 2-3 hair that come out, front and crown. but still got a thick head of hair.

Thank doc hope to hear from you soon.

If you are worried about the quality of your semen, then get it check out by your doctor. Finasteride does change the quality of the semen in some men (about 20%), but it has not been reported that it will reduce your chance of getting your lady pregnant or effect the child’s growth. It is normal to lose 100 hairs/day.

Tags: propecia, finasteride, child, hairloss, hair loss

My Libido is Up with Saw Palmetto and Finasteride

/by William Rassman, M.D./0 /

Hi there doctor, I have a question about hairloss products like finastride and saw palmetto! I have been taking saw palmetto and finastride for the last two years due to hairloss! Before I started taking these products I suffered from depression! One of the things I was depressed about was the fact that my libido was really low in other words my sexual hunger had gone! Since taking saw palmetto I have found that my sexual hunger is up and my hair is slowly growing. the only thing I am concerned about is the safety of these tablets? I really don’t want to stop taking them cause I feel like I have gained hair and gained my life back, I have so much energy and feel great. Please help me? Also do these tablets cause you to gain weight?

I report these comments, but I don’t know what to make out of them. Both of these medications could increase testosterone, but most of the time they have no long term effects. I’m not sure what you’d like my help with if your libido is up. They do not make you gain weight.

Tags: saw palmetto, propecia, finasteride, hairloss, hair loss, libido

My Doctor Found Out I Was Taking Propecia at 26 Years Old and Is Quite Concerned

/by William Rassman, M.D./0 /,

Hello doctors,

I am 26 years old (male) and have been taking Propecia since age 24 (when I noticed my hairline starting to recede). When I last visited my family doctor (this was the first time he found out I was taking the drug), he was quite concerned that, at my age, I was taking it. He said that the long term effects of Propecia are not known, and that he would advise against me, being only 26, continuing on with the drug.

I have never noticed any negative side affects from the drug yet, but I wanted to get a few more opinions. Do you know of significant endocrine effects?

Thanks.

Propecia can be used safely from the age of 18 and up. If you wait on its use, the balding will progress far too much to have the types of benefits it has when it is started early. Sounds like your doctor needs to be educated. You haven’t seen any side effects, so I’m not sure where your doctor’s concerns are based in.

Tags: propecia, finasteride, hairloss, hair loss, concern, doctor

Do I Need to Wash Toppik Off Before Applying Rogaine?

/by William Rassman, M.D./0 /,

I am a 52-year-old woman with diffuse hair loss. I’m using Toppik and thinking about starting Rogaine. My question: do I have to wash the Toppik out of my hair in the evening before I can put the Rogaine on?

The Toppik tends to “clump” on my scalp by the end of the day, so if I don’t wash it out, I’ll be rubbing the Rogaine on top of the Toppik fibers. But having to wash my hair twice a day (morning and evening) seems excessive.

Thanks for any advice.

It is best to use Toppik as the last thing you do. The Rogaine should be applied first and give it some time before the use of Toppik.

Tags: toppik, rogaine, minoxidil, concealer, hairloss, hair loss

After 10 Years on Propecia, I’m Seeing Hair Loss Again

/by William Rassman, M.D./0 /,

Hi:

I am a 30 year old male that started taking Propecia 10 years ago. For almost that entire time, I have been very happy with the results. However, starting just 6 months ago, I have noticed a considerable amount of daily shedding, especially in the shower. I have also noticed a great deal more of recession in the hairline. To help combat this, I have started applying Rogaine Foam, and taking Procerin tablets regularly.

I am sure I will have to wait a little longer to see if the added products help combat the shedding, but my question to you, is should I increase the Propecia dosage as well? Right now I am only taking 1mg. Hair Loss is common in my family, as my two older brothers are almost completely bald. I’d like to do what I can to avoid ending up there myself. If you could share your initial thoughts with me, I’d appreciate it.

Thanks

The 1mg dose recommendation is across the board, but it might be worth a try at 2mg as more and more doctors are now trying a slightly higher dose. Double check with your prescribing physician, but if you do not have side effects, go for it.

We really do not know how finasteride will alter the long term (15+ year) balding pattern. We are hopeful that it will slow the balding down, but the real question is, “Will you still eventually wind up at your final hair loss pattern?” Propecia has been on the market only about 12 years, so we don’t really have the experience over a 20 year time period.

Tags: finasteride, propecia, hairloss, hair loss

Taking Propecia and Applying Revivogen / Minoxidil Combo

/by William Rassman, M.D./0 /,

Dear Dr, Rassman,

First of all i’d just like to say what a source of support your blog has given me over the past year, when i first noticed my hair loss. Being resident in the UK, we really are in terms of awareness, knowledge and treatment of hair loss years behind america! To give an example, my GP had never even heard of propecia! So thank you for creating such an informative forum that really helps people such as myself, educate themselves about the multitude of issues and treatments regarding MPB.

I staerted noticing about a year ago that my hairline was begining to receed above the temples, i was 23 at the time. I went to see a trichologist within a month of this and basically, was given so called “snake oils” and high frequency treatment which i payed a lot of money for. When i look back on this, i cannot believe how naive i was to trust that this approach would work. Basically i was scammed! and i believe wasted precious time, which could have been spent pursuing one of the 2 medically proven treatments.

I’d say in the last year the hairline has gone back about half an inch on the left side, but hardly moved on the right side, but the hair there seems less thick. To be sure i’m doing everything i can to provent further loss- i started propecia 2 months ago, and apply revivogen (natural DHT blocker, medically unproven, but i’m a medical student and have read the trials revivogen performed on its efficacy cf. propecia and they looked promising) once a day to the hairline along with minoxidil 5 per cent 3 hours later daily.

I know that the sooner you catch the hairline recession the more chance you have at getting results- as theres a smaller window of time to restore the hair follicles in the frontal region, as i understand it. What i would really appreciate is your advice on the steps i’ve taken (after noticing minor recession in the past year) have i done the right thing? and in your experience, would you say that if you catch frontal recession right at the beginning, can it be controlled?

I would really appreciate your expert opinion on this, as we don’t really have many specialists in this field in the UK and in general GPs are clueless about hairloss! Having your assessment would really mean a lot to me and take away some of the anguish i have at the moment as all the doctors i’ve consulted up until now have been completely clueless.

thank you in advance

You’re still in your early 20s with early hair loss — so yes, it does sound like you’re doing the right thing by starting Propecia. Having only taken Propecia for two months, you aren’t likely to see any benefits just yet, but stick with it. The Revivogen/minoxidil combo isn’t something I’ve heard tried before, but best of luck with that. It sounds like you’re taking proper steps and even being a little creative with your approach. As long as you’ve got the finances to handle so many treatments at once, then go for it.

I’m glad you’ve found this site helpful in the time you’ve spent here, and I hope you continue to enjoy it. Thanks for your kind words.

Tags: propecia, revivogen, minoxidil, hairloss, hair loss, rogaine

Vitamin C Supplement Ester-C and Hair Strength

/by William Rassman, M.D./0 /,

Ester-C has greatly reduced the amount of hair that I naturally shed. I have tried this three times and have experienced the same results. There are several people that have witnessed my results. Shedding has been reduced by approximately 80%. I also take Avodart, but it is the Ester-C that has had this effect. I haven’t noticed any increase in actual hair growth from Ester-C. I just seems to make the hair stay in the follicle better. To sum it up, by taking Ester-C my hair would survive a pull test far better. This is factual information and could easily be proven.

Thanks

I am unfamiliar with the connection of vitamin C to hair loss prevention or increasing the strength of your hair while pulling on it. Maybe the use of Avodart (dutasteride) is somehow potentiated by it, but that is like playing roulette and any guess is as good as another one.

Tags: avodart, dutasteride, vitamin c, ester-c, hairloss, hair loss

Can I Apply Minoxidil 5% Four Times a Day?

/by William Rassman, M.D./2 /

Dear Dr.

i want to know, if i apply minoxidil 5% solution 4 times per day, will it = applying a minoxidil 10% solution twice daily? which will have better result? i ask this question, as i found that the higher concentration, like 10% or 12% or 15% is much more expensive than the 5% one!

I don’t know the answer to your question, as I’ve not experimented with 10% minoxidil on my patients. Remember, minoxidil is a hypotensive drug and more frequent use could lead to more low blood pressure side effects.

Tags: minoxidil, hypotensive, hairloss, hair loss

Minoxidil with No Propylene Glycol?

/by William Rassman, M.D./0 /

Doctor,

What do you think of minoxidil products sold by doctors with little or no propylene glycol? Do you think they’re still effective as long as minoxidil is the main active ingredient? (Tried Rogaine foam, very hard to apply through hair to the scalp)

It appears on the internet a large number of people are only using minoxidil once a day. Usually at nite. Do you see that at your practice? Are they having results or developing dependency?

Also, it appears I can only handle .5mg of Propecia due to side effects. I think you’ve stated it’s about 80% effective at that dose. Have you seen that 80% result in your clinical practice?

Thanks for taking the time everyday to answer everyone’s questions. I’ve learned more than anywhere else on this blog.

Rogaine FoamI don’t see why the lack of propylene glycol would make minoxidil ineffective. The propylene glycol is supposed to help the minoxidil penetrate the scalp better, but it isn’t used in the Rogaine Foam or in the Women’s Rogaine liquid (which is good for those that may have allergies to propylene glycol), so I’d expect that other delivery mechanisms, such as alcohol, work relatively well. I really have no opinion on the various ways the doctors make their minoxidil formulas. The recommended use is twice a day, but many people do use it once a day. I can not tell if once a day works across the board.

My comments on the 80% effectiveness of 1/2 mg of finasteride came out of a conversation I had with Dr. David Whiting (and might’ve been in something I read), not my own clinical study.

Tags: minoxidil, rogaine, propylene glycol, hairloss, hair loss, propecia, finasteride

Updated Propecia Info Says There’s Erection Difficulty After Discontinuing Treatment

/by William Rassman, M.D./0 /

Dr. Rassman

You have always been against the idea that propecia side effetcs may be permanent, and I saw you telling many people that the side effects as released by Merck are temporary and have been approved by the FDA. now it seems that there is an updated Prescription Information for Propecia. you can check it yourself at this link

among the most important changes are (in section 4, “Possible Side Effects”): “Persistent difficulty having an erection after discontinuation of treatment.”

Anything to comment? Thanks

Interesting, but the information lists that under the heading “Frequency unknown“, which leads me to believe it must be extremely rare. I have no information on this and have never seen it in my practice. I wonder about psychological impact on those that are affected.

The PDF you linked to appears to be for the Austria, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Portugal, Spain and Sweden markets… and Merck doesn’t seem to have the same information in their US pamphlet. I really could only speculate as to why that is the case, though.

Tags: finasteride, propecia, side effects, erection, hairloss, hair loss, medication