Dr. Rassman,

I would like to request your insight into my situation. I am a 20 year old male and have been on finasteride 1.25mg and minoxidil 2% for one year now. I went to my doctor at the age of 19 requesting finasteride for minor hair thinning. I had not yet lost any hair, or even had any major thinning, but my scalp was visible in the front to middle area of my head under moderate lighting. I have also been expecting to lose my hair for a few years now because of a horrible family history; father, both grandfathers, and all biological uncles but one have progressed to NW5+. My doctor agreed based on sight that there was initial thinning and she prescribed. But I have not ever taken any actual photos or measurements of my hair.

Now, one year later, I am unable to tell by the naked eye whether there has been any improvement or not. Essentially, I seem to have basically the same full hair that I had last year, with maybe some minor thinning visible under the right lighting. I have had no side effects on the medications and I continue to use them.

What would you recommend I do at this point? I know that you do not give medical advice online, but this is more of a procedural question. Is it worth continuing both medications if I am uncertain that they have even been needed at all? Should I try to take some measurements now to gauge my hair loss progress for the future? I am not aware of any doctors in my community, in Hamilton Ontario, who perform bulk measurements or miniaturization tests.

Thanks a lot. All the best.

Did you ever receive a diagnosis of androgenic alopecia? I mean, do you even have actual balding or did you get prescribed a medication base on your insecurity? Almost everyone has their scalp visible under moderate lighting, but that doesn’t mean you’re necessary losing hair. Taking a life-long medication like finasteride without a good diagnosis just because you have a fear of balding is not good common sense.

At this point, I would voice your concerns with your doctor. If that does not help, I would find another doctor for a second opinion.

Snippet from the study abstract published in the International Journal of Clinical Practice:

Objective: We evaluated 5-year safety, efficacy and prostate volume data from BPH patients treated with finasteride or dutasteride. Methods: A retrospective analysis of 378 consecutive men treated with 5α-reductase inhibitor monotherapy between January 2004 and September 2009 (197 on finasteride and 211 on dutasteride) in a single clinic was performed.

Conclusions: In this retrospective analysis of data from consecutive patients treated at a single clinic, both finasteride and dutasteride were effective therapies for the management of lower urinary tract symptoms. However, dutasteride resulted in significantly more sexual side effects and breast complications than finasteride.

Read the full abstract — A 5-year retrospective analysis of 5α-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride.

This study contained 378 men with the mean age of 58.7 years old, and the conclusion of the study (see above) is one of the reasons why we do not prescribe dutasteride off-label. Yes, this is a study of men with prostate issues and the dose is most likely different for treating hair loss… but the side effect risks and dosage for using dutasteride as a hair loss treatment are still unclear.

Hello Doctor, I was on 1mg Fin for 4 months, was very happy with my hair results, however I have developed anxiety and slight depression.

I asked my doctor whether I could lower the dosage and she said I could do 1.0mg pill every other day. She did not explain why.

Are there any studies that show that 1mg every other day is better than 0.5 mg every day? thank you!

I don’t know of a study that compares 1mg every other day to 0.5mg daily.

Logically speaking, Propecia’s half life is about 4 to 6 hours. So by the next day the medication is almost all gone from your blood stream. Thus, the medication is intended for daily use. Taking 0.5mg daily would seem more of a steady state than taking 1mg every other day. Practically speaking, I would think 0.5mg daily is easier to remember as a routine in your compliance than taking it every other day.

Your doctor may have her own reasons behind the recommendation, and after all this is a “practice” of medicine. I would speak to your prescribing doctor on this issue and make sure both of you are on the same page before making any changes to your medication. She might not have explained why she suggested the every other day dosing, but it doesn’t hurt to ask her.

Doctor Rassman/Pak thank you guys for the blog, you guys are truly amazing.

My question is, is Dutasteride really better than propecia? I know its no fda approved for hairloss, but in your opinion do you guys think it is better and more effective? Doctor Rassman/Pak I know you guys rarely prescribe dutasteride, but do you guys have any patients that are on it and have had better results than they did with propecia first? also do you have patients that did not respond to propecia at all, then went on dutasteride and had good response? or at the end of the day avodart and propecia are both the same, and the more dht reduction from avodart does not make any impact more than propecia in terms of hair?

thanks guys

You are correct in stating that we at NHI rarely, if ever, prescribe dutasteride. Some doctors in our community prescribe dutasteride and believe that they gets better results with it versus finasteride. There may be differences in their efficacy, but the higher risk of side effects and long term effects are unclear, especially the risks of sterility that have been reported.

I have occasionally seen patients who have taken dutasteride after taking finasteride, but in my opinion their results are equivocal.

Can cutting back on Fin have better results for some that don’t respond well?

I have recently decided to lower my dose of Fin. Since cutting back I have seen a large decrease in the daily hair shedding. I have been on 1.25 mg Fin for about 2 years now since I have been taking and my hair has continued to slowly get worse. It never really increased in density at all. I simply believe that I may be a non-responder.Now that I have been on .625mg, I believe that my daily loss has decreased as while after I dry my hair in the shower I do not see bunches of hair just falling out like I normally do.

My question is that, if someone is one of theses so called non-responders, could cutting back or even getting off of Fin actually help with the hair loss or will I soon see an large increase in the shedding due to my lowering the dose?

Thank you in advance

I do not know if lowering your normal finasteride dose will DECREASE shedding. It does not seem to correlate. You must also consider that your hair loss rate may not be consistent or at a constant rate, and the change in dose may be coincidental. Your perception of shedding may be just that — a perception and not a definitive fact. Without microscopic examination or bulk analysis (objective measurements), it is difficult to tell.

I do not know how lowering your dose will affect hair loss over time. I guess only time will tell. You should talk to your doctor about changing the dose.