In a report in the Australasian Journal of Dermatology published last week, a case was presented of a 47 year old man who did not see the same hair density after 4 years on finasteride. The doctors added 0.5mg/week dutasteride to the treatment plan and there was a dramatic increase in hair growth.

There is a problem for what is called “poor responders” to finasteride, and the focus of this article was to add a low dose of dutasteride weekly. There was no significant sexual side effects with this particular patient, but of course, the issue remains that sexual side effects could be significant in other patients. Dosage is a problem, as some doctors have prescribed 5 times the dose of dutasteride at 2.5mg/week, or even daily use. The dose increases the costs for the patient and no one really knows the recommended period that a patient should take this increased dose nor the time to obtain the therapeutic response. Worst case, we do not know if dutasteride acts as a carcinogen that can cause a high grade prostate cancer, as the story is not in yet on the full extent of the safety of this drug over time.

In no way am I recommending you add dutasteride, but you can talk to your prescribing doctor about your case. The above is just a single case study presented, but it was worth posting here to get your always fascinating feedback.

Hi Doc, Id like to ask you if you have any pictures of the best results of propecia on any of your patients that you could show us. Thanks a lot. I love your blog.

I just searched for “propecia results photos” using the box in the top corner of the site and found these —

1. 1 Year Propecia Results in a 45 Year Old Man
2. Patient Result — 1 Year After Rogaine Foam and 0.25mg Finasteride
3. Reversing Frontal Hair Loss with Propecia
4. After a Year on Propecia
5. Response from Propecia in 49 Year Old Man

There’s more on the site, but these are the first ones I found. There’s a lot more great results I’ve seen in my practice, but I can only publish the photos when I’ve been given permission. Hope this helps!

I want to know if it is normal to experience more hair loss during the 6th month of Rogaine use just as I experienced during the first 4 weeks of use which was considerably.

I have been experiencing hair loss since I was 18 (I am 29 now). 3 years ago I starting using products with Minoxidil 5% prescribed by physicians. However it became to expensive. After 5 months of quitting I decided to start using Rogaine due that I was losing more hair as I stopped using those products.

Results after 3 to 4 months of using were really tangible. However, as I said I am on the 6th month and I am experiencing more hair loss from about a couple of weeks ago. I am assuming is part of the hair loss cycle, however I am not sure if Rogaine is no longer working for me. Or what should I expect in the following weeks?

Thanks for the support

I wouldn’t say it’s common to see increased shedding after 6 months of Rogaine use. I’ve heard about shedding after starting the medication, but that shedding shouldn’t reoccur after half a year. The loss could be coincidental to something else going on.

You might want to go back to your prescribing doctor for a follow-up. Since the Rogaine doesn’t actually block DHT (the cause of genetic hair loss in men), you could be experiencing the normal loss you’re genetically determined to have. I really have no way to know. Or you can just ride it out and hope for the best.

I used Propecia for years but developed serious and persistent sexual side effects. I have had to see various urologists. My testosterone and other medical work up was normal and I am fit and of ideal body weight. I do not have any health problems (no cardiovascular disease, no diabetes, and so on). I also developed brain fog and a sort of amotivational syndrome on Propecia which I had misattributed to other things.

It wasn’t until I stopped the drug that my motivation, aggression, and cognitive performance returned to normal. After four months, my ejaculate volume remains miniscule. The problem I having now is that my hair loss is alarming rapid and I am distressed by it. I have just experienced a serious shedding. Feels as if I lost 50% density and the hairline has shot up seemingly a half inch in the temporal areas.

Despite the side effects, I am considering going back on to slow the loss hoping something else will come out. I am scared that I will be impotent and infertile back on. I feel I am between a rock and hard place. What do you recommend patients do? Would a low dose be wise? 0.25 mg? 0.5 mg?

I generally suggest that my patients reduce the finasteride dose from 1mg to 0.5mg or 0.25mg and see if these lower doses work. Some earlier estimates I have reviewed suggest that the 0.25mg dose still works at about 50% efficiency on stopping hair loss.

Now that I told you this, you need a good doctor to manage your problems. This is a prescription medication, so all I can provide is general advice. You need to talk with your own doctor about what is the right step for you. Lower dosage has shown some effectiveness in my patients that were worried about side effects, but it isn’t a guarantee to work the same for you. Get a bulk measurement of your hair so that you will know if the dose adjustment still works.

I’m almost 26 years old and been using Fin 1.25mg for exactly 4 years for early hair loss. Since starting fin my hair loss ceased completely, I still look the same like 4 years ago! For the past few years I also saw way less hair shedding.

For the past 2 months I see a much bigger increase in hair shedding including weak hairs. My hair length is always the same (medium long) and I been using the same hair products gel & mousse all the time. When fin loses effects is increased hair shedding the first sign? So far my hair still looks the same but I’m definitely very worried.

I have said this over and over here on BaldingBlog: There is no way to completely stop hair loss (your genetics win out in the end).

Finasteride (Propecia) will help, but everyone is different in how they respond and how their genetic predisposition will work out. There is no sign that indicates finasteride is not working, but it is more about how your genetics is winning. It might just be semantics, but I want to be sure everyone is clear. If you see the loss start up again, finasteride is still working, but your genetics are winning out. It doesn’t just stop working.

I can’t explain your recent increase in hair loss, but if you’re concerned you should pay a visit to your prescribing doctor for a follow-up exam. If your doctor made bulk measurements before you started the medication, he could tell if your hair loss has picked up again. Get some good measurements of your hair loss so that in the future, you can tell what is really going on.

Hello Drs. Rassman + Pak, thank you for creating this amazing website.

You recently posted regarding the (encouraging) 10 year Finasteride usage clinical results. And, I believe, you have stated that some NHI patients have used Finasteride for 10+ years and maintained their hair almost completely.

I was wondering about the flip side of the coin — what is the MOST hair loss you’ve seen among patients who have stayed on Finasteride?

I ask because I’m nervous about my own future (as a 28-year-old Norwood 3 on Finasteride who just had a transplant).

Thank you!

I am not sure how to quantify the most hair loss I’ve seen. When I meet with patients and examine their hair loss, I generally give them a Master Plan as to where their hair loss is going. So if an 18 year old male with a full head of hair comes for an examination and I see that they have almost all miniaturized hairs on the front and top in a Norwood 6 pattern, I can explain to them they may progress to a Norwood 6. I would then likely put them on Propecia and after a year they may grow some hair back, or at the least maintain what they have.

Over the following years, I suspect they would lose more and more hair, but at a much slower rate than if they were never on Propecia. Eventually, after 10 or 20 years, they would end up as a Norwood 6, but before this happens they may choose to have a hair transplant surgery to avoid looking bald. This is an example of what I mean by a Master Plan. I don’t immediate recommend surgery, but plan out how someone may lose hair and bald, which is why we come up with a road map to address their hair loss issues (with medication and surgery).

But to give you the short answer — I have seen someone still go bald, despite being on Propecia. Genetics will always win out and I can’t guarantee the medication works the same for everyone that takes it.