Hi, I have a couple of questions about finasteride, if you have any answers they’d be very appreciated:

– Does finasteride shrink the prostate even in men with a normal prostate (no BPH)? Are there any studies available for this?

– I have read that although finasteride is said to increase testosterone, it actually decreases free/bio-available testosterone which is more important than total testosterone for muscle strength/libido etc (see here). This worries me because as much as I want to save my hair, I am also an athlete and want to be at my peak. Could you comment on this?

– Along the same lines, do you have many patients that are sportsmen using propecia without side effects or reduction in their performance (particularly those in more ‘physical’ sports)? Apart from the ‘free testosterone’ theory, I have heard that DHT plays a role in strength/aggression etc.

Many Thanks for taking the time to read. I find it so frustrating that there isn’t more information on the subject and when I do find something I can’t be sure to trust whether it is a study which should be considered valid or not.

I don’t know if finasteride shrinks a normal prostate, though since it is used to treat enlarged prostate it can be inferred that there is the possibility of some effect. I don’t have any studies to refer to off the top of my head, but there have been many studies done relating to finasteride and BPH… so if someone has links to studies that this reader is requesting, please feel free to share.

From a practical point of view, I do not know if taking finasteride will negatively impact your overall physical strength. I would doubt that you would see an impact from reducing your DHT, but everyone is different and this opinion is not universal across the board. I don’t recall any of my more athletic patients mention their athletic performance being limited after taking the medication.

On the flip side of the coin, finasteride/Propecia was once banned in professional sports by the World Anti-Doping Agency due to a similar idea that it may enhance performance or mask steroid use. It does not and it is not banned in professional sports anymore.

I took finasteride for two months and then stopped because of decreased libido. However, I am not sure they were because of the drug. I had low libido even before I started to take it. It just got worse, but it might have been just in my head anyway.

Now, my libido is back to normal so I am considering starting propecia again. My question is, if I already have taken propecia without permanent side effects (because everything is fine now, those side effects were clearly temporary) does that mean that I will surely not have adverse side effects if I get back on it again? That even if I do have the side effects they will be temporary?

I think the key is that you had low libido even before starting Propecia (finasteride 1mg). You should speak about this with your doctor and consider further testing of your hormone levels. If you took Propecia and you believe it caused side effects, you can try a lower dose (such as 0.5mg). A lower dose may give you no or lower side effect profile, and is about 70 to 80 percent as effective for treating your hiar loss. In all my years in practice I have never seen irreversible side effects or even heard of them from short term use (2 months or so).

Hi, I had a hair transplant a year ago January 2010. I had a thinning crown and little hair on top. I had 3000 follicle transplant and use Minoxodile and 1.25 tab of finisteride daily. Wow. 6 months later I was so happy with the results.

Then in November due to published side effects of propecia I quit everything and now am experience a massive hair loss. I hate even washing my hair seeing all the hair on the shower floor. I can lose 50 hairs just by brushing in the morning. My hair is finer than it used to be and when I walk outside without a hat I feel the cold on the sides of my head like never before. I’ve started everything(finesteride and Minoxidle) back up about two weeks ago in hopes of reversing this. What should I do and can I expect some or most to regrow? Thank you

You have experienced what I’ve called “catch-up hair loss” which means that the full benefits of finasteride and/or minoxidil may be lost within a few months of stopping the drug routine. Your hair loss then catches up to the point you would’ve been at had you never used any medications.

I can not tell you what you can do, but just wish you luck. It’s possible you’ll see some benefits restarted in a few months, but I have no way to know if you’ll regrow what was lost. The wild internet postings about side effects from finasteride that persuaded you to abandon your successful treatments may have unfortunately lead to more hair loss, even though you didn’t mention seeing any side effects yourself. The reality, of course, is that if you were to have developed sexual side effects from finasteride (about 2% of men), you would have seen them within the first month of so of starting the medication.

doctor rassman
whatever happened to the fda trials with avodart? we all know avodart is more effective but when will it be cleared by the fda for hair loss? are their trials still going?

We know that dutasteride (Avodart) works when used to treating genetic hair loss. Some reports suggest that it may work even better, but the safety issues in young men, the sexual side effects and other side effects, and the long term issues related to sterility are not known.

The last I remember, there was a Korean study being done… so I looked up the ClinicalTrials.gov site and found this post about recruiting 900 Korean men for a dutasteride post-marketing study by GlaxoSmithKline (makers of Avodart). It was updated just a couple of weeks ago, though I’m not sure which part was updated, and appears to be concluding in July 2013 — AVODART Alopecia Post-marketing Surveillance (PMS).

The FDA will weigh out the safety issues before any application for use in hair loss is approved. So at this point, we’re still in wait-and-see mode.

doctor rassman, this question might sound stupid, but does taking propecia with a glass of water make it less effective? or should it be take wuthout liquid at all?

I’d assume most people take Propecia with water or some other kind of liquid. Water doesn’t change the efficacy. Just avoid taking it with grapefruit juice.

I am 25 years old, and weeks ago i had my first appointment with Dr Pak at your office.

He was very helpful and professional and gave me very good news, we took a look for miniaturization and bulk loss and everything was fine and there was no point for my to worry about.

Dr Pak told me that it wasn’t even necessary for me to take propecia (which i been taken for two years and 6 months), i havent stopped propecia so far, because even though Dr Pak didn’t classify me on the norwood scale, what worries me is the hairline, now i believe i am between norwood 2.5 and 3.

My question is, is it safe to stop propecia when the norwood scale is more advanced that 2?

Perhaps my pictures taken by dr Pak two weeks ago are available in the data, and perhaps you could classify my in the norwood scale.( i’m not ok with having them posted)

Anyway i want to thank you and Dr Pak, I plan to have an apointment once a year if everything stays the same without changes, and i also plan the possibility to have a hair transplant with nhi on the hairline when i hit 30.

Thank you Dr Rassman

I did review your file and it seems your hair loss issue started when you had a long hospitalization stay from your illness (considered stress-related hair loss). You noted hair loss after being discharged from the hospital and since then it has grown back.

There is little harm taking Propecia if there are no side effects; however, if after bulk analysis, miniaturization mapping, and observing your frontal hairline, it still indicates that you are not balding, then taking the drug is unnecessary.

Many men worry that they have frontal balding and often classify themselves as having a Norwood class 2 or 3 balding pattern, but they are really just seeing the appearance of a mature hairline. We often do not agree with their classification, but the final decision about taking Propecia is obviously yours and I can justify the drug in your particular case.