I am a 31 year old male who started Propecia 4 1/2 months ago after noticing very slight corner recession. I have very thick hair and have always seemed to shed a fair amount. After starting Propecia the shedding immediately stopped. However, 4 1/2 months later, my hair has definitely thinned at the corners and my frontal hairline is eroding. While my hair loss is not yet noticeable, I feel my time is short.

Should I still hold out hope for Propecia at this point? Could I still retain those minaturized hairs? Or are they now beyond the drugs grasp? This is having a profound affect on my self-esteem. Any insights you could provide would be greatly appreciated. Thank you for your time.

Let’s start from the beginning with education and facts:

1. There is no drug that permanently stops hair loss.
2. Propecia takes about 8-12 months to see its maximum benefit. Sometimes it takes a little time beyond that.
3. Propecia seems to work mainly on the top and crown area. It does not work well for the front and front corner areas. If it does, it is in a minority of people.

I understand you are trying to address the hair loss issue but you need to discuss these issues with a physician who can give you a realistic expectation and long term goals. We often refer to this as the Master Plan, which we are a big advocates of.

OK, here is my take on the latest happenings in the hair-loss debate…the recently reported topical inhibition of PGD2 and hair loss / re-growth.

OK, prostaglandins are both a GOOD and a BAD thing. You need some prostaglandins, but not others. Some prostaglandins are required for the inflammation associated with healing, while some are responsible for the negative effects of inflammation – mainly pain and the link in the chain that results in disease.

If prostaglandin D2 is indeed partially responsible for hair loss, then why not simply use a product that reduces or inhibits prostaglandin formation? These products do indeed exist. They are called COX-2 inhibitors, namely NSAIDS. However; all NSAIDS are not created equal.

One of the most potent, and selective COX-2 inhibitors is called Meloxicam, otherwise known as Mobic. It is an extremely effective pain reliever and anti-inflammatory. It’s anti-inflammatory properties are due to its inhibition of the cyclooxygenase-2 enzyme (COX-2). Since Meloxicam is soluble in methanol (think EverClear), why not simply put a few Mobic pills in ethanol for a few days, then simply apply it to the balding areas?

I do not claim to be a doctor, I do not even play one on TV. That right is reserved solely for Dr. Rassman, so I may be completely ignorant of the chemistry involved here.

Dr. Rassman, do you think this may be a viable approach to inhibit prostaglandin D2 topically? While I am pretty certain it could not cause harm, since it would not be absorbed systemically, would it be of any value as a topical PGD2 inhibitor?

As always, my deepest respect and thanks to you, Dr. Rassman.

While your insight is interesting, I do not think think the solution is that simple.

For argument’s sake, let’s say you dissolve Mobic in methanol and apply it to your sore back. Do you think it will relieve pain? It does not. Drugs don’t work this way. And I haven’t found any study that shows people who are on chronic pain medication like Mobic (that inhibit prostaglandins) have more hair growth or less hair loss.

The research on PGD2 is interesting, but it is only part of the big picture. I am sure that there will be research carried out.

Hey Dr.Rassman,

What do you think of the placebo effect in regards to side effects associated with taking Propecia? This snippet from Wikipedia on the placebo effect got me thinking about alot of individuals that have expectations/concerns on getting potential side effects from the medication.

Snippet:
Expectancy and conditioning

“In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. Both conditioning and expectations play a role in placebo effect, and make different kinds of contribution. Conditioning has a longer-lasting effect, and can affect earlier stages of information processing. The expectancy effect can be enhanced through factors such as the enthusiasm of the doctor, differences in size and color of placebo pills, or the use of other interventions such as injections. In one study, the response to a placebo increased from 44% to 62% when the doctor treated them with “warmth, attention, and confidence”. Expectancy effects have been found to occur with a range of substances. Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture.”

Sometimes I feel like alot of us convince ourselves we have these side effects when in reality they are non existent.

I have no doubt that many of the problems with sexual side effects reported while taking finasteride, are impacted by the power of suggestion. Also, some men have erectile dysfunction prior to ever starting the drug finasteride, so it is easy to blame the drug for that problem if they exercised denial. Thanks for sharing this with us.

Snippet from the article:

Health Canada is informing health professionals and the public that certain prescription drugs may be associated with an increased risk of developing a serious form of prostate cancer known as high-grade prostate cancer.

High-grade prostate cancer is an aggressive type of prostate cancer that grows and spreads more quickly than low-grade prostate cancer. This type of cancer is rare, and the increased risk seen with prescription drugs finasteride and dutasteride is still considered very small.

New warnings on this risk have been added to the Canadian drug labels for finasteride and dutasteride products.

Read the rest — Prostate cancer risk could increase with use of hair loss drug: Health Canada

There it goes again. Like the pendulum of a clock, the claims on cancer swing in bother directions (positive and negative). The focus here was on 5mg dose of finasteride (for treating enlarged prostate), not 1mg that is used to treat hair loss. And the focus of the study was on the rarer high grade malignancies classified by microscopic assessment of a pathologist. These conclusions may not apply to the lower dose, nor may they not apply to the young men under 50 years old.

We’ve written about the possible finasteride/cancer connection before, most recently here:

1. Propecia, the FDA, and High Grade Prostate Cancer
2. In the News – Finasteride and Dutasteride Raise Prostate Cancer Risk
3. More Opinions About Finasteride and Prostate Cancer Risk

Hi doctor Rassman, I just read the update on the new pdg2 thing for hairloss. I emailed you the article yesturday by the way. I just want to know soemthing, what about DHT? does this mean DHT is not the cause and we don’t have to take propecia anymore? I would really appreciata a reply, becuase I have no clue on this.

There is no other identified effective replacement drug yet available, so it would be advisable to stay on your doctor’s prescribed finasteride. Of course, talk to your doctor about stopping or changing any prescription medication if you really are concerned.

We’re all still learning about this new PGD2 research, so I can’t comment further on it. I know everyone is excited about it, but we need to wait and see beyond these initial reports what the reality is.