Would 0.25mg Finasteride Be More Effective than Saw Palmetto?

/by William Rassman, M.D./5 /,

Hi Doc,

I’m a 26 year old male with a fairly aggresive NW4 developing, and need to do something to stabilize this before going for a HT next year.

I’ve grown pretty scared of finasteride side effects through the experience of a good friend who unfortunately suffered some of the psychological sides we’ve all been reading about online.

Question is, would a 1/4 dose (0.25mg) finasteride still be more effective for someone in my position than the full (320mg) recommended dose of saw palmetto? I’ve tried the latter before with no side effects, but didn’t stay on it long enough to evaluate the results.

Thanks doc and keep up the excellent work!

Propecia is finasteride in 1mg strength that you take daily for genetic male pattern (androgenic) hair loss. It’s been indicated that 0.5 mg finasteride daily is about 70 to 80% as effective as the full 1mg dose. I suppose you can infer how a 0.25mg dose may help. But in general if you are going to take a drug, you should take it as directed and speak with your doctor about all these issues. With saw palmetto, you really do not know the dose of the effective ingredients as they vary per manufacturer. Add to that the knowledge that saw palmetto has never been proven to work on hair reliably with a good scientific study.

My final point is that if you are going to read the issues of Propecia on the Internet and scare yourself with unsubstantiated reports without even seeing a doctor, the chances are you will likely have a side effect from the sheer psychological impact.

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

Bilateral Varicocele and Propecia

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

Yes, another Propecia question for you. Sorry :) I am 37 and have a bi-lateral varocele, grade 2 on the left and grade 1 on the right. If I started on propecia, could its side effects be more potent or affect my condition? From what I remember, the Merck studies did not get into the issue of results or drawbacks of people with Varocle.

This is a question you must ask the doctor who is following your problem. There is no obvious answer, other than you cannot just correlate any medical issue with a side effect. I am not a urologist nor do I treat varicoceles, so I am probably not the one to answer the question.

Tags: propecia, varicocele, finasteride, urology

Caution for Balding Sufferers – Be Careful What You Wish For

/by William Rassman, M.D./4 /,

The following post is by UK-based physician Dr. Bessam Farjo:


Written by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

While I have discussed my reservations in previous blogs with regards to younger men undergoing hair transplant surgery, I felt that the most effective way to raise my concerns is by offering examples of cases I’ve dealt with in the past.

I’ve been liaising with a patient for several years who first came to me at the age of 19. After a couple of consultations at our practice, we advised him that he should try a course of Finasteride or Propecia before surgery. The patient went away and, after a couple of years, returned to the practice having undergone extensive scalp reduction surgery in Europe.

Scalp reduction surgery is a surgical hair restoration procedure that surgically removes bald scalp and stretches hair-bearing scalp upward and across to replace bald scalp that has been removed. While this is considered an effective treatment for sufferers of hair loss especially in the past, it was not the appropriate surgery option for this patient at the time.

He was 21 when he came back to our practice and had since suffered further hair loss. Once again, we advised he was still too young to undergo more surgery as the full extent of his hair loss was still unknown at such a young age. Against our advice, the patient had a further two hair transplant procedures at another clinic which he was unhappy about. He is now 24 and we’re still in regular contact as his hair loss has severely affected his confidence and self-esteem.

While we’re working with him to try and rectify his situation, it’s imperative that potential patients are educated correctly on the future consequences that may result from premature surgery as well as the, potentially irreversible, damage that can be done.

Read more

I’m In My 40s — Am I Too Old for Finasteride to Help My Recent Hair Loss?

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

Hi Doctor, I am 47 yrs old and my hair started thinning a bit at the crown 2 or 3 years back. I started using minoxidil a couple of years back and it seems to have slowed things down a bit.

I was thinking of using finasteride as well but am wondering am i too old for fin? Also i am not that hairy, with very little chest, arms, legs and general body hair so would that mean that my dht levels are low anyway? My father’s hair started to thin in his 40s and he is now in his 70s and still has most of his hair, just thin around the crown with no bald spot. Thanks

Finasteride works best on people with recent hair loss, especially in the top and crown. You are not too old and I would consider this as an addition to the minoxidil you are presently using. Talk to your doctor.

Tags: finasteride, hairloss, hair loss

Can Stopping Proscar Bring on Side Effects?

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

I have been taking proscar for hair loss for about 12 years and recently read a disturbing article in Mens Health regarding side effects. Has new long term evidence emerged that shows greater risks? Can stopping the use of Proscar actually bring on side effects?

We are being overwhelmed with negative information that is out of proportion to the reality of the actual numbers of side effect and the statistics that go with that information. Are you willing to take the chance on reversing the hair benefits that stopping the medication will bring about? Any benefits, even reduced prostate problems, will reverse if you stop the medication.

Tags: proscar, propecia, hairloss, hair loss

My Son Took Propecia for Over a Year and Had Many Side Effects

/by William Rassman, M.D./3 /

My 21 year old son has been experiencing heavy body hair loss since summer 2011. He took propecia for 13 months stopping in February 2011 due to sexual side effects. He still has significant sexual dysfunction,anxiety, panic attacks and depression. Loss of body hair has been reported to the FDA as a side effect of the drug. This is absolutely devastating for him.

Some people experience side effects from the drug that range from sexual to mood changes. Based on my clinical experience, I am of the belief that side effects disappear upon stopping the drug. There may be other things happening to him that your son’s doctor should assess. I hope he’s seen his prescribing doctor for a follow-up after stopping the medication.

Tags: propecia, hairloss, hair loss, side effects

NanoSal Minoxidil

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

Hello,
I’ve been trying to find people who have been using Nanosal for a while to know the results but the only references all I can find are from 2005! Are there really minoxidil products out there that use nanosomes for delivery, is it any good? Thank you.

Most of what I can find online about NanoSal is from 2005-2006. If it was anything special, I am sure the medical community or the drug companies would have picked up on it by now.

So I’ll open it up to the readers — if you’ve used NanoSal, please feel free to post about it in the comments section.

Tags: nanosal, minoxidil, hairloss, hair loss

Could Minoxidil Change My Eye Color?

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

Hello Dear Doc

For hair loss i am using minoxidil 5% solution on my scalp and my eyes burn. Eye burning and irritation is known side effect of minoxidil and i wonder if it might change eye color?

There is a medicine named larissa which may change iris color used for eye lashes.

Thanks for your support.

I am not familiar with Larissa, but perhaps you mean Latisse (bimatoprost ophthalmic solution), which has rare reports of permanent eye color changes in people with blue/green eyes. Latisse is used to grow eyelashes and it is presently being tested to grow hair.

There are no reports with minoxidil changing eye color, but if you’re experiencing burning eyes after using it on your scalp (a common side effect), you should consider discontinuing use if it becomes too bothersome.

Tags: latisse, minoxidil, eye color, hairloss, hair loss

I Haven’t Seen Any Results from Propecia After 6 Months — Is Time to Give Up?

/by William Rassman, M.D./3 /

Hi doctor Rassman. you have an amazing blog and are so informative when it comes to hairloss.

I have been taking propecia (the brand version from merck frost) for 6 months and 3 days to be exact. (I started taking it on June 1 2011, and today is december 3 2011). I have seen no change in my hairloss at all. My hairloss has not gotten better, or it hasn’t gotten worse. It is at the same rate prior to taking propecia. So basically its like I have taken the propecia for nothing. They say you are suppose to see less hairloss by month 3. this is now month six and still nothing.

I went to see my dermatologist and he told me that since I haven’t seen any results within these 6 months that I should stop taking it if I want and further treatment with it will make no sense since it has done nothing in the first six months.. he basically left the decision up to me. These were his exact words, “If I were you, I would stop taking it because since it has done nothing, i don’t think it will be of any benefit, but its up to you. you can keep taking it for another 6 months and see where that goes”.

Now this is my question to you doctor rassman. I know you can’t give medical advice and such, and I completely understand. I just want your opinion on the matter. Since you are a hair restoration specialist, I feel that your opinion is far greater than any dermatologist.

do you think 6 months is to soon to give up? should I continue in your opinion? Have you had any patients who started seeing the benefits after 6 months and such. what do you think? I just want your opinion. I really appreciate it. thank you

Without an examination or documentation of how your hair loss has progressed in the last 6 months, I really would not know what to advise. I can’t tell you whether you should or shouldn’t take a medication I didn’t prescribe to you, but it could be worth sticking with it for a little while longer before making a decision either way. Your doctor gave you the same advice.

We advocate miniaturization studies, bulk measurement studies, and even take photographs under consistent lighting. These tests, while not perfect, are an attempt to quantify and scientifically track hair loss. Hopefully one day we can accurately measure and document hair. As a matter of fact, we have just been granted a U.S. Patent on such method a method (see here).

If you want an evaluation of hair loss and options, I would seek a hair transplant surgeon in your area. I generally tell my patients that they need to take Propecia for 6 to 12 months before the effectiveness can be assessed. I also make it a point to tell those patients that while they may not notice any difference (or even notice more hair loss), that could mean the genetic predisposition to hair loss is winning out over what the drug can offer. It’s possible that the medication has slowed the rate of your loss, and had you not taken it for these past 6 months you’d have even more loss. Really though, I don’t have any way to know.

Tags: propecia, finasteride, hairloss, hair loss

My Friend Found Anti-Propecia Articles Online, But I’ve Had No Side Effects

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

Dr. Rassman,

I have been taking Propecia for 2 years with some positive results. One of my friends, who is also losing his hair, commented on my progress and asked what my secret was. I told him about Propecia, a drug which he has surprisingly never heard about, and he did some research online. A few days later when I spoke with him again, he came across countless articles and webpages stating how dangerous the drug is, cursing my name for even suggesting he take it. He showed me one article in particular that indicated that Finasteride inhibits crucial neurosteroids such as allopregnanolone, and many people online concluded that finasteride can likely cause serious neurological problems down the road. Have you seen this article, and are you able to comment on the validity of these types of conclusions?

I have not experienced any side effects thus far, but I want to ensure I am not setting myself up for disaster down the road. After all, I trust the word of a doctor over a thousand know-it-all’s who post in message boards!

Thank you kindly for your time

Your personal story is like the thousands of men I treat with Propecia (finasteride), including my own son. The internet does tend to blow information out of proportion at times, and Propecia seems to have polarized many balding young men.

I’ve written much about this medication on this blog, so the search box at the top might have what you’re looking for. As for your friend, if you’re not experiencing any negative effects and have seen positive results, I don’t know what more he might be looking for. It’s a prescription drug and completely elective. If he has hair loss and wants to take it (or just wants more info), he should talk to his doctor.

Tags: propecia, finasteride, hairloss, hair loss

Propecia and Body Hair Growth

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

Does Propecia make hair grow faster on other parts of my body?

I have seen reports that Propecia may increase body hair, but so does aging. On the other hand, there are reports that Propecia can decrease body hair in some men. As for the speed of body hair growth while on the medication, I do not know the answer.

Tags: propecia, finasteride, body hair

Patient Result — 1 Year After Rogaine Foam and 0.25mg Finasteride (with Photos)

/by William Rassman, M.D./10 /,

This post comes from Dr. William Parsley in Louisville, KY:

Just saw this fellow (around 50 yrs old) today for follow up. I placed him on 1/4 tab of Propecia QD (0.25mg) along with Rogaine Foam BID a year ago. Attached are his results. Don’t know if he would have had a much better result with a higher dose. The appeal of a very low dose got him to give it a try, as he wasn’t excited about using it for worries about side effects. He had no side effects fortunately.

Click the photos below to enlarge:

After (1 year of 0.25mg finasteride and Rogaine Foam):

 

Before:

 

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

Soccer Star Wayne Rooney’s Transplant Looking Thin Already?

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

Wayne Rooneyjust saw this article online about Wayne Rooney’s hair. Seems like it is thinning on top, what are your views?

Link: Time to ask for a refund? Wayne Rooney’s hair appears to be thinning… just months after £30,000 transplant

The UK press is sure being hard on this guy. It takes around 8 months to see even 80% of the results of a hair transplant. I don’t think enough time has passed to see the final result here.

Loss of the original frontal hair is not uncommon with a transplant if a person is not on finasteride. I suspect that he does not take finasteride, because it is a drug that is detected when screening professional athletes. Many organizations ban finasteride since it can be used to mask steroid use. Because of this, he may not get his ideal result until perhaps after a second hair transplant, which would address the loss of native hair caused by the first hair transplant.

Tags: wayne rooney, footballer, football, soccer, hair transplant

I’ve Taken Propecia for 8 Years for Preventative Purposes

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

Dr. Rassman,

I started Propecia eight years for preventative purposes. My dermatologist said he may have seen some slight thinning on the crown area. However I still had a full head of hair.

Throughout the years I have not shown any indications of balding possibly or likely because of the medication, but who knows. My hairline has not receded and looks the same. But I do not want to be on a prescription med if it is unnecessary. However back then I thought hair loss would run on your mothers side and now my understanding is it can be either or.

My question is, is if I were to stop and see if the medication is even doing anything for me, what would be the best way to tell. Obviously hair loss is the only way, but at what months should I get checked out. Would the HairDX test in you opinion help me in making my decision? And do you think it would be worth a trial without it?

Thank you

My suggestion would be to gather as much information about the status of hair loss that you may have. A hair bulk analysis is the best and most sensitive way to evaluate genetic balding. Considering that you have been worrying about this for at least 8 years, if you would have any balding or thinning of the hair anywhere on the scalp, it would show up in the bulk analysis. With that information, you can be pretty sure that if there are no changes in your hair bulk anywhere on the scalp (including the crown), that you would be reasonably safe to stop the medication. To be extra sure, repeat the test 3 months after stopping the medication.

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

I Can’t Take Propecia Because of the Sexual Side Effects

/by William Rassman, M.D./5 /, ,

I can’t take Propecia because of the sexual side effects and after I visited your office, the news as to where my balding might be going (as you said the worst case) could be a Class 6 pattern. I already had two hair transplants and I have a scar on the back of my head so I can not even shave my head. I am 21 years old now, so I get depressed when I think that I am going down the toilet with my hair problems. I don’t want to give up my girlfriend as sex is important to us and the Propecia stopped that cold. What can I do?

Norwood 6There are no easy answers. Your examination in the office showed that you have already lost 61% of the hair in the crown, 26% of the hair on the top, and 32% of the hair in the front. With my naked eye and your blond hair color, one can’t really make out the balding at this time. The crown is fast approaching the point where the balding can be detected in bright light. You are lucky, because if you had dark brown or black hair, the hair loss in the crown would be very evident, but in blond men, the loss may approach 90% with average weight hair before it would show.

If you can not take finasteride because of the sexual side effects, these numbers suggest that you may eventually end up with a Class 6 pattern (worst case). At 21 years old, you have a lot of balding that may show up as you go through your 20s. If you want to shave your head, you might want to consider Scalp MicroPigmentation (SMP), and provided that the area pigmented was in the distribution of your existing hair, you would have the option to keep it long and/or shave it. We can discuss this option at your convenience.

There is no substitute for Propecia (finasteride) on the market. You might get some benefit by taking 25% of the therapeutic dose (0.25 mg) and this might allow you to get some of the benefits of this drug without the sexual side-effects. Young men (20 years old) who start the transplant process without a good Master Plan and have side effects from finasteride, probably should not have started the transplant process at all, as there may not be enough donor hair to complete the process. Your first transplant doctor should have discussed these issues with you before you started this process. Fortunately, there is the SMP option if you get caught between a rock and a hard place.

Tags: hairloss, hair loss, finasteride, propecia