I am a 46 year-old male and a loyal reader of your blog. Based upon the positive results you have seen with Propecia, I decided to try it, after consulting with a hair-loss surgeon. I have taken 4 pills thus far. I was more than willing to tolerate the side effects reported by Merck if it meant stopping my hair loss. However, I have began to experience possible side effects not reported by Merck, including difficulty sleeping, mental fogginess, breaking out in sweats, along with the more common side effects of decreased energy and drive.

After experiencing these, I began doing some research and ran across sites you may be familiar with, such as Propeciahelp, on which users complain of side effects such as these along with others (e.g., hypogonadism) even after stopping the drug. There are various reports that the drug alters the brain (e.g., mood and thinking) by affecting neurosteroids and can permanently alter the neuroendocrine system.

Obviously, I am freaked out about this and will probably stop taking the drug. I would like to know your opinion on the reports of these side effects, the possibility of permanent alterations of various bodily systems with use of this drug, and your opinion on websites such as these (Propeciahelp) in general. Thank you for your trusted advice.

Suggestions can produce side effects (see “placebo effect” and “power of suggestion”). Your gonads will not shrink in a few days. It is possible (albeit very remote) that there are brain effects, but you should discuss this with your physician and that is why a doctor’s prescription is required for this drug in the United States and many countries. Have an open line of communication with your doctor. If you’re unable to sleep and you think it is related to the drug, talk to your doctor about stopping it.

While forums can be helpful, one must remember that many times they are full of unverified claims and feed into irrational fears. I’ve written about this before here.

Hello Doctor,

Thanks for maintaining such a great blog.

I am a 20-year-old student who started taking Propecia about a month ago. Since then, I’ve broken out in hives about once every two weeks. The breakout lasts for about 3 days.

I have three questions for you:
– Do you think that this is an allergic reaction to Propecia?
– If I am indeed allergic to Propecia, do you think that it will be less effective?
– I have experienced a noticeable increase in shedding since starting Propecia. The Internet tells me that this could be a good sign, but we both know there’s a lot of misinformation out there.

Again, thanks for the great blog.

First of all, if you are breaking out in hives I would see a doctor. This is not a place to get a medical diagnosis or treatment. Any medications can cause a reaction or side effects, but I do not know anything about your medical history or health or habits to even guess why you are breaking out in these two week intervals. Are you doing something different every two weeks?

In general, patients do not shed after taking Propecia. Patients lose hair with or without the medication from natural genetic causes. The “increased shedding” people refer to is very abstract and hard to quantify. This is one of the main reasons you need to see a doctor before you start Propecia and have some form of documentation of where you are starting from (such as a picture of your hair, miniaturization study, or even a bulk measurement). Without anything objective to compare to, it is just anyone’s guess.

Finally, I would guess there are people who are allergic to Propecia, but I have not met anyone face to face at my medical practice who have these allergies people write about on the Internet.

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 8… and final part. Thanks for sticking with me on this!

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Minoxidil as a systemic medication?

Dr. Damkerng Pathomvanich (award winning doctor from Thailand) experimented with the use of minoxidil as a systemic medication on patients. This medication is used in many Asian countries as a treatment for hair loss. He commented that when spironolactone is added to systemic use of minoxidil, there is an enhancement of the hair benefits and a reversal of hair loss in many people. Although the reported side effects of this approach were small, there are still many side effects with these medications (e.g. significant drops in blood pressure, weight gain, fluid retention, rapid heart rate).

These systemic medications are not FDA approved in the United States for the treatment of hair loss, as well as many other countries. Minoxidil was originally used in the 1960s as a treatment drug for high blood pressure, but its impact was not consistent with lowering blood pressure. Many of these earlier patients developed a reversal of their hair loss and many women treated with it developed facial and chest hair.

 
Aspirin and hair transplantation?

A hair transplant surgeon who is also a cardiologist suggested that a person on low dose aspirin can have a hair transplant without stopping the aspirin.

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 5. More to come…

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Does finasteride (Propecia) impact the body’s inflammation response in hair loss?

Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.

 
Are finasteride’s sexual side effects overstated?

Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.

One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.