i have been talking propecia for over 5 months and it does not even look like the hair loss is slowing down. In the past two weeks it seem like it is getting worse. More hair is falling out then ever before. I thought after 5 months hair loss was supposed to slow. I am using rogaine to and nothing appears to be working.

You need a measurement with comparisons of the hair bulk over time to answer the question you posed. This is the very reason we recommend miniaturization studies and bulk analysis of the hair with the Hair Check device. I would get your hair bulk analyzed and then wait another 7 months to see what the metrics tell you. That way you can put an actual number to it, rather than just going on visual guesswork.

I don’t know anything about you or your hair loss history, your dosing, where you obtained the medication, how long ago you added Rogaine, etc, etc. Propecia is a prescription medication, so I assume you were prescribed that drug. You should talk to your doctor about it further.

Hello Dr. I have often seen you say that those who claim that Propecia has ruined their sex drives in a permanent way are really suffering from something that is all in their heads. Even if this happens to be true, does it really matter? Take a converse example with the placebo effect. I’ve heard some people suggest that if, for example, an anti-depressant makes someone feel better that it doesn’t really matter if it’s just the placebo effect or not. So why not have the same standard for Propecia? If it’s all in someone’s head after they quit the drug, did not the drug still cause it in some way? Thank you

I didn’t definitively say that those claiming side effect persistence were just suffering from something in their own heads, but it’s a possibility. In fact, I don’t think I’ve ever said the claims of persistent side effects from Propecia are completely false. I did say that the medical literature and my own experience hasn’t shown any permanent side effects among my patients. I’ve also said that those with sexual issues should see their doctor and have a proper, complete history and physical exam to make sure that there are no other causes that can be identified, such as testicular tumors. I do not diagnose medical problems on BaldingBlog. I do not medically treat or give medical advice to people here on BaldingBlog. I just give my opinion and write about hair loss issues.

I feel like I’m beating the same drum over and over here, but I do not force medications on people and have always left the decision to my patients, as they are not sheep that are herded into a direction. Most come to me prepared after doing their research via the Internet.

The placebo effect is well documented in the research studies and appears almost as high as the actual reports of sexual side effects. I suspect that many of the negative writings about Propecia contribute to the psychological effect that produces a placebo impact. There is a small group of disgruntled readers that want me to acknowledge a possibility of permanent side effect associated with taking Propecia (even one dose)… and while it’s not likely, perhaps in extremely rare cases it could happen. I just don’t know. The science isn’t there, but anything is possible. Correlation does not equal causation.

If, over a period of time your body wins the battle over the effectiveness propecia has on hair; in the same regards won’t your body win the battle over the sexual side effects that propecia can sometimes pose?

There is no correlation between the two impacts of Propecia (hair growth and sexual side effects).

Hi,

I’m 24 yrs old, and I’ve been on propecia for about 1 yr and 3 months. At around the 9th month mark I realized the sexual side effects are real and I couldn’t perform. Therefore I decided to experiment with dosage and frequencies. I tried 1mg eod but I still got numbed genital and low libido after 3 months or so. Recently (about 2 weeks ago) I’ve cut my dosage to 0.5mg/day, I can tell it’s better so far, but some days I would experience those side effects once again. How long does it take for me to conclude that I have to further reduce my dosage? Should I stop for a week before beginning my new regimen? Do most patients not experience side effects at 0.25mg/day?! Should I try 0.5mg eod or 0.25mg/day first?

Thanks & Regards

Ask your prescribing doctor his/her opinion. As harmless as it may seem, changing drug dosages on your own is not in your best interest. You need to be under the care of a physician who can recommend different dosages and come up with an overall plan of how to deal with the side effects. More importantly, your physician can give you a complete physical to make sure there are no other causes of your erection / libido issues.

Sexual side effects from Propecia occurs in 1 to 2 percent of men. It is reversible, as you are noticing. There are focused groups on the Internet that claim the sexual side effects are on occasion not reversible (the debate rages on in the comments section of this post), but I personally have not seen a case like that in my career.

With respect to the effectiveness of Propecia at lower dose, I believe 1/2 the dose (0.5mg finasteride) is about 70% as effective.

Doctor Rassman, I’m curious as to your thoughts on the following article. I just learned of the development process for Propecia and was shocked to find they intentionally engineered the drug to match the hormone profile of pseudo-hermaphroditic children because they had smaller prostates and a lack of male pattern baldness. I can’t see any patient willingly taking this drug if they were aware of its origins. The entire concept seems drawn up by a completely mad scientist.

Only page 1 is necessary to read, the rest is just sycophantic quotations regarding Merck’s profits.

Link: Keeping the Pipeline Filled at Merck

I agree that what you read seems strange, but this isn’t only limited to Propecia/Proscar (finasteride). These types of discoveries in medication development are common.

Scientists often look to nature and outstanding traits/illnesses to understand certain diseases. When scientists found a group of a population with no prostate issues and no male pattern hair loss, they made a connection that it may have something to do with being pseudo-hermaphroditic, which led to the realization DHT had something to do with it. But the converse is NOT true: Just because you have low DHT does not mean you will be pseudo-hermaphroditic. Just because you take a drug to lower your DHT does not mean you will be pseudo-hermaphroditic. The hermaphroditic issues ONLY impact the fetus in the first trimester of pregnancy and not in boys or men. And even then, the dosage for this to occur in pregnancy is not understood.

Back to pharmaceutical discoveries — many drug origins are from strange findings. The common drug penicillin was discovered from molds. The widely used anti-wrinkle treatment Botox is from the poisonous toxin botulism. The flu shot many people get yearly is derived from viruses. The mascara that women put on their eyelashes are derived from earth worms. The first hormone replacement therapy drug to treat symptoms of menopause was made from the urine of pregnant horses. Certain blood pressure medications were derived from venoms of snakes. Coumadin is a rat poison that is used to thin the blood for certain patients to save their lives. My point is: medications can be very strange.