Snippet from the study abstract:

PURPOSE: This post hoc analysis of the Medical Therapy of Prostatic Symptoms trial examined the effect of finasteride alone compared to placebo on the clinical progression of benign prostatic hyperplasia in men with a baseline prostate volume less than 30 ml, or 30 ml or greater.

MATERIALS AND METHODS: Men were randomized to placebo (737), 4 to 8 mg doxazosin alone (756), 5 mg finasteride alone (768) or doxazosin plus finasteride (786) (average followup was 4.5 years). Approximately 50% of patients had a baseline prostate volume of 30 ml or greater. The present analysis was based on the finasteride alone and placebo arms only, and included patients for whom baseline and end of study data were available. We examined the effect of treatment on the cumulative percentage of men who did not experience clinical progression of benign prostatic hyperplasia by study end.

Read the rest — Long-Term Treatment With Finasteride Improves Clinical Progression of Benign Prostatic Hyperplasia in Men With an Enlarged Versus a Smaller Prostate: Data From the MTOPS Trial.

This was new data mining of a previous study that included over 2200 men with an average followup of 4.5 years. The new study concludes:

“Long-term treatment with finasteride led to a significant beneficial effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with an enlarged prostate (baseline prostate volume 30 ml or greater). Finasteride had no significant effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with a smaller prostate (baseline prostate volume less than 30 ml).”

Hi Doc,

I’ve been reading your blog on a fairly regular basis and have found it very informative. I’m almost 19 and my hairline has been creeping back since around my seventeenth birthday. At the moment I’m probably an nw2. My brother who is 21 would be considered nw4 if it wasn’t for a very fine scruff of hair in front.

Concerned that I was following suit with him, I decided to fill a prescription of propecia. The possible side effect were pretty unnerving but I figured it was my only real chance at keeping my hair.

I’ve read on your blog that the 1 mg dose does not affect the prostate but it definitely did in my case. The day I took the first pill, my prostate had sudden pains throughout the day. My semen also became water-like. I know this isn’t supposed to be a big issue, but it concerns me that it started happening right away and seems to me like another sign that it was affecting my prostate.

My question is where do I go from here? Have any of your patients had a similar experience? I recently started using a minox product but am unsure what to do as far as meds. Should I try a lower dosage of propecia? Would saw palmetto be worth trying?

Also, have any of your patients experienced results in the hairline from minoxidil alone?

Thanks for your work

First, how do you know what prostate pain feels like? I don’t imagine most men would be able to pinpoint which internal organ is hurting so quickly… particularly the prostate. Prostate pain generally ranges anywhere from lower back problems to urinary issues. Is that what you felt? Second, you had sudden pains after one dose? That strikes me as extremely odd. It’s worth noting that there are some rare reports of testicle issues after taking finasteride, but I haven’t heard of any case where this occurred on the same day that you took your first dose ever. I’d think it’s more likely that you psyched yourself up for side effects, as you said you were pretty unnerved about the medication before you even took it. You were expecting some negative reaction and you got it — this would also be known as the power of suggestion.

You need to get a good, solid diagnosis with the tests I have suggested (miniaturization mapping, hair bulk measurement) before you make the decision on taking finasteride for life. I hope your prescribing doctor gave your scalp a thorough examination before suggesting you take this medication. Now that you’re noting problems though, you should talk to your doctor about this. I’d get off the medication to see if the pain goes away. Remember, a good Master Plan is needed for every young man facing an uncertain future for hair loss.

As for minoxidil, that is an over the counter treatment and so long as you don’t become worried over potential side effects from that drug, it might be worth a try. It would be rare to see regrowth in the hairline from minoxidil or finasteride.

Snippet from the article:

When it comes to taking medicine, you may get what you expect.

A new study has found that your expectations can affect how well pain medications work. Being optimistic may boost their effectiveness in blocking pain, while being pessimistic may lower their effectiveness.

Unlike earlier research, the new study used brain imaging techniques to examine brain regions that are known to be associated with pain. Scientists say that until now, little research has been done to clarify the brain mechanisms that control how different expectations affect drugs.

Read the full story — Positive Thinking May Make Drugs Work Better

This is a very interesting article. Pessimism may lower effectiveness, wishful thinking may make the drug work. We’ve talked about this before on the blog, and this is something many of my colleagues have expressed. When physicians prescribe a medication to patients who are obsessed or too worried about side effects, they usually seem to get the side effects. It’s almost a self-fulfilling prophecy.

Hello,
I have used Minoxidil 5% with good results for 2 years. In the first year I used a solution with ethanol and retinoic acid but switched to ethanol retinoic-free minoxidil 5% after a year.

1. Are these agents vitally important to the work of minoxidil?
2. My hair seems to go in cycles from quite thick to quite thin and back again over 6 months or so.
3. is this normal with minoxidil use?

Many thanks

1. Retinoic acid produces a mild burn to the skin which increases blood supply and the absorption of minoxidil. That is why, I believe, some doctors use retinoic acid, though it isn’t necessary for minoxidil to show benefits. Ethanol (alcohol) is an ingredient in Rogaine and I’d assume most topical minoxidil products.
2. Some patients have reported hair cycling by time of year. It seems to be rarely talked about, so I really do not know the answer to question #2.
3. Cycling occurs with or without minoxidil use, but this is the normal hair cycle — anagen, catagen, and telogen. I’ve previously written about hair cycles.