I was wondering…when a person begins taking Finasteride, they go thru an accelerated shedding period that lasts roughly 3-6 months. After this initial period of shedding, just say that the Finasteride works and stabilizes the loss. Does the person end up growing back the hair that was lost during the accelerated shed? What if it doesn’t grow back? Is this the price that you must pay to halt or slow down loss with Finasteride? Do you have to take your amount of hair a step down in order maintain whatever’s left?

What if you fall into that 20-25% category of users who don’t respond to Finasteride in terms of hair stabilization? You could end up just accelerating your loss for those 6 months for no reason at all. Whether you stay on it or off, after this period, you will continue to lose. This is a big risk for people thinking about taking meds.

Shedding after starting Propecia isn’t a common occurrence, but I’ve heard reports that it does happen on rare occasions. It is more common with Rogaine (minoxidil) use, though. If we assume that there was some shedding from Propecia, I do not have much faith that those hairs would grow back.

The “what if” part about “20-25% chances” to your question is moot… because if it happens to you, it is 100%. And I do not believe there is a “big risk”, because you are taking a medication to slow down the hair loss (not accelerate it). Please speak to your doctor and be sure to have your hair loss monitored with miniaturization mappings, so that any loss or gain can be charted.

Snippet from the article:

Merck (MRK) is experiencing some rough PR issues on its hair-loss drug Propecia following a study that suggests up to 15 percent of men taking the drug might experience some form of sexual dysfunction. For years, the warning label on Propecia has said that only 2 percent of men might experience erectile dysfunction while using the drug, and if users stop taking the pills everything returns to normal

Read the full story — Why Merck’s Hair Loss Drug Could Make Its Income Statement Go, Um, Limp

This article is from a business-oriented site, so it examines more of the bad press and how it may harm Merck’s stock valuation. And with the Propecia patent expiring in a couple years, Merck would probably like to keep the damage control to a minimum. That being said, I believe the study they reference is actually just an analysis of existing studies. Still, articles like this need to be seen by everyone. Knowledge is power.

I tell those patients who have sexual side effects to see me about reducing the dose. The problem of course, is that if you stop the medication the hair loss will continue.

I did some searching on your site and could not find an answer to my question, so here goes: I’ve been taking Propecia (or splitting Proscar) for over ten years. Two years ago, when the generic became available (from India), I purchased it. Within months I started losing hair, and the loss continued. I went back to Proscar about a year ago. No change in growth but still losing, just not as much or as rapidly. I’ve read similar stories on the internet. I just filled a new Rx from Costco with the Indian finasteride (because of the cost). Am I naive in thinking it was my age (58 at the time) and genetics that caused the loss, or do you think the Indian generic is not up to the brand’s standard? Have you heard similar stories?

Normally, I’d tell a patient or reader that if you believe your medication is not genuine because you get it from India, I would suggest you buy it from a reputable company in the United States. But you got your finasteride from Costco in the US, so I’d expect it would be fine. Plus, there are many large pharmaceutical companies in India (not sure which one you got) and the FDA permits them to import medication here. If you bought it online from a pharmacy that required no prescription, that would be a different story.

If you are losing hair (even at the age of 58) and you are treating it with finasteride, then you are treating genetic hair loss. Remember, the medication isn’t a cure, so it’s possible that it was just coincidental timing that you switched to a generic finasteride around the same time that medication started losing the battle to your genes.

My doctor recently prescribed propecia to me, a 20 yr old male. After reading all this stuff through the web, and i know you even stated that the side effects seem a bit exaggerated, i am kinda skeptical about taking it. I really don’t want to have a decrease in arousal and definitely do not want to develop breasts. Do the benefits outweigh the chances of the side effects?

Also, whats the effect of lowing DHT on your muscles? It seems that the only answers i could find say that lowing DHT would lead to weight gain and muscle loss. This seems quite the opposite of what i have researched since DHT is not the main source used by skeletal muscle and the reduction of DHT would lead to higher levels of testosterone, the ultimate muscle booster. Thanks

Official studies have shown the side effects occur in 1-2% of men. The medication has shown benefits over 5 years in 77% of men (statistics here). So yes, the benefits outweigh the risk… but it depends on your priorities.

The real answer lies in what you think of yourself balding progressively over the years and what you will feel about yourself if you become bald. Balding is the natural way to go, but I am in business because other men do not want their genetic cards showing. If you’re truly concerned, don’t take Propecia. Remember, it’s an elective medication. If you think you could be one of the 2% that has problems, perhaps it isn’t worth it to you. Then again, you could fall within the 98% that has no side effects…

With regard to muscle mass, I have never seen any impact at all.

Dr. Rassman, et. al, the Journal of Sexual Medicine has recently published an article describing the permanent sexual side effects of using finasteride. I quit taking propecia approximately 2 weeks ago and am terrified that I have permanently damaged myself. What are your thoughts on the article?

Adverse Side Effects of 5?-Reductase Inhibitors Therapy

Many of my patients have been taking Propecia for over a decade without side effects. I have yet to meet a person in my practice who complains of permanent side effects associated with Propecia after they stopped the drug. The few that do have side effects at all elect to stop taking the medication and the side effects have subsided as their hair tumbles to the ground. But that is just my humble experience.

The article itself doesn’t provide anything new, just reviewing previously published reports from a subset of men that raises the possibility of a casual relationship. They did report a single case of a man with total sexual function loss, but that sounds peculiar and I’m not convinced. I would wait for confirmation by other investigators on claims of permanent damage from finasteride. The Journal article was digested by the Boston Globe here and even mentions what we’ve been saying for years about the percentage of those that saw side effects:

“In one trial, about 1.9 percent Propecia takers who took the drug for up to two years experienced a loss of libido compared to 1.3 percent of placebo takers; 1.4 percent of Propecia users had erectile dysfunction and 1 percent had an ejaculatory disorder compared to 0.9 and 0.4 percent of the placebo takers.”

For most of the frightened men, I wonder what they’re so terrified about. Did they actually have side effects? Are these men willing to risk balding over a 1-2% chance of side effects? As I’ve often said, the medication is completely elective. You don’t have to take it and I am not trying to convince anyone to do so. I am just presenting my opinion based on experience. The Mayans predicted the world will end in 2012, so I would be more terrified about what will happen in 11 months!

Dr. Rassman,
I noticed Merck is offering men who are prescribed Propecia to save money ($260 for a year).

Link: Propecia Persistence Program

Regards

Yep, this is a good program and relatively headache free. If you’re buying the name brand Propecia, it’s an easy way to get some money back from Merck.

I’m turning 17 this summer, is it too early to start taking propecia? My doctor and I already know I’m going bald.. my hairs thinning and I have a receding hair line. Can I start a 17?

I would make a firm diagnosis with bulk measurements, miniaturization measurements, and great photographs of your hairline location. Then if you decide to take Propecia with your doctor’s assistance, you will know for sure what your diagnosis is and how the drug is working year after year.

I’d suspect that most doctors do not feel that 17 years old is too young for this drug, though I can’t speak for all physicians.