Dear Dr Rassman

It is clear from many of your posts that you believe that although Propecia slows down hair loss in most men with male pattern baldness, it does not stop it and the balding will continue, albeit at a slower rate. I understand that no published data is available which would elucidate this matter and confirm that this is indeed the case. As you will appreciate, many young men with male pattern baldness (in their early twenties, say) would obviously like to know how long they can expect to retain/regrow hair in practice.

Since Propecia hasn’t been available for long enough it seems clear that this question cannot be answered conclusively (the same is, of course, true of any long-term side effects that may be associated with Propecia), but I was wondering if you had access to any figures or data of your own which would support the idea that Propecia only slows down the hair loss rather than stops it for as long as the drug is taken.

Yours sincerely

Your question is like asking how long you will live. Everyone is different. Some die young, some die old. So does hair.

I am a physician, not a fortune teller. Male pattern hair loss is a genetic issue and there is only so much medications can do for each and every individual. I don’t have actual statistical numbers of my own patients, but I have seen some patients hold on to their hair since the drug was introduced over a dozen years ago.

Hi doctor,

you said before that you took propecia but when you stopped you did not have catch up loss. Why is that? shouldn’t the hairs propecia was keeping be lost when you stopped?

I previously wrote about why I stopped taking Propecia, and for those curious about my own hair loss I explain here and here.

When I (Dr. Rassman) started my hair transplant process for my thinning crown, Propecia was not available. As the medication made it to market, I took it with hopes that I’d grow back some hair, even though I wasn’t actively losing any hair at that point. My hair loss had been negligible at the time and it still is… and I doubt I will lose more hair in the future. So I stopped taking the medication, as it really didn’t add or regrow hair for me. In the end, there was really nothing to “catch-up” with.

For those who are actively losing hair, Propecia should slow it down and in some instances regrow some hairs. Over the course of time, the hair loss will continue at a slower rate. This does not mean Propecia has stopped or will stop working, and for those men that decide to stop the medication, the “catch-up” hair loss will bring their hair loss to a state as if they never took the medication in the first place.

Rogaine recommends applying twice daily but it does not say it needs to be every 12hrs. Does that mean I can apply it at 8pm then again at midnight and that would be just as effective as morning and night? Thanks in advance

Equally spread applications twice a day (every 12 hours) is better than an 8 and 16 hour schedule, but it is not practical for most people. I would try to space it out a little more than the 4 hour window you described. Usually it is applied when you get up and then again before you go to bed (just allow it to dry first).

Hello!

we all know the earlier you take Propecia the better but can define the work “early” would it be starting Propecia 1 year into the MPB process or more?

Thanks

There’s no true timeframe for what is “early”, but the earlier you decide to take charge of your hair loss and take Propecia, the better your chances for success. If you’ve let your hair loss progress for a decade, obviously that isn’t considered early hair loss. A year or so is still pretty early.

See your doctor, get a good diagnosis, establish what you have, and find a treatment goal and plan.

Hello, I have been on propecia for 20 months, never missed a dose. My hair line is intact but hair has continued to thin all over. My presentation is very much that of DUPA in my opinion. My eyebrows, facial hair and body hair have all thinned since the start of this medication. If I titrate down to 1mg propecia every other day will I see facial hair come back as it once was? If I completely stop propecia what can I expect? I don’t feel I have gained much from it approaching the two year mark. I am 35 with no past medical history. Mother is extremely thin, dad is now going bald in the crown. What should I do? Thanks

I think you might not be on the right track, as you seem confused about what is going on with your body. I highly recommend that you see a physician or follow up with your doctor who prescribed the drug for you.

Propecia is the brand name of a drug called finasteride in 1mg strength, so I do not understand what you mean by when you ask about titrating it. Propecia doesn’t treat diffuse unpatterned alopecia (DUPA)… nor does it cause it. Also, Propecia shouldn’t impact body hair or beard hair.

If you completely stop the medication, you’ll see any benefits disappear in what we refer to as “catch-up” hair loss. Your hair loss would catch-up to the pattern it would be at if you’d never taken the medication. If you haven’t gained much visually from the regrowth side of things, it’s possible the medication just kept your loss from progressing. Again, talk to your doctor.