Why Do You Keep Saying Propecia Doesn’t Work in the Hairline?

/by William Rassman, M.D./2 /,

Propecia does work in the front!! Why you keep saying it doesn’t or is of little help that confuses everyone! If you mean that for example you are a NW3 and want to become a NW2 then its true Propecia won’t magically grow those hairs but in very rare cases im sure it has. But if your front is thinning it CAN STOP those hairs from continuing to thin and even thicken up some if its early.

I started mildly thinning in the front 2 years ago at age 21 1/2 and as soon as I started taking Propecia it stopped it completely! Today I look exactly like 2 years ago. I was hoping for some thickening up as well but that didnt happen though.

Also from my understanding dht causes hair loss in MPB so in that case why won’t Propecia help the front to stop hairline recession!?

PropeciaI’ve been consistent with my message about Propecia and the frontal hairline. Here’s a post from over four years ago, where I say the same thing — the medication doesn’t regrow at the hairline in most cases. Please understand that there is no cure for MPB. If you have the gene and it expresses itself, you will go through some degree of hair loss… and Propecia can drastically slow this process down.

Propecia works great on the top crown area as research shows, but it doesn’t work as well in the frontal hairline for most men. I don’t have a reason as to why this is the case, but I’ve speculated in the past.

On rare occasions we have seen reversal of frontal hair loss from Propecia, and I’ve even written about it before on this site. If you are one of the lucky patients that saw benefits in the frontal hairline, that’s great, but even as you noticed, it did not thicken the front. It’s obviously not impossible for the medication to work in the front, but the likelihood of seeing major regrowth in that area is slim.

Tags: propecia, finasteride, hairline, hair loss, hairloss

Would My Regrowth Be Even Better If I Didn’t Take 2 Weeks Off Propecia Last Year?

/by William Rassman, M.D./0 /

Dr. Rassman,

Thank you for taking the time with this blog and the questions you have answered for me over the past year. I’m 30, I take Propecia and have been on it a year for crown thinning. I’ve gotten very good results but have a question that has been bugging me.

Last year, after a month on propecia, I read a lot of scare-stuff on the internet about it causing permanent impotence, premature aging, etc. I freaked out and started to think it was happening to me and stopped taking it for a week. It was generally a painful summer,there were days where I got very depressed and thought the baldness was getting worse and the propecia wasn’t working; altogether I skipped about two weeks worth of days before I started reading your blog and got a grip. I haven’t missed a dose for a year now (mid July ’09 to now).

What I want to know is: do you think the approximately two weeks of days I skipped last year have any impact on the results I have gotten now, that is, would my regrowth be even better if I had never missed those days? I am quite happy, the drug has reversed most of the apparent baldness in my crown area.

Thanks always for your time, have a great day

I don’t believe two weeks away from Propecia will have a deleterious or negative effect on your hair. Generally, I advise patients not to take a vacation from this drug, but in your case, what’s done is done. I don’t see the point in beating yourself up about whether your results are 95% of what they could’ve been. If you’re happy with the results thus far, that should be what counts.

Remember, you will still lose hair even if you take Propecia, but it should slow that process down. Stick with the medication as you’ve been doing and try not to let yourself get worked up about everything you read online.

Tags: propecia, finasteride, hairloss, hair loss

Biopsy Indicates MPB or Mature Hairline?

/by William Rassman, M.D./4 /, ,

I just got the results from a scalp biopsy. My doctor had some interesting conclusions. I was wondering if I could run them by you.

  1. She said that the results from the biopsy were able to differentiate between MPB and a maturing hairline. Is that possible? She said that the biopsy did indicate MPB. I find this confusing considering I have only lost hair at the corners of my hairline. I just assumed it was a mature hairline.
  2. She prescribed Propecia. She said that if you have very slow hair loss that Propecia will in fact completely arrest its development. From what I’ve read on this blog Propecia can only slow it down.
  3. She also said that Rogaine works on the hairline as well as the crown.

Your thoughts would be greatly appreciated.

In all my years, I really never relied on a biopsy to differentiate between male pattern baldness (MPB) and a maturing hairline. Actually, I do not know how one would see that on a biopsy and I would want to know exactly where the biopsy was placed. Plus, it would leave a scar if you were to biopsy the frontal hairline. Getting a biopsy to determine the cause of hair loss is generally performed to see if there is an inflammatory or a scarring type of balding from an autoimmune disease, for example. In my opinion, a maturing hairline or genetic male pattern baldness diagnosis does not require a biopsy.

There is nothing that completely stops hair loss. Propecia is a great medication, but it is not a cure for hair loss. It could slow the hair loss down to make it appear that its completely stopped, but there’s still minor loss going on.

Rogaine and Propecia have been tested and proven to work best on the crown area. Many patients use both Rogaine and Propecia for the frontal hairline and it does work for some men… but not as well as it does for the crown.

If you’re concerned that your doctor made the wrong diagnosis, feel free to get a second opinion. You don’t want to take medication if it is unnecessary… so if it turns out you only have a mature hairline, there would be no reason for you to take Propecia or use Rogaine.

Tags: biopsy, hair loss, hairloss, mpb, rogaine, propecia

My Doctor Recommends One Proscar Tablet a Week

/by William Rassman, M.D./1 /

I’m an 18-year old male showing the first stages of male pattern baldness. My doctor has prescribed me 1-tablet of Proscar 5mg, per week. Is this a common dosage? All the literature indicates that 1mg/day of Propecia is the correct dose. If I persist with one tablet of Proscar 5mg/week, is it enough to do the job, considering the short half-life of finasteride?

It seems you already know the answer. The dosage your doctor recommended is incorrect (or in all fairness maybe he forgot to give you or write out specific instructions).

For genetic male pattern balding (androgenic alopecia), the recommended standard dose for finasteride is 1mg a day (not 5mg a week). In the interest of saving money, many patients buy the generic finasteride in 5mg strength and cut the pill into four pieces, taking one piece each day. I realize this is taking finasteride 1.25mg a day, but it isn’t practical to cut a round pill into five equal pieces. Generic finasteride in 1mg strength is not yet legally available in the United States, but the 5mg is (patent laws). Taking 5mg finasteride once a week will not provide the same benefits as taking the proper daily dosage would, as you said, because of the half-life of the drug.

Tags: proscar, hairloss, hair loss, finasteride, propecia

Rogaine Worked Great but I Stopped Due to Loss of Libido

/by William Rassman, M.D./0 /,

Hey thanks for your time. I had been using rogaine 5% solution for about 2 years. I only used it once a day.. but I used a lot more than the recommended dosage(all over my head). I have had a lot of regrowth even on the hair line. I quit using rogaine about a month ago due to face bloating and loss of libido.

I started taking procerin about a week after I quit using rogaine and I started using nioxin about 2 weeks ago. I am still experience a lot of regrowth. I even buzzed my hair the other day and I still see slow improvement like always. Do you think it is my new regimen? or is it still the rogaine that is causing my hair to still improve?

People attribute all sorts of problems to specific medications, but I doubt the Rogaine (minoxidil) caused the libido effects. You used the medication for 2 years before you saw any issues, so it is strange that you’d suddenly develop a loss of libido.

I would’ve tried using less of the Rogaine (or in your case, just using the recommended dosage) before stopping it completely, but that was your call to make. I don’t know what to attribute your continued hair improvement to, but if you only stopped Rogaine a month ago you’ll likely see the benefits disappear over the next few months. Those new products you’re using won’t maintain what Rogaine regrew, since they don’t contain minoxidil.

Procerin’s main ingredient is saw palmetto which is a popular yet unproven hair loss treatment, but Nioxin is definitely not something I’d recommend if you’re serious about treating your hair loss.

Tags: rogaine, minoxidil, procerin, saw palmetto, hairloss, hair loss, nioxin, shampoo

Clobex Spray and Spironolactone to Treat Female Hair Loss?

/by William Rassman, M.D./0 /, ,

(female)
I recently saw a dermatologist for my thinning hair. I’m not familiar with the medical terms he used, but he has me on clobex spray twice daily and spironolactone twice daily. I so desperately want something to work! I use hairmax lazer comb and rogaine. I am seeing hair growth on the sides near the temples but not much on top.Please guide me in the right direction. Thank you

There is a difference in wanting something to desperately work and something actually working. Sometimes you have to face the fact there really is no treatments for some types of balding.

There is no right direction I can guide a desperate patient who will just about try anything. I realize this sounds very pessimistic but nothing (aside from Rogaine) you are trying has ever been proven to work. Clobex is a steroid with the problems associated with chronic steroid use; I’ve written about spironolactone here; and there’s also no evidence I’ve seen that the LaserComb regrows hair to any visible degree.

Tags: clobex, hairloss, hair loss, lasercomb, lllt, spironolactone, female hair loss

Side Effects from Finasteride, But No Side Effects from Dutasteride?

/by William Rassman, M.D./0 /

Hi Doctor!

I am very happy that I found your great site! I am 24 year old male with about a Norwood 2. Here in Hungary I dont think we would have good doctors being expert in hair loss treatment. I visited one of them (advertised by the spectral dnc site), but she stood against taking pills for my hair loss at such a young age (and after reading some hair loss forums I think she seemed to be incompetent in the topic). However a lot of international sites contain posts by even younger men successfully applying medications. I insist on trying them because any more hair loss would destroy my self image.

My frontal hairline must have started receding about when I was 20. The previous and this summer I observed that my frontal hairline rapidly shedded about 2-3 millimeters and I have a bit high forehead already. All my existing hairs are thick and they suddenly switch to short light hairs so the thinning is not gradual. What I want is to keep my current hairline from getting worse, but I would like to aim regrowing some hair, and I would have a few questions regarding this. I may also have some thinning on the entire crown, but Iam not sure about that, maybe its only my hair dresser who lessens the density…

I already tried Spectral DNC for 6 months with no success. (Note that the source of the DNC was not trusted but I admit that it was truly minoxidil because it made the hair on my hands and face much stronger…) I want to attack the problem at its roots so I would like to take finasteride or dutasteride. Is it possible for some men to keep all their hair with finasteride? I have a lot of small light hairs along my original juvenlie hairline. Do I have a chance to regrow them, or is it going to remain just normal bald scalp for sure? What do you think about starting with dutasteride 0.5mg if I want better results (www.dutasteride.com)? I read about some men with side effects on finasteride, but great success without side effects on dutasteride, is this possible? Thanks for your answers!

Cheers

AvodartIf any medication made it so you kept all of your hair, that could be considered a cure. At the risk of sounding like a broken record, there is no cure for hair loss. Finasteride (and perhaps dutasteride) will slow the loss down, possibly regrow hair, and should hopefully maintain the existing hair for some time.

Dutasteride (also known as Avodart) has a longer half-life and is a stronger medication than finasteride. If you see side effects from finasteride, I would assume you’ll have those same effects from dutasteride… but they may be stronger and possibly last even longer. Dutasteride was studied as a prostate medication in men over 50 years old, and I don’t have all the info because as far as I’m aware, proper studies of younger men taking it to treat hair loss have yet to be released. It also isn’t approved by the United States FDA for treating hair loss and thus, I can’t recommend it at this time.

Regardless, both finasteride and dutasteride are prescription medications and you’ll need to talk to your doctor about taking either. If your doctor wishes to prescribe dutasteride to you, that’s not my call to make.

Tags: dutasteride, avodart, propecia, finasteride, hairloss, hair loss

Staph Infection on My Crown

/by William Rassman, M.D./0 /,

i had a staph infection on the crown of my head. my question is that it has left bald patches in my scalp and in other areas around my head but mainly on the crown. I do not have male pattern balding but will Rogaine help regrow the hair?

Rogaine (minoxidil) may help regrow some hair, but it usually takes about one full year for you to notice some difference. I’d just be patient and wait out for the hair to regrow on its own if you’re certain you don’t have genetic male pattern hair loss.

Tags: staph infection, hairloss, hair loss, minoxidil, rogaine

Is the Hairline More Sensitive to Testosterone?

/by William Rassman, M.D./5 /, ,

Doctor reading this really scared me. Its from hairlosshelp.com

This is what someone posted regarding propecia

“Yes. I barely had any recession, it honestly looked like maturing of the hairline, and me having my dads hairline, it looked like thats what was happenning. Eight months in 2/3 of the front of my head fall out, I end up shedding 100+ hairs a day for 5 months, where as before Fin I only shed 15 a day. I was in so much denial I kept using it. So yah I ruined my hairline. Thankfull it’s growing back, but I probably permanately turned on the balding genes in those hairs, because it raised my testosterone so much. My testosterone used to run around 650, it got all the way up to 900 on fin. And, by the way, fin DID DO what its suppose to – it lowered my DHT signifcantly, it’s the testosterone that killed my hairline. Hairlines are beleived to be more sensitive to all androgens.”

Is it true? The hairline is more sensitive to testosterone and fin make the testosterone go up?

I would really appreciate it if you can answer this question ASAP. Im sure alot of people would also want an answer to this question.

The hairline is less sensitive to DHT blocking, but I don’t know if it is more sensitive to testosterone. The probability is that frontal hair experiences apoptosis (cell death) at an earlier age than the hair in the crown in most people.

In regard to the story you read that was posted about Propecia, that is one person’s experience and the story hasn’t been validated. I won’t make light of what this person says, but it isn’t objective and I just don’t believe everything I read (particularly on message boards where anyone can sign up with fake information). You can find all kinds of claims on the Internet, but who will validate the story?

And even if it is true, what would you like me to add? Are you asking for reassurance that Propecia will not cause hair loss? You will lose your hair with or without Propecia if you have the gene for male pattern baldness. Hopefully you have a doctor to work with, so talk to your doctor. Get the facts straight. If you look hard enough the Internet, you will probably never leave your house due to the fear mongering that goes on.

Tags: propecia, finasteride, dht, testosterone, hairline, hairloss, hair loss

Did I Lose Part of My Hairline Because I Stopped Propecia for a Week?

/by William Rassman, M.D./0 /, ,

hi doc,

A few months ago i was studying for exams, which was obviously stressful. Around that time i ran out of propecia for a week, suprise suprise, i then realised my left hairline had taken a beating which wasnt there before. my question is, is it possible that i lost hair by stopping propecia for a week? if i lost hair because of stress when can i expect to see it grow back?

thank you

PropeciaIt does not quite work that way. Just because you stopped Propecia for one week does not mean it caused the loss of your frontal hair. I wouldn’t expect you to notice much loss in benefits from a week off the medication. Moreover, Propecia isn’t really as effective for treating frontal hair loss and works best in treating crown/top hair loss.

Now there are rare occasions where medication does provide some regrowth at the hairline, but these are very rare and it most likely won’t regrow. There is no medication that can prevent or reverse this with any level of certainty.

As well, stress-induced hair loss in those men with genetic hair loss will likely not regrow. Perhaps your hairline is maturing?

Tags: propecia, finasteride, hairloss, hair loss, hairline

I Was Told to Use Minoxidil After My Hair Transplant

/by William Rassman, M.D./1 /

Hi
I recently had a direct implantation and I was told to use minoxidil 5% which I am not sure if is something I would like to use because of its many, quite weird for me,side effects.

Is it essential after implantation? or is there something else I could use that could be safer? thanks

RogaineMinoxidil (Rogaine) isn’t essential after a surgery, but Propecia would be recommended to prevent shock loss (and taking it before surgery would be optimal). I hope your surgeon discussed the possibility that the transplant could cause additional loss around the recipient area, and taking Propecia before the surgery could help to prevent that.

What weird side effects from minoxidil are you talking about? It could cause skin irritation, which isn’t too “weird” to consider for a topical medication. That being said, side effects are rare in both minoxidil and Propecia, but you’re under the care of a doctor already so I’d expect you should discuss these with him/her.

Tags: minoxidil, rogaine, hair loss, hairloss, propecia, finasteride, hair transplant, shock loss

A Limited Physician Survey About Finasteride

/by William Rassman, M.D./0 /

SurveyI belong to an email group of hair transplant physicians who communicate regularly to share information. Most recently, the group was polled to determine the side effects that these doctors see with finasteride.

Most doctors reported sexual side effects (range from 2-5%), breast enlargement (very rarely, seems like substantially less than 1%), reduction in ejaculate volume (substantially less than the 20% I have seen when I ask about it), bouts of testicular pain (rare), and mood swings (rare). All side effects have been reversed by stopping the medication in 100% of the experience of these doctors.

This was an informal survey, but the general numbers seem to be similar to the instance of side effects reported by Merck. If someone in our group hopefully formalizes this possibly in a publication, I will post the results.

Many of our questions posted on BaldingBlog relate to Propecia/finasteride issues, which we point out may reflect the panic of some posters on the internet. Those in panic mode or those who are very fearful do not reflect the majority of men taking this drug.

Tags: finasteride, propecia, proscar, side effects, hairloss, hair loss

Preventive Propecia?

/by William Rassman, M.D./0 /

I have read many articles and questions on Propecia, but one think I never see is if propecia can be used as preventitive measure. For example Im 22 years old and still have a pretty thick heas of hair with a small receiding hairline, but my father is bald and so was my mother’s father so it is more then likely I will also go bald, so I was mainly wondering, is it ever to early with the hair loss stage to start using propecia even if I’m not sure if I will actually go bald.

You should not use Propecia (finasteride 1mg) for preventive measures. It’s a prescription medication, and you’d use it after you are examined by a doctor who can diagnose you with androgenic alopecia, prescribe it to you, and discuss all its risks and benefits. You have to know what you are treating first.

Tags: propecia, finasteride, hairloss, hair loss, preventive, preventative

I Can’t Take Medication During Military Basic Training, But I’m on Finasteride!

/by William Rassman, M.D./0 /

Quick Question:

I am joining the military, slighted to leave for boot camp in a few months. I JUST started taking finasteride about a week ago (experiencing lots of shedding, which I am fine with), but I am not allowed to ingest any medication for the duration of basic training, which lasts a minimum of 11 weeks.

Should I continue the treatment, knowing I have to stop? Will the shedding I have encountered even grow back without treatment? Will stopping, then starting again, effect future treatment (the drug’s potency)? Thank you in advance!

Army trainingI do not believe 11 weeks in and of itself should have a detrimental effect on your hair loss issue.

I have had patients in the military that didn’t have issues with taking Propecia during training, particularly since it is a medication prescribed by a doctor. Even in boot camp I believe it would be against the law for the government to flat-out keep you from taking a physician-prescribed medication. Now if you are taking Propecia obtained from the Internet without a valid doctor’s prescription that would be another issue entirely.

About.com has more on taking prescription medication in basic training — “Over-the-counter medication is not allowed in basic training. If you bring any with you, it will be taken away. All prescription medication will be re-evaluated by a military doctor upon arrival. If the doctor determines that the prescription is necessary, the civilian medication will be taken away, and the recruit will be re-issued the medication by the military pharmacy.”

So I guess it depends on what the military doctor believes is a necessary prescription. Since it is a cosmetic issue, there might be some resistance… but perhaps you should talk to your recruiter about meeting with a military doctor ahead of time to find out for sure.

Tags: medication, military, army, hairloss, hair loss, boot camp, finasteride, propecia

Keeping My Hair Short After FUE?

/by William Rassman, M.D./0 /, ,

I have been on propecia – Generic for about 7 months. I am bald on my crown. I am 43. I have not seen any hair growth. Should I stop. I am interested in FUe and not FUT. I keep my hair really short. I am happy with not having a full head of hair, and have successfully used a hair fiber to conceal my bald spot.

Can you provide me any advice on the propecia and also what I need to get FUE. FUT is just not an option for me due to the pain, healing time and the inability to exercise for 30 days.

I don’t know your medical history, you’re not my patient, and I didn’t prescribe you Propecia. Any one of those would be reason enough to make me uncomfortable giving you personalized medical advice about your prescription drug regimen. You should discuss any changes with your medication with your doctor. That being said, Propecia might not regrow your crown, but could be preventing it from getting worse. Like I said though, I don’t know your history so I’d just be making complete guesses if I continue.

As for your interest in follicular unit extraction (FUE), short hairstyles are possible without revealing any linear scarring (because there is no line), but if you shave your head you will still be able to see some tiny pinhole scars. I don’t know how short of a haircut you’re talking about.

You are correct in that healing time is quicker with FUE compared to the traditional strip technique, but the biggest trade-offs are price (FUE is more labor intensive and thus more expensive) and with the strip, we have the ability to get more hair in a single session. Those may be non-factors though, depending on your hair requirements and finances. For more info about FUE, see here and here.

Tags: fue, hair transplant, hairloss, hair loss, propecia, finasteride