Hi Dr. Rassman,

I want to start off by thanking you for acknowledging and attempting to help people in what can be such a stressful and consuming problem for people.

My question is in regards to the possible mental side effects of finasteride. I understand that you have touched on this in the past, but I was wondering if you could say based on your experience if you believe these claims have any merit. I took finasteride for about a month a few months ago, and thought that I noticed these symptoms(stuttering, etc) upon quitting. I really believe in the drug in the battle against hairloss and want to start again, but these claims and my possible experience with it prevent me. I am 32 years old, but I believe that my hairloss(mostly crown area) is in its early stages and I could benefit greatly from this drug.

P.S. I would try minoxidil, but am afraid of the experiences that I read online(bloated face, wrinkles, shedding, etc)

When a formal drug study is done it is carried out on thousands of people and the side effects are reported. When the drug is actually used by millions of people, I am sure there are rare side effects that were never reported that will come to light.

I do not mean to dismiss or invalidate the unusual reports such as yours. In my practice since Propecia has been introduced into the marketplace, I have seen this complaint once (while the patient was on the medication, not after he stopped it), but I generally do not see or hear of these issues other than on Internet forums. The one experience a patient had does not prove anything statistically. It is also very difficult to pinpoint if there really is a direct cause and effect relationship, as there may be other factors.

For example, it is conceivable that men who take Propecia are also taking other medications with other medical issues (such a blood pressure or depression). Certain blood pressure lowering and anti-depressant medications are well know to cause decreased erections and libido. Certain anti-depressants can even cause stuttering (Ritalin, Prozac, as an example). Certain medical conditions which you may not be aware of can also cause stuttering. So I really cannot even begin to say what your particular cause of stuttering may be. I would discuss your issues with your doctor and see if there are other issues at hand as well.

I find it rather interesting that you were more scared of minoxidil’s side effects than Propecia’s side effects based on what you read on the Internet. The web can be a scary place when researching medical issues, as most users with positive results won’t spend their time telling people about it, but those that feel slighted will try their best to alert everyone. Again, go see a doctor for medical questions and get your answers in person, where a doctor can evaluate your case better without the back and forth delay of emails.

Hello!

Congratulations for the great insight that you give with your blog.

I’m probably hopping on the Propecia bandwagon and would like to know your clinical experience with it concerning side effects. Do many patients discontinue it after some time? I know the whole debate about Propecia’s safeness, for me it’s probably more of a psychological issue, becoming dependent of a drug is not high on my list, but I’d like to keep my hair hoping that some effective topical or surgical treatment comes out in the meantime.

Thanks!

Propecia does not completely stop hair loss forever, nor does it cure hair loss. It slows the process down, usually for many years. If you stop taking it after a period of use, the hairs that you gained or kept from falling our will disappear. Your hair loss will catch up to where you would’ve been had you not taken the medication in the first place, which is why I refer to it as “catch-up” hair loss.

There is no dependency issue. Like all medication if you stop taking it, the benefits are gone. Propecia is meant to be taken for life, much like cholesterol medicine, blood pressure medicine, etc. Most of my patients do not stop taking the medication.

In non-hair loss news:

Sure, Pfizer’s wonder pill has side effects such as headaches, facial flushing, upset stomach, erections lasting more than four hours, bluish or sudden loss of vision. There’s one more risk to the pill that grants erections: Hearing loss.

Research published this week in Archives of Otolaryngology-Head and Neck Surgery showed an association between long-term hearing loss and Viagra.

This side effect is already acknowledged by Viagra – especially after the U.S. Food and Drug Administration forced this labeling changes for oral erectile dysfunction medicines known as PDE5 inhibitors in 2007.

Read the rest of the article — Viagra associated with hearing loss

Interesting. All medications carry some side effect risks, regardless of rarity… but there are some medications, like Viagra, where many of the side effects are well known. It got me to think about how many millions of people still take Viagra despite those side effect warnings, including sudden loss of vision and now apparently hearing loss. Yet the pills still sell incredibly well and men (even those without erectile dysfunction) are eager to take it!

And then think about all the men who worry about Propecia’s sexual side effects, which occur in 1 to 2% of men (which are reversible) and are afraid to even try it. I guess it is all about perspective. I suppose we’d rather be bald, blind, and deaf than to not have sex!

Dear Drs,

I’m concerned about the rebound effect of stopping finasteride.

I was having a look at some website, I should stop searching about hair loss as I’ve become so lost, but one website had a comment which gave me some concerns. This is what they had to say about finasteride. Basically it means that whoever takes it and then stops it, will be in a worse situation than if he never took finasteride in the first place. Is that true? If I take it for a year or few years, then decide to stop, would hair shed as it would have naturally or is there be a rebound effect where I would go balder than if I never used finasteride?

Thanks a lot

The internet is a great resource, but it does not always mean it has accurate information… and as you have found out, it can be very confusing.

What you are describing is “catch-up” hair loss from stopping Propecia. In brief, if you stop taking Propecia after months or years of use, you will lose any benefits you saw and go back to what your hair loss “would have been” if you never took it in the first place. So if you never took the medication and were destined to be a Norwood Class 5, then you’ll see a Class 5 hair loss pattern emerge. This does not mean you will be worse off than if you never took it.

I have used minoxidil7% (2mL/day)and finasteride for 13 months with good results, including a period of shedding 10 months in. Then, suddenly, I felt burning on my scalp so discontinued minoxidil. I returned to the minoxidil after 2 months but can tolerate only 0.5mL/day). I have been back on for 3 weeks. In that time I have noticed a loss of density.

My questions are:

1. might 5% minoxidil be right for me?
2. is 0.5mL minox 7% likely to be ineffective?
3. could this recent loss of density be due to resuming the minoxidil, albeit at a reduced level of application?

Many and sincere thanks for your time and expertise.

Really, the only way you can know if 5% minoxidil is right for you is by trying it. Generally, I do recommend the 5% minoxidil if you want to use a topical. Higher percentage is not necessarily better, as you’ve found with the irritated scalp. Are you applying it twice daily, as recommended? As for the hair loss you’re seeing, it could be due to using only 1/4 of what you previously used, but there’s really no way for me to tell.

I have just started taking Propecia on Tuesday (5/11/10) and almost instantly my beard has been growing slowly. Usually I shave on Monday mornings and Wednesday mornings… Instead I have the amount of stubble on my face that would amount to 2 days of growth except it has been nearly 4 days..

What you’re describing is highly improbable after taking Propecia for just a day or two. While there’s been no identified link, some people do report slower facial hair growth after taking Propecia in very rare cases, but this would take weeks or months. And even then, I haven’t seen any proof that this occurs.

Look on the bright side, if Propecia does indeed slow your beard hair growth you will save 50% on your shaving supply and needs!