Hey doc, I just saw this article that talks about a Consumer Reports poll about hair loss treatments. Kinda interesting that minoxidil doesn’t seem to work all that well for most men but Propecia did have a good response rate.

‘Consumer Reports,’ stylists say hair loss remedy results mixed

Here’s the part of the article that you’re referring to: “Twenty-seven percent of men who used finasteride (marketed as Propecia) said the pill was ‘very effective’ at treating hair loss and 41 percent said it was ‘somewhat effective.’ Only 4 percent of men who used minoxidil (marketed as Rogaine) called it very effective.”

It’s an internet survey of just over 8000 Consumer Reports readers so it isn’t scientific at all, but this sounds about right to me. Minoxidil works for many men, but “very” effective it is not.

Hi Doc

After spending hours on your site I have decided to take the brave step of seeking help from my local GP, Doctor, about my hair loss. I still have a good head of thick, black hair but I am shedding some hair. Uaing Nitozrol seems to have helped, less loss and thicker heir.

My GP stated that he is willing to prescribe me Finasteride in the 5mg ‘as we have seen best results at this dosage from our patients’.

Doc is that perfectly normal to take 5mg I thought it was 1mg per day not 5? Have you seen better results with 5 then 1 with your patients?

Thanks

Reports originally sent to the FDA by the pharmaceutical company Merck show that the 1mg dose of finasteride is as good as the 5mg dose of finasteride for treating hair loss. There may be an occasional patient who does better on a slightly higher dose (2mg), but as the dosage goes up the side effect risks become higher. Even in those cases, I have a difficult time delineating that a higher dose provides more benefit. I have suggested to some patients that have seen a cessation of visible benefits after some time on Propecia to increase their dosage, but so far the results have not been clear… and I’ve not recommended those few patients increase to the full 5mg.

On the flip side, there are some doctors out there who believe 0.25mg finasteride is just as good and there is some evidence that this tiny dose is 50% as effective as the 1mg dose! In my practice, I recommend the standard dose for treating genetic hair loss: finasteride 1mg. As most people likely know, the reason a 5mg pill is available is because it is a prostate treatment (marketed as Proscar). 1mg for hair loss, 5mg for prostate.

Is there a danger to taking Finasteride if I don’t have androgenic alopecia? I have a lot of hair loss, but it’s possible that it could be from an Iron or a B12 deficiency from a poor vegan diet the last 3 years. If I start taking Finasteride, but it turns out my hair loss is not due to androgenic alopecia, will Finasteride cause me to lose more hair somehow?

Finasteride 1mg (Propecia) is meant for treating genetic androgenic alopecia (hair loss) in men. If you do not have this genetic hair loss, you should not be taking Propecia. You shouldn’t be taking any medication if it is not meant for you. Hair loss from iron or vitamin deficiency is not androgenic alopecia and hair loss patterns are completely different. They are two completely different things and easy to distinguish.

It sounds like you are trying to play a guessing game and experiment on yourself so rather than continue doing that, I suggest you see your physician.

Dear Doc,
Just read that 0.2mgs of finasteride taken once every three days is just as effective as 1mg daily at this site: hairloss-research.org

Is this bollocks?

That is just the opinion of one doctor, and I am also aware of similar opinions regarding low dose finasteride (though taken daily). I generally prescribe and recommend the standard 1mg treatment dosing to treat hair loss. From some research I have read, lower doses of finasteride 0.5mg and 0.25 mg will have an impact on DHT, but less of an effect can be expected from these lower doses.

In a recent post (Propecia and Coffee) you mentioned that some people believe that the increase in urination from drinking coffee and/or alcohol might diminish the impact of Propecia.

I currently drink about 1 gallon of water a day and because of this I urinate a lot. Could this prevent me from seeing maximum results from Propecia? Should I drink less water?

With respect to the post you are referring to, I never stated I believe in the theory that urination will make Propecia less effective. People write about these things on the Internet and the speculations get propagated (as I have probably contributed). So no — I do not think drinking and increased urination contributes to less efficacy of Propecia. I wouldn’t worry about it.

But, isn’t drinking a gallon of water a day considered excessive? I’d be concerned with possible water intoxication or hyponatremia.

Hi Doctor –

I was using propecia (Finax 1mg) since Nov’2009 till Feb’2010, I was also using minoxidil 5% tropical solution. During Dec and Jan I experienced palpitations and Feb I felt stress around my face and chest which turned out to be high blood pressure 145/90. This did not happen for a month and then again suddenly I have started palpitations and sometimes feel stress. I have stopped the usage of both the medicines since 3 weeks but nothing seems to work.

Please help me out with how much time it should take to get rid of these side effects, do I need any medication that can help me wash this off easily… I have developed sleeping disorder as well. My physician who advised me for this is not ready to believe that these medicines can cause these issues.

Looking forward for you help. Thanks

Here are the listed rare side effects for topical minoxidil — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in hearing or vision; difficulty breathing; excessive, sudden weight gain; fainting; lightheadedness; increased chest, arm, or shoulder pain; increased heart rate; pounding heartbeat; swelling.”

And here are the listed rare side effects for finasteride — “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast enlargement, lumps, pain, or tenderness; nipple discharge; testicular pain.”

So what you describe as stress in your face could be an allergic reaction to either medication, but this doesn’t explain your blood pressure spike. In fact, minoxidil is taken in pill form to lower blood pressure. Stress is a likely reason for any abnormal sleep patterns, and the stress itself could be from your health. What troubles me is that you still are experiencing issues even after stopping the medication, leading me to wonder if your symptoms are unrelated to your hair loss treatments and could possibly signal a serious (undiagnosed) underlying medical issue.

Hi Doctor,

Thank you for maintaining this great and informative blog and answering all our questions.

I was on propecia for 9 years until last year I was prescribed Avodart because propecia was losing its effectiveness. I decided to go off avodart after a year and go back to propecia. The dermatologist told me to give it a year before deciding to switch back. It appeared to me that my hair loss had increased slightly on avodart and the side effects built up after a year were a bit too much – slight loss of libido, slight ED. After a week of switching from propecia my hair loss accelerated substantially. Could this be catch up hair loss – maybe avodart was not working for me – or could this be a shed as of a result of restarting propecia.

Thank you.

There is no drug in the world (yet) that completely stops hair loss. Avodart and Propecia work in similar ways (the two drugs are not drastically different in the mechanism of action) although there are reports that Avodart is better at stopping hair loss, particularly when Propecia benefits have been exhausted. I personally have not seen a worthwhile benefit of taking Avodart because:

1. My patients that have taken Avodart have not noticed a significant change in hair gain/loss.
2. Sometimes the risk (of sexual dysfunction, etc) outweigh the benefit of (marginal) improvement over Propecia.
3. I rarely prescribe Avodart, so my personal experience is admittedly limited.

While I will never know what is going on with your specific case, your experience is real and there may be the correlation you are asking. However I would not think your hair loss is from “catch-up” hair loss for not being on Propecia as you were still taking Avodart and you only noted the hair shedding after starting Propecia. Coincidence? Maybe.