Some of the posts on this site about minoxidil frightening! I have used this for 2.4 months and this scaly bumpyness has covered my ears and spread down my forehead to nearly my cheeks. This has pretty much entirely happened in the last 1-2 weeks. It is uncomfortable and looks bad and i hope it goes away! someone said this could be permanent in one of these posts. Any idea here?

More important question: After 2 months of treatment the lymph nodes on my neck front and back have swollen up, mostly on one side. They havent gone down and its been 2 weeks. Also parts of my head are sore to touch – this came on suddenly so i cant be sure if its a reaction or an unrelated medical issue.

Any advice or feedback – at what point do i need to go to a doctor? Thanks

It could be allergic reactions to an ingredient(s) in the minoxidil, but really just from your descriptions alone — “scaly”, “swollen lymph nodes”, “sore”, “spreading” — you should’ve seen a doctor by now. What are you waiting for?

Rash or hives are a known rare, but severe allergic reaction to this medication… however, it’s odd that you’ve been using the medication for months and just started to see these symptoms in the last couple weeks, which makes me wonder whether it is coincidental. Any of these things might unrelated to your minoxidil use, and there could be other medical issues you have to worry about. See your doctor!

From your practice, what is the worst progression of balding that you have seen with someone taking only Propecia and not anything else like Minoxidil? Like what Norwood was he before and after and how long was he taking it and how old was he?

I routinely prescribe finasteride for all balding men, so progression is not evident as the process slows down considerably. In the days when Propecia was not available, the balding process was very evident in a matter of a few years, but now when Propecia is used, I just have not seen the radical changes in balding patterns.

Dr. Rassman,

Thanks so much for this valuable site.

I am considering Propecia. It is the possible sides, not the $$$, that has me hesitating. I have done the research on Clinical Studies, Dr. Frankel’s article, your posts, etc. The data seems to indicate, and you’ve agreed that .5 mg is roughly 80% as effective for hair growth/retainment as a full 1mg. My question is, are the side effects proportionally decreased? Is there any data out there?

B/c of the efficacy of the .5mg dose, and because the decreased DHT/Serum levels appear to stay in the same range for almost 72 hours, my plan is .5mg Merck Propecia every other day, in order to decrease any chance at both short and long term side effects. Does this sound logical to you?

I really do not see your logic. I mostly see your fear… fear that the drug can give you side effects. Is it worth the risk (for you)? Maybe you should question taking it altogether. There is a phenomenon known as the placebo effect… and it goes both ways. If you are preoccupied that a drug will give you a side effect, then you will likely see that side effect because that is what you believe will happen. If you don’t try it you will never know if you will have a side effect.

I don’t know if there is statistical data available that shows decreased side effects with decreased dosing, but I’ve seen that to be the case if a patient has experienced side effects from the full dose. If you have genetic androgenic alopecia and Propecia is recommended by your physician, then I would start with the recommended dose. If you end up with a side effect then you can just as easily not take it and the side effects would be gone.

I am just following up on a recent post I read on your Blog – I am 44. I have been on Propecia for almost 4 years – starting off as a Norwood 2.5, I have probably progressed to a Norwood 3 over this time. My hairfall seems to be less than a few years back, so I am not going to risk getting off Propeica – it is probably doing some good.

My question however is about the impact on body hair – I have probably seen a 30-50% reduction in body hair over the 4 year period. Is this likely to be related to Propecia, or is their some other factor. (FYI I am a regular smoker and accept that this may be impacting the benefits of Propecia)

It very likely could be the Propecia is causing your reduction in body hair. People have reported body hair loss with Propecia, and one rare occasions I have heard it go the other way. I wish I’d experienced the loss of body hair when I was taking the medication, but I wasn’t that lucky. I’d expect most patients would prefer to have this side effect, particularly those with excessive hair in undesirable areas (back, shoulders).

A recent publication in the New England Journal of Medicine shows that Avodart (dutasteride) reduces the risk of prostate cancer along the same lines as finasteride did in earlier studies. The study also shows that in those men on Avodart, there was an increased incidence of heart failure.

Here’s a snippet from the Associated Press article:

Full results of a big study testing a drug for preventing prostate cancer show a higher risk of heart failure, a surprise finding that could dampen enthusiasm for expanding its use.

On Monday, GlaxoSmithKline PLC asked the federal Food and Drug Administration to approve its drug Avodart as a cancer preventive for men at higher-than-normal risk of the disease. The drug is already sold for urinary problems, and no heart failure risks have been seen with that use, doctors say.

Results of a study testing it as a cancer preventive were given at a medical conference last year, but the heart risk information had not been analyzed at that time so only the main results of the study were presented, a Glaxo spokeswoman said. Full results are being published in Thursday’s New England Journal of Medicine.

The study involved 6,700 men with high scores from PSA blood tests but no sign of cancer on biopsy. They were given Avodart or dummy pills and new biopsies four years later. Prostate cancer was found in 25 percent of those on dummy pills and 20 percent of those on Avodart.

Read the full article — Study finds possible heart risk with prostate drug

As the article does mention, the heart risk could be a fluke, but it is important to study this further. Just another reason why I can’t endorse dutasteride for users that wish to take it for treating hair loss.

Dr Rassman, I have been using minoxidil 2% for 12 months and have found it quite effective on my crown. But in the last 3 months its having a strange effect on my eyes making them red and my facial skin is looking more grainy with larger pores. I have read other reports of this but of course they may be incorrect so a professional opinion would be appreciated. Thanks

Assuming that you do not apply the minoxidil to your face or get it in your eyes, I do not know what is the cause of your problem. It may not be related at all, or perhaps you are having a systemic reaction to the drug. I would follow up with your physician.

I have not heard of minoxdil making pores larger and eyes red, though I did get an email that I posted about a year ago from a reader that claimed the medication was giving him black rings under his eyes.