Hi Dr.Rass . I have been under OCD treatment for the past 11 years. I am undergoing SSRIs (Es-Citalopram oxalate) Would you recommend Finasteride in my case.

Shall I try topical minoxidil will it in any way interacts with my OCD medication.

I can’t recommend finasteride to you, since I do not know if you’re even a candidate and it is a prescription medication. Talk to your doctor about a prescription and you can learn his/her thoughts on it. As for minoxidil, that is over-the-counter so you can use it without my input (read up on it and use your best judgment). You shouldn’t have any interaction problems with your OCD meds and minoxidil, but without knowing which medications you’re taking I can’t say for sure.

There have been some reports of some mood / behavioral changes with Propecia, although these changes are very infrequent and it needs to be studied further. That is why you need to have a good relationship with your doctor.

Dear sir,

When I started on finasteride I noticed a very strange but rather pleasant side-effect: an increased libido. This makes sense since finasteride raises the levels of total testosterone; it is, however, contrary to the science literature, which commonly reports DECREASED libido as a potential side-effect.

Why do some men suffer a decreased libido when finasteride actually gives them more testosterone? Thank you and best regards

We really do not know the reasons for the increase or decrease in libido that some rarely observe after taking finasteride. The decrease is seen in 1-2% of men, and the increase is even more rare… so congratulations!

Hello,
I’m an 18 year old white male. I first started wondering if I was thinning a little over a year ago. Since then I have gone back and compared photos and noticed a huge difference. I can no longer grow my bangs out without them looking thin and scraggly, particular the hairs coming from the temples. I have gone to a shorter haircut, and am still very satisfied with the amount of hair I have left on my head. Most people would think I was crazy if I told them I was balding, but given my family history (Father and Grandfather started balding at 17, every adult male in my family is bald)and the thinning I’ve seen, I’m certain the process has begun. Since I’ve started studying my hair, I’ve noticed some changes in the color of the hairs on the top of my head (brown to a lighter almost blond) particularly on the crown. I appear to have a very preliminary bald spot.

So finally to my question. I have done a lot of research about hair loss and I understand the concept. It is my understanding that Minoxidil is used to stimulate new growth but won’t fix the route dht problem. Only Propecia can do that. I’m really worried about the side affects of Propecia, even though I believe that a lot of what is on the web is junk. Would Rogaine be an effective treatment to halt my hair loss? Or would you recommend propecia. Also, I’ve been using Nizoral over the counter for almost 4 months and appear to be seeing better growth and thickening. So final question. Will Rogaine halt the loss or should I just go see a Doctor about Propecia. If so, what kind of doctor?

Thanks for all your help. I love your website.

Propecia (finasteride 1mg) is the best approach for men with early hair loss, not minoxidil. Minoxidil can grow hair in the crown in some people, but it doesn’t halt the loss (because it doesn’t block DHT, as you mentioned). Propecia, on the other hand, halts the loss and regrows hair. The side effect risks of Propecia are about 1% and if you get them, you can deal with them if you have a doctor managing you. It is insane to worry about a side effect you probably will never get while your hair loss progresses.

Find out what is going on now! You need to have your hair mapped out for miniaturization, so that you can establish a baseline for where your hair loss is today. This mapping procedure will give you a metric that you can compare over the years.

Since starting propecia 7 months ago, my hair loss has become significantly worse. In the 3 to 6 month period, my temples and mid-anterior scalp became noticeably thinner. Although “shedding” in these frontal areas slowed down/stopped at the 6 month stage, my crown is now thinning even though I had not noticed any hair loss in that area before beginning propecia. I have 3 questions:

1. is it possible that propecia is making my hair loss worse-has this ever happened to a patient of yours before?
2. is it possible that this shedding is a positive sign because I am young and in the early stages of hair loss i.e. as the drug has a lot of hair to act upon? Doctor Bernstein states on your website that shedding is fairly common and can be a positive sign.
3. is it common for propecia to take over 6 months to yield noticeable effects i.e. stopping hair loss and/or creating regrowth, or should I stop the drug and save my money?

Thanks

1. Your hair loss on Propecia probably has nothing to do with the drug, but rather the progressive nature of your genetic hair loss which (based on what you wrote) seems to be aggressive. Shedding at 9 months is not a good sign.
2. At 1-2 months shedding can be a positive sign as we interpret this as an acceleration of the normal hair cycling, but that acceleration should not occur over 9 months. Most people will see a reduction in shedding by the 4th month.
3. It generally takes about 6-12 months to see the difference after starting the medication. So you’re still in the time frame and I wouldn’t suggest stopping the medication at this point unless you have experienced any side effects that you can’t deal with.

The effect of finasteride on spermatogenesis

I was wondering if you had see this study on hampsters? It concluses that animals treated with finasteride showed significant changes to the testicular seminiferous tubules as well as on spermatogenesis when compared to the control group.

Sounds scary! Is it something to worry about?

Link: Study

OK, but how did their hair look? If you have a pet hamster who is balding and you are concerned that he may not reproduce on finasteride, then you have a real problem.

In all seriousness, this might be interesting to some degree, but it isn’t enough to even consider being worried about. I’m not a veterinarian, but I can clearly see there are vast differences between humans and hamsters. Besides, the study says they gave the equivalent of 5mg finasteride to the hamsters… and unless you have prostate issues, you shouldn’t be taking that much anyway (1mg is for treating hair loss). And for those men with prostate issues (which usually occur later in life), getting a girl knocked up isn’t high on the to-do list.

Note: I believe these were from two different people, but the questions are related so I’ll answer them together…

Email #1

Now doc , i have a suggestion to make just like you do.You write “Every person will eventually lose the benefits of this drug, but the open question is when” – there is no proof for this , or you do have one ? Even if this statement is based on your experience , you are aware that this is not official and there is not way to be.The official one is that after 5 years only 10 % of the people lose some hair , and please attention – more of teh 50 % of the rest CONTINUED to improve even after this.So unless you can prove the opposite ,please flag those ones as “my opiniion ” or “may” or “might ” , but please do not make statements which are neither proven nor stuided in the medical literature – 10x

Email #2

Why do you recommend Propecia to people that come to you for hair transplants if the effect is only temporary? I just ask because you emphasize a master plan for long term benefits, and it seems like as soon as the drug stops working, the hair it saved will fall out and the patient will have that embarrassing pluggy look -bald head with transplanted hairs. Isn’t it setting up people for more misery to take a drug that temporarily grows their hair back, only for it to fail and then they experience going bald again?

Thanks for your time

Read the official study posted at Hairlosstalk.com and you can draw whatever conclusions you want from it. I believe that this drug has a forever component, but that does not mean that it will hold all of the initial benefits forever. Each person will react differently and I can’t give an exact timetable for when you’ll start to see thinning continuing (if ever). So yes, the medication does work “forever” as long as you continue taking, but the benefits may eventually appear to be less. It could be 5 years, it could be 20 years. The only facts at our hands are in the official Merck/FDA studies.

Propecia’s benefits aren’t quite temporary. It’s not just going to suddenly one day turn itself off 100%. The entire point of a Master Plan is to create a roadmap for a worst case scenario of hair loss so that nobody is taken by surprise if the progressive nature of MPB becomes more evident a decade after you start Propecia. With the modern hair transplantation, the “embarrassing pluggy look” you described shouldn’t occur.

Propecia is a miracle drug for many people, as it gets them some (or a lot) of their hair back… and it largely slows or stops the hair loss. Many of my patients swear by this medication. This is a type of medication in that if it grew hair back and stopped or slowed hair loss, them some benefit will probably last ‘forever’. Of course, you can test this by just stopping the drug and seeing what happens. Most people who saw substantial benefits and then stopped the medication saw hair loss, which suggests that the drug had some residual value. The alternative is that you can elect to take your natural balding process to its conclusion, reflecting your genetic makeup. Your choice, of course.