Should I Wait to Start Propecia — and How Much Should I Take?

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

I am 21 years old and noticed the hair on top of my head is thinning and is very easy to see the scalp when wet. Also have a little bit of a receding hairline and very small bald spot on the crown (can only really see when hair is wet). I am just wondering if I should wait a few years before starting propecia because i heard it loses its effects after a while? Also if I do start since it is not that bad yet should I take propecia everyday or every other day or any other sort of amount?

The dosing should be 1mg a day, but this is a prescription medication and I can’t give alternate dosing advice as I’m not your doctor. Talk to your physician about it.

If you’ve got male pattern baldness, Propecia (finasteride) works best when started early in the thinning process. You should not want to wait until you’ve lost a ton of hair before you start it as it might be less effective. If you start the medication earlier, it has a greater chance to halt the hair loss. As a 21 year old, the frequency of reversing the thinning and loss is some areas is much higher than if you wait 5 more years.

Tags: propecia, finasteride, hairloss, hair loss

If I Stop Minoxidil, What Kind of Hair Loss Should I Expect?

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

I am 26 years old male and i’ve applied minoxidil once a day since age 21, but only in the two sides of my hairline where i had a problem, not in the rest of my hair. My father is totally bald. My treatment was taking place with some breaks, like 8-9 months treatment, 2 months stopping treatment. When i was stopping the treatment, the hair that was grown from minoxidil were falling out, and then after re-starting the treatment they were starting to grow again.

i have no sign of baldness in my crown, where i’ve never applied minoxidil. i want to ask you that if i stop using it at all, what kind of hairloss should i expect?

If you’re going to keep starting and stopping the medication, I don’t see the point in using it. If you stop using the medication completely, I’d expect any benefits that the minoxidil gave you will soon disappear. I don’t know what your hair loss pattern is or how much the medication was helping, so I have no way of knowing what kind of hair loss you’ll see. But if minoxidil regrew hair, that hair will fall out when you stop using it. Why are you playing Russian Roulette with your hair?

Tags: minoxidil, rogaine, hairloss, hair loss

Would Avodart Protect Against Shock Loss?

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

Dr.Rassman,
I certainly look forward to reading your blog each day. In the past you stated that some individuals are convinced that topical Nizoral 2%, used in conjuction with Propecia, helps with hair growth. What are your thoughts about using Avodart with Nizoral instead? Also, do you think Avodart might have the same effect as Propecia in minimizing shock loss in a hair transplant?

Thank You!

I generally do not recommend Avodart (dutasteride), and so I really don’t have any experience with patients that use it to protect against shock loss following a hair transplant. In theory it should protect against shock loss similar to how Propecia does.

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

I’m a Teen Worried About Hair Loss — What Should I Do?

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

sir,
i have seen your ht results. truly fantastic. congrats.

now my problem is my dad’s bald but none of his brothers (4) are bald. i have had a big forehead and recession in temples from childhood which is hereditary even for my uncles. so i dont know whether i will have hairloss in future? i am 19 years old (nw 2) now. what shall i do?

also i dont know when to start propecia or rogaine. to add further, i heard propecia decreases cancer risk but if a person still gets it, then he will get a very dangerous form of cancer. is it true? plus will propecia cause male breast cancer? i dont know what to do but i want to keep my hair at least up to 55 or so. but i am scared about these info’s here about the side effects? could u please guide me. it would be so nice of you if you mail me answering to my queries and tell me what i shall do to keep my hair on.

TeenAt the age of 19 and a Class 2 Norwood scale balding, you are not a candidate for surgery. If you are really balding, then you will have the appearance of miniaturization in the hair on your head. In that case, the drug finasteride is the best way to stop the balding problem in men who are balding in the earliest stage. Get a good doctor to review your personal situation and please do not have a surgery under any circumstances.

I’ve been getting a lot of similar emails from teens that want to take medication before they need to, or want me to tell them if they’re going bald based on 2 sentences they email to me. I’m going to make this as easy as possible for everyone to digest, and there’s no better way than an itemized list…

  1. You have a family history of hair loss, but that doesn’t necessarily mean you will experience loss to the same degree or at all. It can skip generations.
  2. Some refer to the corners of the hairline as the temples. Corner recession could be the maturing of the hairline. Recession of the actual temples will usually not see benefit from medication and surgery will likely be required to restore them.
  3. I can’t tell you when you should start on Propecia (finasteride), as it is a prescription medication and therefore must be prescribed by your physician. Generally speaking, you shouldn’t take medication as a preventive medication against hair loss anyway. Everyone is different, and some men will need the medication at 18 years old, while others will need it at 35. It depends on when you’re experiencing miniaturization and to what degree. A 25 year old man already showing thinning in the Norwood Class 7 pattern will not benefit from Propecia unless it is caught early and still it may not do much more than stop the loss from occurring.
  4. Propecia side effects are real, but they are also quite rare. Internet reports are unverified and overblown (some people will post the same basic negative messages over and over under different usernames across different sites). The major health concerns that you brought up (prostate and breast cancer) are worth considering, but more information needs to be collected. Studies into these types of issues might have been minimal, but the FDA lists the medication as safe and effective, and I’ve seen the effectiveness first hand (and have posted many photo results on this site).
  5. Get a good, caring doctor who has an interest in hair loss. Most often they build their expertise in the surgery of hair transplants, but there are many good doctors who care enough about their patients that they will not be trigger happy and rush you into a surgery before you are ready. Check the physician search at ISHRS to get started.
Tags: teen, teenage, hairloss, hair loss, propecia, finasteride, hair transplant, cancer

Is There a Good Way to Wean off of Minoxidil?

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

Hi Doc, I have to say, this is really nice what you’re doing in this site. My question is this…

I was using minoxidil for a year and I suddenly stopped. I had hair fall immediately and now my hair is very thin. How does someone stop or taper minoxidil treatment?

Currently I am on propecia medication. Do you think I’m still going to grow back my hair with propecia?

Minoxidil and Propecia are medications you need to take for life. If you stop either medication you will lose the benefits that each provided. Patients for one reason or another (knowing these risks) who want to stop taking the medication wean off from them over the course of several months to decrease the perception of sudden hair loss, but make no mistake, you will lose the same amount of hair. It just may not appear as drastic.

Propecia will likely not grow back all the hair you lost. Sorry, I know the news is not good.

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

Is Propecia Changing My Ejaculate?

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

Hi,
I have been taking 1mg of Propecia once every other day for the last month. Initially there were no issues – I could take the drug and by midday I would even forget that I had taken it as I wasn’t paying particular attention or worrying about side effects or waiting for them to occur.

However, in the last week or so I have noticed just one side effect – my ejaculate appears less white and less ‘sticky’ than it was just a month ago. There are alot of conflicting reports on the internet and my prescribing doctor (who is also a HT surgeon here in the UK) said that side effects usually diminish with continued use. Have you had any experience with this side effect through your work and has this proved to be the case?

I’m only 18, but a NW3 – my self-esteem can’t take any more hair loss, I am becoming concerned about this side effect however with regards to being able to conceive in say 10-15 years from now. Is this side effect really as serious as I am making out?

Thanks very much – your time is really appreciated.

One of the side effects of Propecia (finasteride 1mg) can be less volume or less viscous ejaculate. This does not change your virility or sperm count. If you are worried about this please see your doctor for a check up. The problem may disappear over time.

Tags: propecia, finasteride, sperm, ejaculate, hairloss, hair loss

Could Finasteride Increase Muscle Mass?

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

If Testosterone levels do go up by about 15% by taking finasteride could this drug increase muscle mass?

Doubtful. The slight increase in testosterone is very minor and only temporary.

Tags: finasteride, testosterone, muscle, hairloss, hair loss, propecia

Extenze and Hair Loss?

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

Does Extenze cause hair loss? If you’re on Propecia would that combat any hair loss potential by Extenze?

Extenze I know very little about herbals like ExtenZe that claim to increase the size of a man’s penis, which is what Extenze seems to promote. I have seen the commercials for this product advertising it on CNN and frankly it is unbelievable for me to imagine that it can do what it claims to do. If someone out there has actually used the product (hold the spam, please), feel free to post a comment to let our large group of male readers know. I tried to do some actual research online, but its difficult due to the amount of advertising spam hidden as articles about this product. They really have a large marketing campaign going on the web (and television, obviously).

I did manage to look up the ingredients for ExtenZe and it lists DHEA, which can cause hair loss in some men. I haven’t seen any reports of hair loss from the pill, though. Connecting it with Propecia is well beyond anything my imagination can muster.

Tags: extenze, hairloss, hair loss, dhea, penis, male enhancement

Can Shock Loss be Temporary?

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

Great SITE. Useful info and look forward to my next transplant if I have 1 to be done by you…

A few questions. I been reading about shock loss. In your opinion do most shock loss come back?? If so how long after. If NOT with propecia bring it back?

I did my transplant about a month ago around my hairline and hairs are growing but it’s kind of itchy and a little red still where the graphs where placed. Is this normal cause hair is coming out now?

Last question. I’m 33, dirty blond hair and got graphs in my crown. i can feel hair everythere like a brushcut, and I know it TAKES months to see results BUT what are the chances that the density will cover that crown. Given I have light hair and very fair skinned.. Thx in advance…

Shock loss in the men who are actively losing hair from genetic hair loss is more often semi-permanent or permanent. Some hair may come back, but in my experience it is not common. The use of finasteride (Propecia) will protect the hair in most young men from shock loss and I always insist that the patient go on the medication prior to the surgery for that very reason.

Men with blond hair will often take less hair to cover any area when compared to a man with dark hair and light skin. To be more specific, I would want to know how many grafts you received, what was the hair count, what is the size of the area covered, and what is the weight of your hair shafts (fine, medium or coarse) before I would want to venture a guess about your crown coverage.

Tags: shock loss, hairloss, hair loss, hair transplant, crown

Propecia at the 10 Year Mark

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

Hi Dr Rassman I have a question regarding long term efficacy of Propecia in older men who have been using it for an extended period of time.

I am in my mid fifties and have been using it for 10 years and I’m happy with the results it seems to be maintaining fairly well. However I see posts on other hair sites (by users not doctors) who say it stops working. I tend not to trust some of these people as it sometime seems they are freely expounding personal experience rather than hard facts.

Can you shed some light on this for me?

I’ve written about this before, but if the benefits of this medication eventually becomes less apparent and if you should stop it, then you’ll surely find out if it was still working when you begin to lose more hair. In other words, it is best to continue it even if you think it isn’t working anymore, because it likely is still working and stopping the medication may cause you to lose any hair that it was holding onto.

As an aside, there is great evidence that this medication will reduce the risk of prostate cancer in men over 55 years old.

Tags: propecia, finasteride, hairloss, hiar loss, decade

Fasting and Propecia Side Effects?

/by William Rassman, M.D./3 /

From your medical point of view, if someone had side effects from a year’s worth of Propecia, could fasting help speed up the side effects going away? I’ve read that water fasting or juice fasting accelerates recovery because energy usually spent on digestion is now used for healing and returning the body back to a baseline level.

I don’t advocate fasting and I really don’t know that water or juice fasting would speed up recovery or increase the speed of side effect disappearance. It’s an interesting idea, but to be completely honest, what you are saying makes no sense to me.

Tags: fasting, propecia, finasteride, side effects, health, juice fasting, water fast

Resveratrol and Hair Loss

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


There is a website called www.hairloss-research.org which has some great natural hair loss information. They note that an Italian company patented resveratrol for a male pattern baldness remedy. The site also notes studies on the positive synergistic effects of various substances like resveratrol, turmeric, cinnamon, and green tea.

Back to resveratrol. I’m the guy who always complain that massive amounts of soy made me hypothyroid. I recently Googled resveratrol and goitrogen and came across a study that notes resveratrol has goitrogenic effects on the thyroid, or it suppresses thyroid hormone. Check out this site.

It notes at least one study from King Saud University I believe. I know that resveratrol is found naturally in red grapes, red wine, and peanuts, and that it’s hard to “overdose” on natural foods eaten in relative moderation, but I’m worried about taking a resveratrol supplement now. I started taking resveratrol in May 2009, about a year after my problems started, so resveratrol didn’t cause them, but perhaps it’s exacerbating things. Yet I assume many people out there take resveratrol on its own and feel perfectly fine, or nothing noticeable.

I came across studies about resveratrol’s potential anti-aging benefits, which look promising, so I don’t want to shortchange my youthful looks by stopping the supplement. Any thoughts?

RatI don’t know how the patent process works in Italy, but if its anything like the patent process in the US, ridiculous things can slip through the cracks. So just because something is patented, it doesn’t mean it is proven to work or has any science to back up the claims. I haven’t seen the patent you’re referring to, so I’m just speaking in generalities.

I found the King Saud University study you referenced, which was carried out as a student’s Toxicology class requirement, isn’t peer-reviewed, and was based on 4 weeks of testing on rats. It might be interesting reading, but I wouldn’t base any nutritional changes on it. Like I’ve said over and over and over though, it’s a buyer beware market out there. I’m not a thyroid expert, nor am I easily convinced that something will grow my hair (or cure hypothyroidism) just because a website with “great” natural hair loss info run by a guy with no medical background told me it would do so… but perhaps I’m alone in that way of thinking. That website also just happens to sell those very same herbal treatments they claim will grow your hair, so keep that in mind when you’re reading about how great the newest “hair loss miracle cure” is.

I couldn’t possibly know how various supplements will react in each and every person, so of course, I think you should discuss this with your physician, who will have a better understanding of your health needs and concerns. As for us, Dr. Pak says he gets his dose of resveratrol from a good bottle of wine with a juicy rib-eye steak, while I (Dr. Rassman) take resveratrol in pill form daily. This will not regrow hair, though.

Tags: resveratrol, hairloss, hair loss, thyroid, natural, hypothyroid

I’m Noticing Small Hair Growth at the Hairline After 3 Months on Finasteride

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

Hello Dr. Rassman,

I am a 22 year old male, most likely a Norwood Class 2. I have recently begun taking 1.25 mg generic Proscar, which I started about 3 months ago. I have recently noticed there appear to be some new very small, light, and almost invisible hairs growing at the corners of my hair line. When I say these hairs are almost invisible, I mean that they are very, very hard to see, but in the right light they do show up.

Could these hairs be growth from Proscar? Does initial regrowth usually begin as very fine, light hairs, and later grow in as thicker hairs? Finally, I have noticed that a small number of my thicker hairs are not always uniform in width, one end of a hair my be extremely thick, while the other is thin, and even a different shade of color.

Thanks for your time, and keep up the excellent work!

Let’s not check this out hair-by-hair. If you wait out the full 8 months to 1 year you will see just what you are getting. Patience is a virtue in this business. Do you ever actually see grass grow in real-time? I mean, to see it you need to take a step back and wait to see the change over a few weeks for the grass (and months for the hair).

It would be a very rare thing for you to see growth at the hairline, particularly after just 3 months. But I suppose it isn’t out of the realm of possibilities…

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

My Dermatologist Sees Hair Loss But Wants to Wait to Prescribe Propecia Later

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

Hi Dr. Rassman,

Is it always best to start Finasteride sooner than later? I’ve read some information suggesting that finasteride only works for a certain period before losing its effectiveness. Should it be started at the first sign of balding, or should one wait a bit until it is absolutely necessary?

I am 26 male and have started to thin in the front. Dermatologist confirms male pattern baldness by inspection only, no mapping. He is hesitant to prescribe me finasteride for life, considering that we don’t know its long term effects and he’s considering that it might cause more aggressive forms of prostate cancer (though it lowers prostate cancer risk overall). But reading your archives it seems that you think finasteride is the best treatment option for young men who are starting to bald.

Do you have any concerns about its long term safety? Say usage for 10 years plus?

Thanks!

I think that your dermatologist is off base. The medical facts do not support him and the earlier you start Propecia, the less hair you will lose. Propecia should be started at the early onset of hair loss. Hair loss is a one way street, progressing only to more balding when it is caused by genetics in the male. I haven’t seen you, so if your dermatologist says you are experiencing early genetic loss, you may consider getting a second opinion for the Propecia.

Propecia has been available on the market since early 1998 (FDA approved in 1997), but I’m unaware of any recent studies on patients that have been taking it for that long. I do have my own patients that have been taking it for over a dozen years with great success. Some have experienced a perceived reduction in benefits after 5-10 years, but the medication is still working to some degree. If the medication were to be discontinued at that time, more hair loss will be seen (catch-up hair loss). It’s the tug-of-war between the medication and your genetics.

Tags: propecia, finasteride, hairloss, hair loss

Is Propecia Safe to Take Daily?

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

Is Propecia safe to take everyday the rest of my life. I’m 33. Pretty healthy with no known issues. I work out.. Thinning a bit in the middle of head and I heard Propecia will slow down or stop completely hair loss. Internet is vaque on question. So Doctor is it safe to use on a everyday basis on the ones liver or a other life threating issues taken it long term..

There is no evidence to suggest that taking Propecia for life could cause problems with your health. Evidence that it may be harmful is what the FDA wants to know as well. Taking the medication for your lifetime is important, because the hair loss problems are lifetime problems.

I’ve had a patient taking Propecia for over 12 years, and the results show that his hair loss visibly stopped and his crown hair regrew within the first year of taking it. I have recommended that my son, who has been on it for 5 years now, stay on it for his entire lifetime. All of his frontal thinning stopped on the drug and I am convinced that if he discontinued the medication, he would experience hair loss.

Tags: propecia, finasteride, hairloss, hair loss