Hello Dr Rassman,

While scouring some medical journals, I came across this 2007 clinical study that involved a comparison between Finasteride, Dutasteride and a Placebo. The subjects were 18-55. And the study seemed to confirm your suspicions concerning sperm count; however, not to the extent that may have been feared. Please find link below:

Journal of Clinical Endocrinology & Metabolism

Thanks for bringing this study to my attention. What is needed is a double blind approach where sperm count is high on the list of targeted outputs. Without such a study, the safety of dutasteride (with regard to fertility) may be a problem for young men wanting children.

You know how the literature says that Propecia takes a few weeks at most to leave the body because of tissue fixation? How come when people start a new diet, such as cutting out milk, gluten, or soy, they say to wait 90 days in order to see results? An herbalist told me the threshold is 90 days because that’s the time it takes for the blood to recycle/cleanse completely or something.

Of note, red blood cells have a life span of 120 days, but this really has nothing to do with tissue fixation. Red blood cells are not tissue nor do they carry Propecia.

You are asking me about starting a new diet and things that herbalists practice. They generally do not have any good science behind them. Let me reiterate with an example: A few of my acquaintances heard about colon cleansing (colonics) and how it rids the body of toxins, so they went as a group to try it since they thought it was a great idea. Now personally, I find it a bit disturbing to go with a group of friends to have a stranger in a white coat put a hose up my bottom, followed by flushing gallons of fluid up there for a good sum of money just so I can watch the fecal waste come out. Granted, I’d find it equally disturbing if it wasn’t a stranger… but the point is, there is no good science behind colon cleansing. All of this is a bunch of B.S. (pardon the pun).

I realize I’m going off on a tangent, but people will believe what they want to believe. I also realize there is a community of alternative medicine supporters out there, but I’m a Medical Doctor. There are some alternatives that have been shown to work just as well as claimed, but there are also many of them that are just don’t work at all.

if i know for a fact that i am going to go through male pattern baldness can i just start taking propecia to completely prevent it before it even starts and if i do will i keep my juvenile hairline?

p.s. i have a phobia of going bald

You’re not alone in having a fear of going bald (not to be confused with peladophobia, the fear of bald people). I see that fear every day in the eyes of my patients and I certainly read it every day in the emails I receive through this site. There are a couple problems I see with going the route you want to take:

1. How do you know 100% for a fact that you will lose hair? Do you have a deep family history of hair loss? I’ll assume a family history is what you’re basing your hypothesis on. Nothing is guaranteed and the genetic markers have been known to skip generations. I’ve seen families with a completely bald father, balding son #1, and hairy son #2. I’m not a geneticist, so I couldn’t tell you why it skips the way it does, but ultimately, you don’t want to take medication that is unnecessary.
2. Propecia is not a cure for hair loss. There’s simply no cure at this time, so hair loss can’t be completely prevented. The medication might delay the process for years, but with that being said, Propecia likely wouldn’t even keep your juvenile hairline. If your hairline matured and you saw the progression of further hair loss starting, then would be the ideal time to take the medication.

As I’ve said time and time again, the best way to track if you are going to bald is to use a video magnifier to map your scalp. Watch your hair for the appearance of miniaturization, which is the first signs of balding. When and if this happens, you should see a doctor and then start Propecia.

I’ve been on propecia for 9 years now. My hair has held up pretty well but in the last year I fell it’s gotten thinner. I’d like to up my dosage of propecia to 2mgs a day or 1.5mg’s a day in hopes that I’ll get better results. Unfortunately, my doctor nor dermatologist believes in upping the dose.

What can I do? After 9 years would increasing my dose help to prolong the benefits? Any help would be appreciated.

If I was your doctor and you had no side effects from the 1mg (which I’d assume not, since you’ve taken it for 9 years), I would go along with a higher dose provided that you do not develop side effects. The studies on the 1mg dose is an idealized study (middle of the bell curve) so there may be benefit of a higher dose in some people.

Did you ask your doctors why they won’t consider increasing the dosage? You always have the option of pleading your case to another doctor.

Dr Rassman, I have been using both rogaine and propecia for the past ten years. I think they have worked fairly well but I have read that rogaine becomes less effective over time. My question is it still worth using, does it have any negative effect if you continue to use it even if it does not seem to be growing as much hair as when it was first started. I don’t have any shedding due to its use and have always read that using them together is a good approach to fighting hair loss.

If it is working now and you’ve had success for a decade, I’d keep up with your daily routine. Why take chances? Do what you know best. If you discontinue its use now, you’ll lose any benefits you’ve had for all this time. Remember, new hair that has grown from minoxidil is dependent upon the drug and if it is withdrawn, it is highly likely that these dependent hairs will fall out.

I hear you say any Propecia side effects are gone within a few days or weeks at most. But what about other drugs that the FDA has recalled because of permanent side effects? Those drugs presumably had half lives, and the literature indicated that side effects would go away soon after stopping those drugs. Maybe the same scenario goes for Propecia.

You have an agenda in your question. God does not reside at the FDA, which means that their activities are less than perfect, and yes, they’ve made mistakes in the past. We can only tell you what we believe we know. Finasteride has been on the market for over a dozen years now. If you can’t find the research and proof to be credible by now, I don’t know what more I can do to help.