Does Any DHT Reduction Shrink the Prostate?

Hi Dr. Rassman,

I regret to inform you that after recently undergoing a v. successful hair transplant I was prescribed 1.25 mg of finasteride every Mon, Wed and Fri. This is all good news but the bad news is that when I got to my laptop I got on the internet and started researching the drug and found the scaremonger sites about permanent side effects. Although I’m skeptical and like you believe more in scientific research plus I am impressed at your responses to people who ask about the drug, it has still planted a seed in my head. I’m going to make a decision on whether to take the ‘risk’ soon but first have some questions that I cant find the answers to.

1. Does ANY reduction of DHT i.e. any amount (1.25mg every other day-5mg daily) of a suppressant like finasteride result in a shrinkage of the prostate? Or is it possible to suppress the hormone enough to slow hair loss but not interfere with the prostate?

2. I took Avodart 0.5mg for a year and got slight ED. I was prescribed it for hair loss in the UK which I’m sure is not ethical. I stopped taking it but that was about 2 years ago, I’m 25 now and as finasteride is weaker is it logical to assume that the sides if I get them may not be as bad even though I’m older and my neuro endocrinal system and gonadal system (I think that’s right) could be at a different stage to when I was 22?

3. If you have looked at some of the YouTube videos and forums for the men who claim to have permanent side effects from the drug, although you haven’t seen their medical records or examined them and I know you are professional in that you don’t like to jump to conclusions, if you made an educated guess what would you assume has done this if it isn’t the drug?

I know that the decision is mine to take, but I am worried about the stuff I have read. I feel that your answers to these questions could help me make my decision. Thank you

I am curious about your research on the Internet. As you found your “scaremonger” sites on finasteride, have you researched the “scaremonger” sites on hair transplants? Because you will find many and it will be a double whammy for you since hair transplants are permanent (side effect from finasteride are not).

To answer your questions:

1. Finasteride in 5mg is used for certain prostate conditions. Finasteride in 1mg or 1.25mg should have little or no impact on prostate health, but the inferences are there.

2. Avodart (dutasteride is the generic name) works in a similar way as Propecia (finasteride is the generic name) by blocking DHT production. Side effects from dutasteride and finasteride are similar, but with dutasteride being a stronger medication, it’s difficult to suggest you wouldn’t experience any side effects from finasteride. No matter how similar they are still different.

3. I have seen some of the YouTube videos, but you highlighted what many of these videos tend to be with a single word: “scaremonger”. I can’t begin to hypothesize what those people are going through, but there is clearly an agenda. They do not like finasteride. That doesn’t mean finasteride is the cause of their problems, but some people simply aren’t willing to look past that to see if there is something else going on.

You decision should be made with your doctor (not me).