Merck’s Site Doesn’t Say Anything About Initial Shedding from Propecia

Dear Doctor,

Great website !!

Re: Propecia and Minoxidil – The reality please

I am been sending you several emails regarding the following questions which I very much appreciate if you could answer:

– Propecia and initial shedding: Several comments on the internet mention that this medication may cause increased shedding at the beginning of the treatment (3 to 4 months). However, nothing thereupon is mentioned in the Merck product description. Moreover, this does not correspond to the timeline for results indicated in the propecia website (www.propecia.com). This website indeed indicates that one may on the contrary expect reduction of hair loss within 3 months and some regrowth within 6 to 12 months. Similarly, several dermatologists to whom I spoke indicated to me that this initial shedding my occurr with Minoxidil (which acts as a growth stimulant) but not with Propecia. What is your experience in this area with your patients. What is the reality please ? If initial shedding was a common effect of Propecia I am sure Merck would have mentioned it in the product description just like the makers of Rogaine did for Minoxidil ?

Minoxidil 12.5 + Azelic Acid 5 % in the form of a cream: I have been advised by a clinic in London to combine the use of Propecia with this cream. However, I am 36 years old and I have JUST started to thin (on the crown but not on the temples and hair line). Do you think that addition is necessary or would propecia be enough.

Age concern: I hear that propecia best works for men under 30. However, if I have just started to thin (since a year) at 36, does this mean that the medication will have little effect.

Many thanks

I have never actually seen a patient with shedding from Propecia (finasteride 1mg), but I have read many such complaints through this site. Maybe I just get the unusual bad news. Maybe there’s some commonality (outside of taking the Propecia) that isn’t being said. That is a problem with getting one email from a random reader that I may never hear from again. I don’t have enough medical history to really know what to make of it all. I can not comment on adding the combination of minoxidil 12.5 and azelaic acid 5% cream, but the acid does irritate and may cause increase absorption of the minoxidil (that is the theory, anyway).

You are correct that the best results from Propecia are in younger men, but I have seen many men in their 30s get wonderful benefits from the drug. It will be what it is and it will be better results than not trying the drug at all.