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

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.