Propecia and Reflex Hyperandrogenicity
Dr. Rassman, if you could, please answer this question. It’s very important, I’ve seen a ton of people online that really need this clarified for them by an expert in this field. Can Propecia cause Reflex Hyperandrogenicity, thus actually accelerating your MPB and, if so, what are the symptoms? I can’t tell if this is happening to me or not. Also, if I have lost hair due to Reflex Hyperandrogenicity is that hair gone forever or is there a chance I can get it back?
HairLossHelp.com has a good explanation of reflex hyperandrogenicity —
“When the effects of androgens in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor blockade, the body seeks equilibrium through a process called upregulation. This can take the form of increased hormone production and/or increased tissue sensitivity to the remaining hormones. The reason side effects usually gradually disappear with finasteride is probably due to such upregulation. In a small percentage of individuals, it may be that this process overshoots the mark, resulting in significant hyperandrogenicity. This is marked by such signs as greatly increased facial oil, increased pimples, and greatly elevated libido. It’s possible that in certain cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride, though this does not appear to be the case for the vast majority of people.”
The term “reflex hyperandrogenicity” is a new one to me, and while I unfortunately do not have the answers to your questions directly, hair loss from genetic causes in men is usually not reversible.
More about reflex hyperandrogenicity at PropeciaHelp.com and Google Answers.
Hi Dr. Rassman,
I need your advice regarding reflex hyperandrogenicity.
I went on propecia in March of this year.
The doctor who prescribed me the drug told me to come back in 6 months for an evaluation.
Within probably two weeks I started to experience what I thought was the usual shedding. I was obviously concerned and turned to discussion boards where I found countless responses indicating that the shedding, regardless of the severity, was just part of the process.
I wanted to believe that that was the case so I carried on. I was (and still am) experiencing hundreds of lost hairs every day, increased (though admittedly not drastically) acne, increased sebum production, increased sexual function for about two and a half months. Finally, I went to see the original doctor who prescribed it and another doctor. They both confirmed that this is not anything close to normal. Actually the second doctor (not the prescriber) told me that he had prescribed Propecia to thousands of patients over the years and he had seen maybe a dozen patients who responded like this.
Obviously I am distraught. I don’t know what to do. I am one week off this Propecia and still shedding like crazy. I have lost maybe 60% of my hair. The loss is all over my head but it’s worse on the crown and the sides (I NEVER experienced loss on the sides before Propecia). Both doctors told me cautiously that some of it may grow back eventually. The sad thing is that my male pattern baldness wasn’t even that bad. I was losing my hair for sure. But I turn 40 next month and I probably would not have got to this point for a good number of years.
Most of the hairs I’m losing are thick dark hairs and most have NO bulb on them.
So my questions are
(i) Given your experience, do you believe that some of my hair may grow back?
(ii) Is there anything I can do, any product I can use, to increase my chances of getting my hair back?
You have to wait it out for a full year to give finasteride a chance. Minoxidil, an additional medication also works best for the crown (not the hairline) and it also takes a year. When used together, you get better overall response. Hair transplants become an option if this approach does not solve your problem.
Shedding is not an unusual report for the first few months after starting finasteride, but it almost always stops and most patients find less hair loss after a few months. One family member of mine, did have an increase sex drive after starting the finasteride. I have never seen a report that Finasteride kicked off massive hair loss as you are reporting. I would expect that considering your age, that stopping the drug might work in your favor and reverse the shed, but frankly, I am not sure. You should see a doctor who has the HAIRCHECK instrument to measure your hair bulk and then follow you over a year to report what is actually measured with regard to your hair loss.
William Rassman, M.D.
Dr. Rassman,
You are doing a great disservice to clients when you dismiss what they are saying about Reflex Androgenecity. It’s very real and it devastates your hair, when it occurs. Admittedly, it seems that it is a relatively rare occurrence. But there are enough people reporting the exact same symptoms that this is obviously a possible outcome from using Finasteride.