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If propecia blocks DHT and DHT causes hair loss, why doesn’t this drug work for everyone who takes it?

The genetic elements of the balding genes influence the degree to which finasteride works. I would imagine that taking the new HairDX (RxR) Genetic Test for Finasteride might shed some light on who finasteride might work for best. Although it is a press release, this link contains a lot of good info about why Propecia works better for some — check it out here.

does hair transplant or products like toppik work for all hair textures? i mean like hard african hair

Yes, these concealers work for all hair types, including coarse African hair. Hair transplants also work very well for African hair types (see a recent post about this here).

I have a question regarding to the use of 0.5mg or 1 mg propecia.

I’m a 23 year old male and i started using 0.5mg propecia since september 2008. Its a pitty that my hairline havent grown back, but my hair looks thicker and much healthier. And the hairs are not falling out anymore. And the side-effects are minimal to none, so thats great!

But I started using 0.5 mg instead of 1 mg because I thought i can begin low and when its needed i can always increase later. But now im actually curious what the results are when i increase the medication. Do you think its worth the try? And can there be any problems when i go back to 0.5mg later (that the drug then maybe isnt working optimal anymore because my body is used than to 1mg or something?)?

Also I just want to note: Because of the many negative news on the internet about propecia side-effects. I doubted for almost a year to begin with using propecia. Since I use it, i can almost shoot myself that i didnt begin with it immediately. I could have saved probably so many hairs!!

Thanks

Thanks for sharing the positive results with Propecia, even with just half a dose. Often times the success (or positive) stories of Propecia aren’t expressed on the Internet forums and websites because of our human nature. We seem to express our anger and share negative experiences in public more often.

I would discuss your results and goals with the doctor who prescribed you the medication. There are studies that show that a half dose may be 80% as effective as a full dose. While I am happy with your results, there are things about your story that trouble me. First, you are driving the process by the side effects you MIGHT get, not the optimal dose of the medication. Propecia generally does not work for restoring frontal hairline loss. At best Propecia may slow down a receding hairline. Drugs (like Propecia) do not just “stop” working. It is often difficult for patients to understand that Propecia may still be working as it slows down hair loss. If you are taking Propecia thinking that it will regrow hair or reverse hair loss completely, you are in for a big disappointment. In the end if you are going to go bald you will go bald. Propecia will slow this process down, but not stop it completely. In other words, Propecia will continue to work even if you notice that you are losing hair.

Finally, you are experimenting on yourself by changing medication doses around and asking for medical opinions without a physical examination (miniaturizationstudy). I cannot give you a recommendation one way or another because I don’t know if you even needed the medication in the first place. Hair loss is a medical and physiologic process. As such, I recommend that you discuss dosing with your doctor.

Dear Dr. Rassman,

Before talking to my doctor I wanted to get your idea on my problem because of your expertise. I am 31 years old guy who had HT four and half months ago.I have been on 0.5mg propecia per day almost 2 months. The amount of shedding during this period has been incredible. I just got what people mean when they talk about propecia shedding. From your blog I know that this is a very good sign that propecia is indeed working. My problem is with “puffy areola”; I have always had a little bit gynecomastia, but it was not disturbing and when I put on weight it was just little bit noticeable. But I never had “puffy areola” which I have now and makes gynecomastia more visible. I believe that propecia will do a great work on my head and I don’t want to quit it. Here are my questions;

1. Is puffy areola a symptom of developing larger male breasts if I continue to propecia or will it remain as puffy areola? (which is more bearable)
2. What if I reduce the amount of propecia from 0.5mg/day to 0.5mg/every-next-day do you think propecia will still work for me and not cause this side effect?
3. I have had a quite amount of shedding during this period. If I quit propecia completely does this mean I lost them forever or will they grow back and I will lose them in time?

Regards

1. I would not know about your areola problem without examining you myself. A doctor must have prescribed Propecia to you, so you should go back and see that doctor. Small amounts of weight gain do produce changes in the male breast, more in some men than others.
2. With regard to dosing adjustments, get that from your doctor and you can read some of my previous posts on the subject — here, here, and here.
3. If you stop Propecia and you had benefits, you will get “catch-up” hair loss. For more on that, see here, here, and here.

(female)
I am 35 years old. My hair has been falling out for 2 years now and has become extremely thin. It comes out in HUGE handfulls every morning. It has pretty much stopped growing as well. Now the hair on my legs stopped growing and some eye lashes have fallen out and will not grow back. My cycles are regualr, dead on every month to be exact. My doctor says he sees no signs of disease in my scalp and my thyroid has come back normal. I am convinced this is not just a “cycle” of hair loss I’m going through. What else could it be? Please help. I am devistated.

Female hair loss is a difficult analysis and requires many tests, not just thyroid testing. I simply can not write a textbook on the subject on this site, but here’s a list of past posts that may help you understand what you’ve got going on:

1. Female Genetic Hair Loss Is Different From Male Genetic Hair Loss
2. Birth Control Pills and Hair Loss
3. Woman With Thinning Hair After Family Tragedy
4. Diseases Causing Women’s Hair Loss
5. Female Hair Loss

I also discuss female hair loss in my book, Hair Loss and Replacement for Dummies — available in all good bookstores.

Hi Doc,
I’ve been taking about 0.25mg of Finasteride for 2 months. Due to paranoia, I was on the look out for sides. I noticed my erections, despite being just as hard, could not be ‘tensed’ quite as well. And didn’t feel as intense as a year or so ago (But I’m not sure if it was like that before I started the treatment). I’ve come off Propecia for 2 weeks with no change. Is it safe to say Finasteride was not the cause of this minor change, and it could simply be related to aging/diet? (I’m 22). It doesn’t cause me any problems as my erections are still easily hard enough for intercourse, it’s just I’d rather be at ‘100%’ if possible.

Thank you.

It sounds like you have an erectile problem which should be addressed by your doctor. It is generally safe to assume that once you are off finasteride for 2 weeks, it is essentially out of your system (if there is some tissue fixation) and should not be contributing to your problem. Plus, you’ve been taking only a fraction of the recommended dosage and say that you’re paranoid and looking for side effects (which could lead to a psychosomatic illness).

What is your opinion on Sun exposure for a new Hair transplant patient? Is there a danger to getting any direct sun on the scalp at all? If so, what is the proper waiting time after the surgery? Is it only sunburn I need to worry about? If I use sunscreen on my head, what is the correct SPF I should use. I was told direct sun might slow or prohibit any new growth. Thank you for taking time to respond.

UV light is not good for fresh wound healing and is known to slow it down. This would be most sensitive in the first few months, which is when I would suggest using a good sunscreen with an SPF factor of 45 or more. Generally, it is easier to wear a baseball cap.

One of my favorite singers in music is dave gahan. From these pictures, would you say he has a mature hairline? My hairline seems like it will be going down this road.

Photo 1 and Photo 2

He’s got a good, strong hairline, but with the way the corners are creeping up a little bit, I’d say this is about where the mature hairline exists. I would want to see him wrinkle his brow to be sure.

What are the hair restoration options for a black male with a receding hairline, and preferred style of a brushcut?

With respect to hair transplant surgery, there is no difference in black men or white men or Asian men or any other ethnicity or race. For very short haircuts, follicular unit extraction (FUE would likely be the way to go so that there isn’t any chance of a visible linear scar, but even the strip method doesn’t discount a short haircut in all men. Scarring is dependent on multiple factors that I’ve described before here.

Actually, I have seen great results for black men with hair transplants. I wish I had some very current results to show, but I can only use photos of those that allow me permission (privacy issues, of course), and with that being said, below is a patient that was featured in our NHI video from quite a few years back. His photos are also on our site here.

Dr. Rassman, generic finasteride is available in india manufactured by Cipla and other pharma companies. the name written in them are Finasteride tablets USP 1mg (eg: finpecia from cipla). A search in internet for USP returns “the United States Pharmacopeia (USP) is an official public standards–setting authority for all prescription and over–the–counter medicines and other health care products manufactured or sold in the United States.” Link: http://www.usp.org/aboutUSP/

so does that means these generics are approved by FDA or are they keeps the standards set by US law? thanks

There are some companies outside the US that make generic drugs that are marketed in the United States and they are legitimate. There is a difference between when the manufacturer meets FDA manufacturing guidelines and the company’s ability to sell the drug in the United States.

In the case of finasteride 1mg tablets, the restrictions are enforced through the laws that govern patent protection. If company ‘X’ decided that it wanted to sell a drug in the US that is covered by U.S. Patent, the patent owner can get a court to supply a cease and desist order to company ‘X’. The owner of the patent can also file for triple damages for lost revenues under existing patent laws.