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Dr. Rassman,

Thank you for maintaining this blog, its great to have a free trustworthy resource in a world full of scammers and misinformation.

I’m a 24 year old man and have been experiencing loss since age 18. I started on Propecia at 20 and was able to maintain my hair and score some regrowth. Unfortunately I stopped taking the drug for 10 months starting about two years ago. I started back on Propecia last May(2009).

My problem is that in the past 10 months, while back on Fin, I have experienced significant loss. My hair has gone from a solid norwood 2.5 with full density in the mid scalp and mild thinning in the crown to a norwood 3v with profound diffuse thinning all through the pattern. I have added Nizoral shampoo and some multivitamins to my regimen a few months ago. Still, my hair is getting progressively thinner. Do you think my situation is attributed to the catch-up loss phenomenon or could it be that my body has stopped responding to Propecia…or something else?

Thanks for your advice.

Thank you for following the site, but unfortunately, I really cannot give you a definitive answer.

You are likely losing hair due to genetics, but the degree of your balding is yet to be determined. Maybe you are destined to be a Norwood Class 3V and will stop there. Maybe it’ll get worse. I really couldn’t say. The key point I want you to understand is that there is nothing to stop your genetic fate at this point. Propecia will only slow things down, but I don’t believe your body stopped responding to it nor do I believe it necessarily stopped working. In fact, you may have experienced “catch-up” hair loss after stopping Propecia for 10 months. You could’ve experienced a shedding after restarting the medication or it could just be coincidental timing as the progression of your hair loss was in full swing.

In the end, I would suggest you follow up with your prescribing doctor and continue on with the treatment plan (Propecia).

Hi there

I’ve been using Propecia for nearly eleven months and minoxidil for the same amount of time. In the first three months of the treatment I experienced severe hair loss (shedding) and a succession of side effects such as anxiety, depression, stomach cramps, mood swings and slight swelling of my pecs. After this my hair became thicker and looked like the head of hair I had when I was sixteen.

However, recently I’ve noticed further shedding. The side effects have gone which bothers me as I feel my body might be getting used to the Propecia and is fighting the drug. What furthers my guess is that I don’t feel any pains in my testicles or any absentmindedness which I experienced in the first nine months.

Could you advise as I’m worried about this. Kind regards

I really cannot comment on what you are experiencing. You may have other issues unrelated to Propecia. You list a wide variety of complaints that seem random and unrelated. In addition, as much as I believe in Propecia, the drug does not necessarily give you a head of hair of a 16 year old as you describe and all of a sudden cause thinning (all within 11 months?!). Something does not sound right. I would see a physician for a follow up and a complete examination.

In non-hair-loss news, here’s a snippet from the article:

Good news for coffee drinkers—new observational data presented last week at EPI|PNAM 2010, the Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity, and Metabolism 2010 Conference, suggests that multiple cups of Joe are associated with a lower risk of arrhythmias.

“A lot of people think they have palpitations from coffee, and doctors commonly tell people not to drink it, but there are very few actual data, and the data that are available suggest no relationship,” said lead investigator Dr Arthur Klatsky (Kaiser Permanente Division of Research, Oakland, CA). “We went into this study thinking there would be no association, but to our surprise, there was actually an inverse relationship. It could be protective, although one observational study doesn’t prove anything yet.”

Read the full article — Coffee associated with lower risk of arrhythmias

In a significant article recently published, the benefits of coffee include a reduction of arrhythmias and other antioxidant properties. The story goes on to point out that it could be caffeine that is the key, but this is all observational data and needs to be studied further. It is interesting reading…

I’ve been noticing hair loss across the crown of my head for about 18 months now. I have been taking Propecia for close to 8 months with continual shedding and thinning of my hair. More recently in the last month I have started taking Regaine as part of my fight against hair loss and though I have noticed less of the burning feeling on my scalp my hair continues to shed - though im pretty certain its not at the rate it did a year ago. One thing I have noticed since using Propecia is a phenomenal amount of sebum in my scalp. Is this simply as by-product of MPB, or is it possible that the Propecia and Regaine are causing this?

I only wash my hair now every third day in the fear that I will lose more hair doing this and i struggle to massage thoroughly the scalp of my crown, worrying that more hair will be lost by this. I tend to just massage the back and sides and just rub shampoo on the top of my head hoping it will trickle into my scalp.

Any advice would be deeply appreciated…

Washing more frequently (like once a day) should solve the sebum issue as it will not be building up. Use a shampoo that says it is good for oily hair. Neither Propecia (finasteride) or Rogaine/Regaine (minoxidil) has any impact on sebum production.

I hate to keep bothering you, but I’m full of questions! With fine hair, how much hair can be lost before it is considered noticeable? 25%? 50%? I am 4 months into using Propecia, and have new hair sprouting all over. I am surprised, as I have been losing hair for 20+ years. I am going to see where Propecia takes me, then finish it off with transplants.

In general, you need to lose about half (50%) of your original hair density (in even distribution) to notice social thinning but that also reflects your hair and skin color. In those with platinum blonde hair, you might be able to lose 80% before it is socially detectable. On the other hand, if you had black hair against white skin, a loss of 20% might be socially detectable. In other words, you need to lose between 20-80% of your original hair density to have others notice that you are thinning and this is based upon hair and skin color and the character of your hair. Of course, you (yourself) would notice that you are losing hair much sooner. This is generally if you lose hair evenly everywhere (and not in a pattern).

For those who respond well to Propecia, it takes about 8-12 months to see early differences… but it will not regrow all the hair you lost. Propecia mainly works to sustain what you ALREADY have and make those finer (miniaturized) hairs thicker and healthier. This will make it look like you have more hair as your hair diameters are thickening. You see, it’s not only about the numbers. Also be careful and note that Propecia should not be considered a cure to balding, but rather it slows that process down (dramatically) in some patients.

Hello Dr. Rassman,

I know that you don’t put a lot of stock into herbal remedies for hair loss, but an article I found on the Reishi Mushroom does have some interesting information regarding the mushrooms effects on 5-alpha-reductase.

Perhaps you’d like to look at this: Study

Thanks for you wonderful blog and let me know what you think in regards to this helping at least slow hair loss.

It would not surprise me to find finasteride type of molecular formulations in things that grow. The original finasteride was identified in the Amazon rainforest as the natives ate tubers that had DHT-blocking abilities. In the naked native people it was clearly seen that the children did not develop their external genitalia (their penis) until they were close to puberty, there was something wrong. The drug finasteride (a DHT blocker) was eventually formulated from the analysis of this tuber. The sexual side effects were also identified in some of the children who were hermaphrodites, probably caused in the first trimester of the mother’s gestation. So I would want to know more about the Reishi mushroom (pictured at right) before you use it, and I would take Propecia (finasteride) rather then take a gamble on anything unknown. Propecia is taken by millions of men, so we know the side effects, rare as they are.

Can Propecia cause shedding after 6 months? Or is it just a sign that it is not working as well as I once thought? My hair density seemed to get better but after the 6 month mark I have noticed a big step backwards. Thanks guys for the great info.

If shedding were to occur, it generally begins upon starting Propecia and ends within a few months. If you see accelerated loss 6 months after starting the treatment, that is uncommon and might not be shedding from the medication. As for what it is, I couldn’t say with any certainty — but that is why talking to the doctor that prescribed Propecia to you is important.

If there were miniaturization studies with mapping of the scalp done prior to starting the Propecia, then this question could be answered a little better, as a new mapping would show changes since the original mapping. Baseline studies will tell you if this is an acceleration of your balding process.

Snippet from the article:

Women who took a drug to fight breast cancer say they were never warned of a side effect – permanent hair loss – that left them looking sick long after they were treated for the disease.

“I had a normal head of hair and I am now completely bald,” said Cynthia MacGregor, 50, of Montreal, who has been diagnosed with alopecia universalis, a loss of all body hair.

Another sufferer, Shirley Ledlie, 51, of Brittany, France, said: “It’s like having ‘I am a cancer sufferer’ tattooed on your forehead. … I look like an 80-year-old, ugly old man.”

This lasting side effect of the chemotherapy drug Taxotere, in combination with other drugs, came to light when cancer patients began living longer. These women are now finding that survival comes at a cost.

Read the full text at The Globe and Mail — Women who took chemo drug say they weren’t warned of permanent hair loss

Taxotere (docetaxel) slows the growth and spread of cancer cells in the body, and is used to treat breast, lung, prostate, stomach, and neck cancer. Hair loss has been a known side effect of this medication, but the possible permanence is just coming to light.

Hey doc,
I am 13 months in on propecia and my hair is a little worse than when I started. I have read that best results occur at 18-24 months. So have you ever had anyone who was unhappy with their results after 1 year on propecia, but the results improved during year 2?

I can’t recall such a situation with one of my patients, but we do know that Propecia will build and some people report gains after the second year of use. Continuing the medication is up to you, but I’d speak with your prescribing doctor about this.

Dear Dr.,

I had a hair transplant (840 3-4 follicular grafts) in February of 2009. The areas treated were the large crown and also throughout the temporal areas. I still do not see a drastic difference. I am not sure why. I am continuously also using Rogaine foam and Propecia. When under any bright lights, I see such thinning as to where the transplant was supposed to have worked. I am not sure if something went wrong, or everyone’s bodies are different; thereby it may look better within another year. Have you heard of my situation? Does a hair transplant take up to another year in order to see better hair density results?
Thank you!!!

Without knowing more about your case, it would be difficult to provide much precise information. Sometimes a thin look can appear under harsh lighting because of your hair color, hair character, thickness, etc. The Rogaine and Propecia are good to continue using, but after a year you should’ve seen results by now from the surgery. Everybody is different, every surgery is different, and every medical group is different, but it generally takes 6 to 8 months to see the beginning results of a hair transplant surgery. Either your surgery has failed or you continued to lose more of your native hair and what you are seeing is the lost native hair. I have seen transplant failures, and generally these occur because of surgical errors, inexperienced or sloppy teams or techniques, or rarely the presence of some associated disease like diffuse alopecia areata (though this is unlikely in men).

I’d discuss this with your surgeon to find out his/her take on why your grafts haven’t grown. Be sure to compare your current look to pre-operative photographs, because sometimes patients don’t realize just how bald they were before the surgery (the hair grows in gradually so its hard to notice if you’re not focused on it all the time).

See this recent post for more — If There’s No Growth a Year After My Hair Transplant, Should I Just Get Another One?