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In past posts you have said that Propecia has increased sex drive in 10% of your patients (Propecia and sex drive -September 27 2005). On March 4 2010 Why do some men have increased libido on Propecia, You said a increase is less common than decrease in libido. Could you explain which one is correct?

Thanks Doc and love your dedication to us losing are hair and educating us about are concerns.

Very few patients have reported an increased sex drive on Propecia. I am fairly sure that the post in question (where I wrote about 10% of patients seeing an increased libido) is just a typo that went uncaught for half a decade. I posted it in 2005, but never saw the mistake until now.

My apologies for the confusion and I’ve since updated that post to show the number at 1%. Even that 1% number is just a rough estimate, but increased libido is certainly not as common as 10%. Oops.

Snippet from the article written by Dr. Maria Hordinsky, a dermatologist from the University of Minnesota:

Stress has been cited frequently as a factor in autoimmune diseases, including alopecia areata. Yet experimental evidence to decisively link stress and alopecia has been lacking.

It is easy to link alopecia with stress, as many but not all patients associate stressful events with the development of hair loss. Moreover, there are a lot of nerves in and around hair follicles. The actions of these nerves, as well as various nervous system products called neuropeptides, could affect the hair growth cycle.

Read the full text at NY Times — Can Stress Cause Hair Loss?

I have seen a few cases of surgical stress induced alopecia areata. One patient that comes to mind had a hair transplant surgery just before the alopecia areata appeared and it was active for about 6 months.

From the US Dept. of Labor site:

Labor Day, the first Monday in September, is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country.

And looking at my calendar, that day is now. In other words, it’s a good excuse for a BBQ and a 3-day weekend.

We’ll be back tomorrow with more posts! Have a happy labor day!

So the average person has 100,000 hairs on their head and they loss 100 hairs a day. This got me thinking though, how many hairs does a person loss per year? I did the math 365 X 100= 36,500.

That’s over a third of the hair on your head that you loss per year! That’s pretty crazy to think about! So my question is how fast do those hairs grow back

You forgot something with the math — you are also growing back 100 hairs a day to counter the 100 hairs you lost. Human beings constantly lose and constantly grow hair asynchronously. You can imagine where one falls out another is growing on another area.

As for how fast an individual hair will cycle, I answered that previously here.

Hello Dr.,

A little back-story: I’ve been on generic propecia (1.25mg) for the last 9 years. I am a 32 year old male. When i started taking it, I was a Norwood 1.5. Presently, my hairline is the same and i’m still a norwood 1.5. My father is not bald. However, my maternal grandfather was.

Unfortunately, for the last 2 years or so, i’ve noticed a severely lower libido. I suspect that it might be the finasteride, although i am not 100% certain.

Hoping to get off of finasteride by confirming whether i have (or will develop) MPB, i decided to take the HairDX genetic test. My results stated that i was: “Low Risk” (Negative for the “short” CAG allele; CAG >= 24)

In my report, it stated that a score greater than or equal to 24 had approximately a 60% chance of NOT developing male androgenetic alopecia.

Doctor, should i get off finasteride? In your view, am i reasonably safe from developing MPB? I would like to get my libido back. Do you think i need a miniaturization test to truly CONFIRM whether i am at a risk for MPB?

Any thoughts would be greatly appreciated, kind sir!

The HairDX genetic test for balding is not a simple yes/no test. It provides a percentage factor, which is why in my humble opinion, it only confuses patients (as it seems to have done for you).

So basically the HairDX test said you have a 40% chance of developing MPB… and now you’re asking me if that means you should stop taking Propecia. With all due respect, I am not your doctor. You must have a discussion with your prescribing physician before starting or stopping or changing your medication.

Having said that, there is no such thing as a Norwood 1.5 (which I guess means nearly a NW 2?), but for some men that could just be considered a mature hairline. In other words, it isn’t balding. Could it be that you didn’t need the medication to begin with? Or could it be that the medication halted the early loss from progressing? I do not know the reason for the utility of finasteride for a non-balding man, but I will defer that judgment to your doctor.

You took the medication for 9 years, and for 7 of those years you didn’t see any sexual side effects. The libido issue might be unrelated to the finasteride. For example, up to 25% of men in their 30s may experience erectile dysfunction. Lower libido can come with age, or it can also be a sign of other serious medical issues (not related to medication). See your doctor.

Hi Doctor,

Thanks in advance for reading.

I have a pretty important question that I would love to receive feedback on. I’ve been on rogaine for about 5 to 7 years and I do believe it has helped maintain my hair; but unfortunately, it has not been up to the task of keeping it 100% stable. Due to my thinning, about a year ago, I decided it’s time to consider propecia. I’m in my 30s.

For various reasons (my wife was prego), I decided for about a year on propecia and try natural supplements first and other topicals first. So, I purchased a specific type of shampoo (I’m drawing a blank on the name) and soy isoflavones. I took those for about one or two months and stopped because my sister (who’s had breast cancer) told me excess soy can cause cancer.

At that point, I heard good things about saw palmetto. So, I bought a bottle of saw palmetto. I took this for roughly 3 or 4 months, although I gained some weight and had normal decline in libido (watery semen)… this really did seem to make my hair thicker. I don’t remember the dosage. But, it was purchased at a pharmacy.

At about month 4, I noticed a swelling on one side of my chest. I got it checked out mammogram, and they said it was unilateral gynecomastia. I quickly stopped the saw palmetto usage.

So, it’s now 8 months later and my hair is still thinning. My chest is now improving to the point it’s no longer really noticeable, other sides are reversing too. I’m considering waiting a few more months to see if it returns 100% back to normal completely, and considering propecia again at that point.

Am I crazy for doing so? What would you recommend?

Thanks

It seems you are self-treating and experimenting without a clear focus and understanding of what is going on. I realize saw palmetto is available over the counter, but there is still side effect potential that people tend to ignore.

I am really not in a place to recommend a specific treatment plan for you, as I don’t know enough about your hair loss history and I’m not your doctor. I would recommend you see a doctor for your hair loss issues and discuss your concerns. Together, you can come up with a Master Plan.

Although I have no direct experience with saw palmetto, I would not be surprised that breast enlargement could occur on rare occasions. I must point out that one of the rare side effects of Propecia is gynecomastia and if you switched to that, you may also have the same problem.

Hi Doc,

im 19,and I have been having good hair in my home country,since i have moved in dubai,i have been noticing my hair thinning and falling.Is the climate to blame or the water?

I’ve been thinking to take some nutritional tablets like Wellman’s Tricologic, But i guess propecia would me more effective. Would it be ok to take proscar 5mg and break it into 4 pieces as suggested by you. Will it cause any side effects.

Thank you so much for your concern

Proscar/Propecia is a prescription medication. I can’t say whether you’re a candidate for taking it. That is up to a doctor to decide after you are examined.

Climate and water shouldn’t be to blame, but I don’t know what is in the water. Mercury or lead from old pipes could contaminate water, for example. Chances are, your move is coincidental to the start of your genetic hair loss, as genetics are the number one cause of hair loss in men. But again, I can’t make that call without an examination. See a doctor!

I lost all my hair in the pattern of NW 6 at 28 yrs old. Not a hair in sight, smooth as a babies bottom. It remained that way for 20 yrs. After which i used minoxidil 5% and Finasteride 1 mg I regained full coverage including the hair line.

So i don’t agree with the Doc’s Statement that hair follicles die. They are just being kept in a resting phase by dht.

Thanks for the comment and sharing your experience. The experience is certainly very, very rare. I’d love to see before and after photos, as I’ve never seen a patient have such a result from medication after being completely bald for decades.

I’m 25 years old from Israel and I’m a big fan of your website and very impressed by the elaborate answers you give. As part of my research of treating my own hair loss, I read a lot about dutasteride (Avodart) and ran into this clinical trial.

It looks like GSK is doing the last phase before taking it out to the market as a hair loss product. What is your opinion about this study:

Avodart Phase 4 Protocol Summary

Thank you for bringing this to our attention. I really don’t have anything to add, as this Phase IV study just started in April and isn’t scheduled to end until 2013. There’s not much info available beyond what is listed on that summary page.

The US ClinicalTrials.gov glossary describes the four phases of clinical trials: “Phase I tests a new drug or treatment in a small group; Phase II expands the study to a larger group of people; Phase III expands the study to an even larger group of people; and Phase IV takes place after the drug or treatment has been licensed and marketed.”

The glossary further defines Phase IV as: “Post-marketing studies to delineate additional information including the drug’s risks, benefits, and optimal use.”

So while Phase IV trials are generally done after the drug is already approved by the FDA (at least in the US), perhaps things are different with the phases outlined by the Korea FDA. Searching the Korea FDA site isn’t proving too helpful. I do know that Avodart (dutasteride) isn’t approved for treating hair loss yet in the US, though. Any readers out there with some knowledge about the various clinical trial phases and how they might different by country, please feel free to set me straight in the comments section.

Hello Dr,
I used to have very thick eyebrows and due to over plucking for many years, one of them is incredibly sparse. I heard that using minoxidil daily will help to make them look fuller. My question is, are there any potential side effects? I have read online that using minoxidil can cause permanent hair on your forehead and face and other ghastly things, are these true? Also, if the treatment does work, will I have to continue using it forever? And is there a chance it will cause me to lose the hairs I currently have as well? Thank you for your time, it is greatly appreciated!

If you plucked your eyebrows and they are sparse, the hair missing from the overplucking probably will not return. Hair transplants work well to fill in the missing hair in the eyebrows.

Minoxidil will probably not help grow new hair at the eyebrows, but I suppose you can give it a shot. If it works, you will have to use it forever. Side effects would be the standard minoxidil risks found here.

There are other treatments available that may also be worth a shot, like a transparent gel with fibers to give the illusion of fullness, Latisse (the eyelash medication), and an eyebrow conditioner that may or may not do what it claims. Check out the write up at NY Times — After Overplucking, It’s Time to Call the Professionals.