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In response to “Propecia Benefits Won’t Last Forever?”

I understand this is a difficult question to answer but say two identical twins under same environmental conditions etc were losing their hair, one took propecia the other didn’t and continued indefinitely, would some time down the track (say 40 years) would they reach the same point of hair loss as each other or would their be lasting effects of propecia maintaining a substantial difference between the two?

I would guess that the twin taking Propecia will not lose the same amount of hair as the untreated twin, but that would depend upon the final pattern of the non-treated twin. The lower the Norwood balding pattern (see patterns here), I’d expect there to be less of a difference after 40 years, but the treated twin would have the benefits of maintaining his hair longer than his brother if he treated it in the early stages of the balding process. Good question!

I’m 26 and have been thinning for the past year on top/crown and my hairline is receding a little. I have finally started rogaine and just found out about “shedding”. This makes me very nervous, and I have some questions:

1. What percentage of men who use rogaine experience shedding?
2. What are the side effects if I discontinue rogaine during the shedding phase?
3. How many men who report shedding also report not regrowing the hair that was shed?
4. Are there other drugs that can be used besides propecia that contain finasteride?
5. If rogaine only regrows hair and doesn’t prevent hair loss how is it helpful in maintaining a full head of hair?
6. How many of your patients who use rogaine see results?
7. Do you recommend Propecia and, if so, why?

Thank you very much

Calm your nerves!

1. Shedding from Rogaine (minoxidil) is really not that common, but I don’t have actual percentage statistics to back that up. I’m just going by my experiences with patients. It might seem like there are a lot of incidents as reported on the Internet, but remember that those with a complaint will often want to alert others, and those with no problems just go about their day.
2. If you have taken Rogaine for some time (more than 3 months) you can shed hair when stopping it, as there is a dependence on Rogaine in some people.
3. I can not answer this question. I’ve got no statistical info.
4. There are two pills available that contain finasteride. They are Propecia (1mg finasteride for hair loss) and Proscar (5mg finasteride for prostate). Plus, generics depending on your country. You do not want to take Proscar for hair loss treatment though.
5. Rogaine does not work all that well for most patients. Sure, there are some results, but I’ve never seen Rogaine give anyone a full head of hair. Hair growth is a side effect of the drug.
6. My candid view is that minoxidil generally does not yield much regrowth in most patients. Again, I don’t have actual stats to tell me how many patients that just use a single medication have had positive results. This is the kind of information that is gathered by doing a focused study, of which I have no interest in doing. Plus, many patients that use Rogaine will also take Propecia, making it difficult to say which medication is providing benefits.
7. I do recommend Propecia. For known genetic balding, finasteride is the drug of choice to stop, slow, or reverse hair loss.

Dr uses Latisse on scalp. Here is the youtube link

I’d consider this as human experimentation and there is no evidence that Latisse (bimatoprost) grows hair on the scalp. It was FDA approved for growing longer eyelashes, but it is not approved for use on the scalp. Could it work? Possibly, but I don’t know why you’d want to be the guinea pig. Aside from potential safety risks in applying it all over the scalp, there is the financial part of it since the drug is normally sold in a very tiny tube meant to apply to eyelashes.

I’ve embedded the video here:

Since starting propecia 7 months ago, my hair loss has become significantly worse. In the 3 to 6 month period, my temples and mid-anterior scalp became noticeably thinner. Although “shedding” in these frontal areas slowed down/stopped at the 6 month stage, my crown is now thinning even though I had not noticed any hair loss in that area before beginning propecia. I have 3 questions:

1. is it possible that propecia is making my hair loss worse-has this ever happened to a patient of yours before?
2. is it possible that this shedding is a positive sign because I am young and in the early stages of hair loss i.e. as the drug has a lot of hair to act upon? Doctor Bernstein states on your website that shedding is fairly common and can be a positive sign.
3. is it common for propecia to take over 6 months to yield noticeable effects i.e. stopping hair loss and/or creating regrowth, or should I stop the drug and save my money?

Thanks

1. Your hair loss on Propecia probably has nothing to do with the drug, but rather the progressive nature of your genetic hair loss which (based on what you wrote) seems to be aggressive. Shedding at 9 months is not a good sign.
2. At 1-2 months shedding can be a positive sign as we interpret this as an acceleration of the normal hair cycling, but that acceleration should not occur over 9 months. Most people will see a reduction in shedding by the 4th month.
3. It generally takes about 6-12 months to see the difference after starting the medication. So you’re still in the time frame and I wouldn’t suggest stopping the medication at this point unless you have experienced any side effects that you can’t deal with.

Is it true that Silibinin inhibits cytochrome P450 enzymes? I take Propecia but also make my own herbal tea from milk thistle seeds and loose horsetail, mainly for the health of my liver and to get some extra silica. If Silibinin does inhibit cytochrome P450 enzymes then is a waste of time taking propecia? Moreover, do you know of any other plants that inhibit cytochrome P450 enzymes. Any comments would be appreciated.

Sorry, this is out of my scope of expertise. The best I could do is offer you some links I found via Google (like here or here), but I’m sure you could do the same thing. I’m not familiar with silibinin or the cytochrome P450 enzymes.

One thing I can point out though is that the statement in Wikipedia about silibinin inhibiting the P450 enzymes is unsourced, meaning there is no valid reference explaining where that information came from. I assume you (or someone on a forum) saw that mentioned in Wikipedia, which prompted your initial email. Just food for thought.

The effect of finasteride on spermatogenesis

I was wondering if you had see this study on hampsters? It concluses that animals treated with finasteride showed significant changes to the testicular seminiferous tubules as well as on spermatogenesis when compared to the control group.

Sounds scary! Is it something to worry about?

Link: Study

OK, but how did their hair look? If you have a pet hamster who is balding and you are concerned that he may not reproduce on finasteride, then you have a real problem.

In all seriousness, this might be interesting to some degree, but it isn’t enough to even consider being worried about. I’m not a veterinarian, but I can clearly see there are vast differences between humans and hamsters. Besides, the study says they gave the equivalent of 5mg finasteride to the hamsters… and unless you have prostate issues, you shouldn’t be taking that much anyway (1mg is for treating hair loss). And for those men with prostate issues (which usually occur later in life), getting a girl knocked up isn’t high on the to-do list.

Hey Doc, I have been on propecia for almost 2 years now, last summer marked my 1st full year on the drug. Last summer (late August) I missed 2 weeks of the pill and soon after realized that my crown got a bit balder. Now the crown has gotten a bit more balder - my question is, is there any way to tell whether the 2 weeks of missed dosage caused this or whether its just MPB taking its course?

Thanks Doc

There is no way to truly tell other than not having missed the drug (and comparing the results to the you in an alternate universe that never missed a dose). In other words, it just isn’t possible to tell if that 2 weeks made a difference. I would doubt that you’d notice hair loss so soon after stopping the drug, but I’m not sure how long “soon after” was. If you’re talking months, then it is possible.

You might want to consider adding Rogaine Foam (or any minoxidil 5%) to see if that makes a difference in the crown. Perhaps Propecia is slowing the loss and minoxidil could regrow some.

Note: I believe these were from two different people, but the questions are related so I’ll answer them together…

Email #1

Now doc , i have a suggestion to make just like you do.You write “Every person will eventually lose the benefits of this drug, but the open question is when” - there is no proof for this , or you do have one ? Even if this statement is based on your experience , you are aware that this is not official and there is not way to be.The official one is that after 5 years only 10 % of the people lose some hair , and please attention - more of teh 50 % of the rest CONTINUED to improve even after this.So unless you can prove the opposite ,please flag those ones as “my opiniion ” or “may” or “might ” , but please do not make statements which are neither proven nor stuided in the medical literature - 10x

Email #2

Why do you recommend Propecia to people that come to you for hair transplants if the effect is only temporary? I just ask because you emphasize a master plan for long term benefits, and it seems like as soon as the drug stops working, the hair it saved will fall out and the patient will have that embarrassing pluggy look -bald head with transplanted hairs. Isn’t it setting up people for more misery to take a drug that temporarily grows their hair back, only for it to fail and then they experience going bald again?

Thanks for your time

Read the official study posted at Hairlosstalk.com and you can draw whatever conclusions you want from it. I believe that this drug has a forever component, but that does not mean that it will hold all of the initial benefits forever. Each person will react differently and I can’t give an exact timetable for when you’ll start to see thinning continuing (if ever). So yes, the medication does work “forever” as long as you continue taking, but the benefits may eventually appear to be less. It could be 5 years, it could be 20 years. The only facts at our hands are in the official Merck/FDA studies.

Propecia’s benefits aren’t quite temporary. It’s not just going to suddenly one day turn itself off 100%. The entire point of a Master Plan is to create a roadmap for a worst case scenario of hair loss so that nobody is taken by surprise if the progressive nature of MPB becomes more evident a decade after you start Propecia. With the modern hair transplantation, the “embarrassing pluggy look” you described shouldn’t occur.

Propecia is a miracle drug for many people, as it gets them some (or a lot) of their hair back… and it largely slows or stops the hair loss. Many of my patients swear by this medication. This is a type of medication in that if it grew hair back and stopped or slowed hair loss, them some benefit will probably last ‘forever’. Of course, you can test this by just stopping the drug and seeing what happens. Most people who saw substantial benefits and then stopped the medication saw hair loss, which suggests that the drug had some residual value. The alternative is that you can elect to take your natural balding process to its conclusion, reflecting your genetic makeup. Your choice, of course.

Dr Rassman, I have been using minoxidil 2% for over 12 months with ok results but have noticed a change in my eyes. The lids are thicker and my eyes look darker, tired. The skin above my eyes also seems less smooth and hangs lower. Do you think is could be Minoxidil or something else. Thanks

I don’t know how to answer your question without knowing more about you. How old are you, for example? If you are 60, maybe you are having changes that are age related and are now just noticing it. If you are 20, well that is a different story… but without seeing you myself, I don’t know.

Minoxidil should not impact your eyes or skin color on your face, but there are comments on an old post that would tend to disagree with that. Take those comments with a grain of salt, as none of them are independently verified and could just be people messing around or confused about the cause of their change in appearance. There might be something else going on, so I’d talk with your dermatologist.

Drs

I have recently started a course of Propecia. Based on what I’ve read, I understand that the drug can, in rare cases, cause sexual side-effects, namely decreased libido, reduced ejaculate and even erectile dysfunction. I’ve found that it has had the reverse effects on me, that is, it has heightened my libido and increased my ejaculate, as well as the frequency with which I get erections.

Does that mean that the drug will, in my case, also have a reverse pathology on my hair loss (that is, make me lose more hair instead of arresting the hair loss process)?

Congrats! You are one of the few people with a good side effect appreciated by some men (but not all women married to those men). The results on saving your hair have no correlation with the sexual side effects of finasteride one way or the other.