Propecia and Young Men

Dear Dr. Mohebi,

I was doing a quick research on the hair loss solution, that I came across your weblog. I wanted to ask you regarding my hair loss problem. I am 28, with history of hair loss in male members of my family. My hair loss started more than 10 years ago, and I started using Minoxidil (first 2% and then 5%). At the time, I was told that Minoxidil will just postpone the total hair loss. Well, I never went bald that much. About four years ago, I started taking Finasteride 1mg, and I think it worked out really well. But the concerns regarding the side effects for men made me stop it about a year ago. Now, I am seeing more hair loss. I was just wondering how careful should one be in taking Finasteride, especially when all the researches are doomed to an inherit uncertainty, and that the side effects might prove much more severe only in future.

So, I would appreciate if you please advise me and let me know about the solutions that is out there for my case.

Thanks very much,

Patient’s name

A:

I understand your concern. You have stopped finasteride (Propecia), despite of experiencing good results. Finasteride has been out in the market and widely used for prevention of hair loss in past 10 years. Finasteride has a few side effects that they are all reversible with discontinuation of the drug. The most problematic side effect of finasteride is decreased libido that if occurs should go away in about 3-7 days after stopping the medication. I have seen this side effect mostly in elder patients who recently start taking finasteride. I have never seen any patients who won’t recover from this side effect within a few days. In fact, instead of stopping the medication, I usually change the dose to half or prescribe it in alternate days and that way I have been able to manage the side effects in the most cases.

You are concerned with delayed Propecia adverse effects that may have not been discovered or reported and could potentially be a cause for concern in the future. That could be brought up for almost every medication, but I believe we had better stick to the proven facts. All medications that are used in the United States are regulated by the FDA after thorough evaluation of solid results from extensive clinical research.

There are other medications that are prescribed by some doctors for hair loss treatment. Some are currently being evaluated for hair loss prevention such as Avodart (dutasteride), which works through a mechanism similar to Propecia. Avodart is even more effective for hair loss prevention in comparison with Propecia, but it also causes more side effects and that is why the FDA has not yet approved it for hair loss treatment. I do recommend Propecia to most of my patients with male pattern baldness because even if you want to treat your hair loss with hair transplant, you are still better off doing a lesser number of sessions and preserve your own natural hair as much as possible.